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Approved ior public release;

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MEDICAL DEPARTMENT, UNITED STATES ARMY

UNITED STATES ARMY

DENTAL SERVICE IN

WORLD WAR II

By

GEORGE F. JEFFCOTT

Colonel, DC, USA

Acceaion F®r

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MAR 091995

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OFFICE OF THE SURGEON GENERAL

DEPARTMENT OF THE ARMY

WASHINGTON, D. C, 1955

DISTRIBUTION STATF&ENT A

Approved for public release;

Distribution UnBmited
The volumes comprising the history of the Medical Department of the

U. S. Army in World War II are divided into two series: (1) The Administrative and Operational series which constitutes a part of the general series of

the history of the U. S. Army in World War II, published under the direction

of the Office of the Chief of Military History, and (2) the Professional, or

clinical and technical, series published as The Medical Department of the

united States Army under the direction of the Office of The Surgeon General.

Both series are being prepared by the Historical Unit, Army Medical Service.

This is one of a number of volumes to be published in the latter series.

JOHN BOTD COATES, JR.

Colonel, MC, USA

Editor in Chief
r

THE MEDICAL DEPAETMENT OF THE UNITED STATES AEMY

A History of the United States Army Dental Service

in World War II

By

George F. Jeffcott, D. M. D., F. A. C. D.

Colonel, DC, USA

This volume was prepared by the Historical Unit, Army Medical Service,

under the direction of Colonel Calvin H. Goddard, MC, AUS, formerly Editor

in Chief; Associate Editor for this volume, Eebecca L. Duberstein.

111
roreword

The techniques of dentistry as practiced in the United States Army do

not differ significantly from those in civilian life. The task and problems,

however, involved in applying these techniques in providing dental care to

some 8,000,000 men and women, under such trying conditions as existed in

a global war, stand unique and unparalleled.

The Dental Corps expanded from its strength at the end of 1939 of

approximately 250 dental officers to over 15,000 during the World War II

period of hostilities. The Dental Service was constantly confronted with

the perplexities concerned with personnel procurement, training, assignment,

utilization, and administration. In addition, equipment, supplies, and ancillary dental facilities had to be obtained, distributed, and maintained throughout the world in support of American troops. Further, as the result of

increased manpower requirements on the part of the Army, and the necessary

concurrent lowering of dental standards for individuals entering the military

service, the Dental Service was called upon and expected to accomplish a

mission of Herculean magnitude—that of restoring and maintaining the dental

health of the Army.

This record, so admirably presented by Colonel George F. Jeffcott, Dental

Corps, relates how such dental care was provided. The lessons learned and

experiences gained by those concerned primarily with that care should be

studied by all who are now, or may be in the future, confronted with similar

responsibilities.

Finally, this portion of the History of the Medical Department is a tribute

to the dental profession and to the men and women who faithfully, with

outstanding success, served with the Army Dental Service during World

War II.

GEORGE E. ARMSTRONG

Major General, United States Army

The Surgeon General
Preface

In the preparation of this volume free use has been made of the published and unpublished works of earlier authors, among which the contributions of Colonel Walter D. Vail, DC, Colonel Pearson W. Brown, DC,

and Colonel John C. Brauer, DC, are particularly significant. In addition,

the author has had the benefit of advice and assistance from a large number

of individuals who filled key positions in the Office of The Surgeon General

during and following World War II, whose wide experience and personal

understanding of the problems of operating a wartime dental service enabled

them to provide invaluable information not available in official files.

It is regretted that the necessary screening and destruction of obsolete

Army files has resulted in the loss of a considerable number of the documents

from which information in this volume was compiled. Though these documents are no longer available for study, they have not been removed as references since identification of source material may enable the reader to assess

the validity of the information. Documents which are no longer available

are specifically identified in the footnotes by a [D] symbol.

While this volume is primarily concerned with the Army Dental Service

during World War II, some discussion of problems and events preceding that

conflict has been included. The inclusion of some of this material is justified

on the ground that it involves problems or policies which later affected the

operation of the Dental Service in wartime. Other material concerning the

initiation and early development of the Army Dental Service has been included because of its general interest and the fact that very little information

on this subject is available in standard publications to date.

GEOKGE F. JEFFCOTT

Colonel, DC, U. S. Army.

Vll
Contents

Page

FOREWORD v

PREFACE vu

Chd'otcT

I. DEVELOPMENT OF THE UNITED STATES ARMY DENTAL

SFRVICE --

II. ADMINISTRATION OF THE DENTAL SERVICE 22

III. THE PROCUREMENT OF DENTAL OFFICERS 35

IV. PERSONNEL AND TRAINING 105

V. DENTAL EQUIPMENT AND SUPPLY 165

VI. OPERATION OF THE DENTAL SERVICE—GENERAL CONSIDERATIONS 199

VII. DENTAL SERVICE IN ZONE OF INTERIOR 257

VIII. DENTAL SERVICE IN A THEATER OF OPERATIONS 287

IX. DEMOBILIZATION OF DENTAL PERSONNEL 332

INDEX 344

IX
CHAPTER I

Development of the United States Army Dental Service

ORGANIZATION OF THE ARMY DENTAL CORPS PRIOR

TO WORLD WAR II

Dentistry, during the pioneer days of the profession in the United States,

had no military status; and there exist only a few unofficial references to dental

treatment in the accounts of the first wars in which the country was engaged.

A notable exception, however, was the dental treatment accomplished for General George "Washington, who experienced dental difficulties during the time

he served as Commander in Chief of the Colonial Army and later during his

terms as President. Records reveal that Washington had several dentures

made by civilian dentists and that he was very much pleased with his dental

service.1

Almost one hundred years passed after the Revolutionary War before

there was any official Army recognition of dentistry or legislative action to

initiate the organization of an Army Dental Corps. During these hundred

years the profession continued to develop and to broaden its scope.

The first organized effort to secure dentists for an army was the conscription of these to serve in the Confederate Army in 1864.2 The soldiers of the

Confederate armies could not pay for dental treatment in the depreciated

currency of the Confederacy since the fee for one gold filling was more than 6

months' pay of a private. Consequently, the Confederate States Congress

passed a law for the conscription of dentists who were to have the rank, pay,

and allowances to which their position in the Army entitled them, and in addition extra duty pay for extraordinary skill as allowed by The Surgeon General. The rank and pay offered the Confederate dental officers is not recorded.

Each dentist furnished his own instruments, but other equipment and supplies

were purchased from hospital funds.

After the Civil War, a number of years passed before there developed

another wave of concerted interest in making dental service available to the

Armed Forces. Members of the dental profession and the National Dental

Association initiated and sponsored legislative measures to provide for the

appointment of dental surgeons for service in the United States Army. The

i Robinson, J. B.: The foundations of professional dentistry. In Maryland State Dental Assoc.,

and Am. Dent. A.: Proceedings Dental Centenary Celebration, 1840-1940. Baltimore, Waverly Press,

Inc., 1940.

»Burton, W. Leigh: Dental surgery as applied in the armies of late Confederate States. Am. J.

Dent. Sc. vol. I, 3d series, No. 4. Baltimore, Snowden and Cowman, August 1867, p. 180-189. SG:

39611.
2 DENTAL SERVICE IN WORLD WAR II

first such legislation approved by The Surgeon General and the War Department was enacted 2 February 1901. This bill authorized the employment of

a maximum of 30 dental surgeons, on a contract basis, to serve the officers and

enlisted men of the Eegular and Volunteer Army.3

One of the first dentists so appointed was Dr. John S. Marshall who formulated the plans for the organization of the dental service.4 Dr. Marshall, who

was one of the most active, versatile, and forward-looking men in the new service, served as senior dentist until 1911. His continual efforts to promote a

better dental service for the Army and to effect a more favorable status for the

contract dental surgeon are reflected in the legislative acts and Army regulations which have appeared in the years since 1901. These are tributes to Dr.

Marshall and the small group of original dental surgeons who were willing to

sacrifice position, pride, and income to demonstrate the real value of dentistry

to the military service.

Initially, the contract dental surgeons were attached to the Medical Department and assigned to duty by The Surgeon General or chief surgeon of a

military department. In 1908, they were authorized by law to become a part

of the Medical Department,5and finally, in 1911, a bill which included a provision for the commissioning of dentists was enacted into law. That part of

the act of 3 March 1911 (36 Stat. 1054), pertaining to dentistry, reads:6

Hereafter there shall be attached to the Medical Department a dental corps, which,

shall be composed of dental surgeons and acting dental surgeons, the total number

of which shall not exceed the proportion of one to each thousand of actual enlisted

strength of the Army; the number of dental surgeons shall not exceed sixty, and the

number of acting dental surgeons shall be such as may, from time to time, be authorized

by law. All original appointments to the dental corps shall be as acting dental surgeons, who shall have the same official status, pay, and allowances as the contract

dental surgeons now authorized by law. Acting dental surgeons who have served

three years in a manner satisfactory to the Secretary of War shall be eligible for

appointment as dental surgeons, and, after passsing in a satisfactory manner an examination which may be prescribed by the Secretary of War, may be commissioned

with the rank of first lieutenant in the dental corps to fill the vacancies existing therein.

Officers of the dental corps shall have rank in such corps according to date of their

commissions therein and shall rank next below officers of the Medical Reserve Corps.

Their right to command shall be limited to the dental corps. The pay and allowances

of dental surgeons shall be those of first lieutenants, including the right to retirement

on account of age or disability, as in the case of other officers: Provided, That the time

served by dental surgeons as acting dental or contract dental surgeons shall be

reckoned in computing the increased service pay of such as are commissioned under

this Act. The appointees as acting dental surgeons must be citizens of the United

States between twenty-one and twenty-seven years of age, graduates of a standard

3 GOs and Cirs 1901, Hq of the Army, GO 9, 6 Feb 1901, sec 18, p. 8. SG : 1027.

4 Marshall, John S.: Organization of the Dental Corps of the U. S. Army, with suggestions upon

the educational requirements for military dental practice. In Transactions of the National Dental

Association, Dental Digest. Chicago, J. N. Crouse, 1902, p. 32-46.

5 GOs and Cirs 1908, vol I, WD, GO, 67, 2 May 1908, Washington, Government Printing Office,

1909, p. 1. SG : 1036.

«U. S. Statutes at Large, 61st Congress, Washington, Government Printing Office, 1911, Pt I, 26:

1054-1055.
DEVELOPMENT OF THE DENTAL SERVICE 3

dental college, of good moral character and good professional education, and they shall

be required to pass the usual physical examination required for appointment in the

Medical Corps, and a professional examination which shall include tests of skill in

practical dentistry and of proficiency in the usual subjects of a standard dental college

course: Provided, That the contract dental surgeons attached to the Medical Department at the time of the passage of this Act may be eligible for appointment as first

lieutenants, dental corps, without limitation as to age: and provided further, That the

professional examination for such appointment may be waived in the case of contract

dental surgeons in the service at the time of the passage of this Act whose efficiency

reports and entrance examinations are satisfactory. The Secretary of War is authorized to appoint boards of three examiners to conduct the examinations herein prescribed, one of whom shall be a surgeon in the Army and two of whom shall be selected by the Secretary of War from the commissioned dental surgeons.

The following were appointed dental surgeons with the rank of first lieutenant, after the act of 3 March 1911:7

1. John R. Ames 16. John S. Marshall

2. Julien E. Bernheim 17. George L. Mason

3. Siebert D. Boak 18. Robert H. Mills8

4. Alden Carpenter 19. Robert T. Oliver9

5. George H. Casaday 20. Robert F. Patterson

6. William H. Chambers 21. Rex H. Rhoades

7. George D. Graham 22. Edward P. R. Ryan

8. George I. Gunckel 23. Harold O. Scott

9. John H. Hess 24. Minot E. Scott

10. Raymond E. Ingalls 25. George E. Stallman

11. Frank K. Laflamme 26. Frank P. Stone

12. Clarence E. Lauderdale 27. Edwin P. Tignor

13. Samuel H. Leslie 28. Hugh G. Voorhies

14. Charles J. Long 29. Franklin F. Wing

15. John A. McAlister 30. Frank H. Wolven

A number of the men among this group played important roles in the

further development of the Corps and participated actively in both the First

and Second World Wars.

Forty-seven dental surgeons entered into contract with The Surgeon

General during the period from 1901 to 1911. Contracts of 3 were terminated as a result of death and 15 were annulled, 10 at the dentists' own request

and 5 for miscellaneous reasons.10

'Memo, SG for CofS, 8 Feb 11, Dental surgeons in the U. S. Army, with list of dental surgeons,

and their years of service, attached. Natl Archives, SG : 106047.

s Lt Robert H. Mills was destined to become the first major general in the Army Dental Corps

some 30 years later. WD SOs, 1943, vol IV, Nos. 276-363, WD SO 280, 7 Oct 43, sec 1

»In 1942 the general hospital located at Augusta, Ga., was designated as the Oliver General

Hospital in honor of Col Robert T. Oliver, Dental Corps, ü. S. Army. WD GO 64 24 Nov 42

«The Dental Corps. The Dental Bulletin Supplement to The Army Medical Bulletin 6: 18, Jan

1935.
4 DENTAL SERVICE IN WORLD WAR II

Early in 1915, the Association of Military Dental Surgeons submitted

to The Surgeon General a "Bill to Increase the Efficiency of the Dental Corps,

U. S. Army." " The Adjutant General informed The Surgeon General 5 February 1915 that the Secretary of War did not approve of any legislation for

the Dental Corps.

However, the Legislative Committee, National Dental Association, whose

chairman was Dr. Homer C. Brown, continued to initiate and support legislative measures which would increase the efficiency of the Dental Corps. Late

in 1915, recommendations which provided for the organization of a Dental

Reserve Corps, and for the increase in rank in the Dental Corps to captains,

majors, and one chief with the rank of colonel, were submitted to The Secretary of War and to The Surgeon General.

The Surgeon General, in response to the recommendations made by the

Legislative Committee, directed a memorandum to the Chief of Staff in which

he declared that the Dental Corps as organized then did not attract the best

men graduating from the various dental colleges, and that he was in favor

of the various grades with the exception of colonel. The Surgeon General

believed that the grade of colonel and a chief of the Dental Corps was unnecessary. The organization of a Dental Eeserve Corps, however, was deemed

advisable.

The next development was the receipt by The Surgeon General on 20

February 1916 of the following telegram:12

The National Dental Association of nearly 20,000 members and an equal number

in other dental organizations must vigorously oppose the contract status and the

relative rank for dental corps as proposed in your recently published bill. We consider this discrimination as unnecessary and humiliating and must insist that our

representatives in Army be accorded dignified recognition and actual rank in keeping

with importance of service rendered. We prefer to cooperate with you and will

greatly appreciate your support but under herein mentioned conditions we have no

choice. Wire collect if your attitude is misunderstood or any change in situation.

In his reply to Dr. Brown, The Surgeon General stated that: "My desire

is to increase the efficiency of the Dental Corps and provide a proper flow

of promotion. The question of titles given to the various grades is, I believe,

a matter of secondary importance. There is no objection upon my part to

the same provision regarding rank as is now authorized for the Medical

Corps." 13

Finally, after much activity on the part of the National Dental Association, the Association of Military Dental Surgeons, state, and city societies,

legislation was enacted on 3 June 1916 14 which provided for the organization

11 Ltr, Pres, Assoc of Mil Dent Surgs, to SG, 12 Jan 15. Natl Archives, SG : 90384-1.

12 Telegram, Dr. Homer C. Brown, Chairman, Legislative Committee, Natl Dent Assoc, to SG. 20

Feb 16. Natl Archives, SG : 106047, Pt 11-65.

13 Telegram, SG to Dr. Homer C. Brown, Chairman, Legislative Committee, Natl Dent Assoc,

21 Peb 16. Natl Archives, SG : 106047, Pt 11-65.

11 H. R. 12766, National Defense Act approved 3 Jun 16, sec 10.
DEVELOPMENT OF THE DENTAL SERVICE 5

of a Dental Corps in the National Guard, and for the establishment of an

Officers' Keserve Corps. Included in this legislation was the following section

which gave further advantages to the Army Dental Corps:

The President is hereby authorized to appoint and commission, by and with the

advice and consent of the Senate, dental surgeons, who are citizens of the United

States between the ages of 21 and 27 years, at the rate of one for each 1,000 enlisted

men of the line of the Army. Dental surgeons shall have the rank, pay, and allowances of first lieutenants until they have completed 8 years' service. Dental surgeons

of more than 8 but less than 24 years' service shall, subject to such examinations

as the President may prescribe, have the rank, pay, and allowances of captains.

Dental surgeons of more than 24 years' service shall, subject to such examinations

as the President may prescribe, have the rank, pay and allowances of major ; Provided,

That the total number of dental surgeons with rank, pay, and allowances of major

shall not at any time exceed 15: and provided further, That all laws relating to the

examination of officers of the Medical Corps for promotion shall be applicable to

dental surgeons.

The act of 3 June 1916 authorized the President through the governors of

States and Territories and the Commanding General of the District of Columbia to appoint and commission dental surgeons as first lieutenants at the rate

of one for each thousand enlisted men of the line of the National Guard. However, only the President was authorized to appoint and commission reserve

officers in the various sections of the Officers' Eeserve Corps. The act provided

that the proportion of officers in any section of the Officers' Reserve Corps

should not exceed the proportion for the same grade in the corresponding army,

corps, or department of the Regular Army, except that the number commissioned in the lowest authorized grade in any section was not to be limited.

According to The Surgeon General's annual report to the Secretary of

War, 30 June 1918, the National Guard included 249 dental officers on 5 August

1917. By 30 June 1918 the number had increased only to 253, of whom 251

were first lieutenants. There were only two who were promoted to the rank

of captain, and this was not accomplished until March 1918."

The same report indicated that by 31 July 1917 there were 598 commissioned in the Reserve Corps, while on 30 June 1918 there were 5,372. The distribution of rank in the total number of dental reserve officers commissioned

and on duty on the latter date was as follows: majors—36, captains—244, and

first lieutenants—5,092.16

With the advent of World War I," the rapid mobilization of the Army and

with it the Dental Corps led to many additional responsibilities for the dental

surgeons. The National Dental Association, various state dental societies, as

well as individual officers of the Dental Corps made requests for increased rank

15 Annual Report of The Surgeon General, U. S. Army, 1918, Washington, Government Printing

Office, 1918 (cited hereafter as Annual Report . . . Surgeon General).

18 Ibid.

17 Annual Report . . . Surgeon General, 1917.
6 DENTAL SERVICE IN WORLD WAR II

and privileges commensurate with these responsibilities.1819 The Surgeon General was favorable to the request that the Dental Corps be given equal status

with that of the Medical Corps, and this status was achieved by the passage

of H. K. 4897, the act of 6 October 1917, which provided that:

Hereafter the Dental Corps of the Army shall consist of commissioned officers of

the same grade and proportionally distributed among such grades as are now or may

be hereafter provided by law for the Medical Corps, who shall have the rank, pay, promotion, and allowances of officers of corresponding grades in the Medical Corps, including the right to retirement as in the case of other officers, and there shall be one

dental officer for every thousand of the total strength of the Regular Army authorized

from time to time by law: Provided further, That dental examining and review boards

shall consist of one officer of the Medical Corps and two officers of the Dental Corps:

Provided further, That immediately following the approval of this Act all dental

surgeons then in active service shall be recommissioned in the Dental Corps in the

grades herein authorized in the order of their seniority and without loss of pay or allowances or of relative rank in the Army: Provided further, That no dental surgeon

shall be recommissioned who has not been confirmed by the Senate.

Much credit for the passage of this bill was reflected upon Dr. Homer C.

Brown, chairman of the Legislative Committee of the National Dental Association 20 for his untiring efforts to place dentistry on a plane equal to that

of medicine in public service. The Journal of the Association of Military Dental Surgeons of the United States in commenting on the splendid work of

Dr. Brown said:

In regard to credit, much credit for wholehearted, unselfish, untiring devotion to this

cause is due to several of a small coterie of men. Some of these have been laboring to

this end for years ; others for months only, but for once in the history of dental politics

all had a hold on the same end of the rope in the final tug of war, and by pulling

together achieved the result.21

In the period between the two World Wars, enactment of various legislative measures 22 did not significantly change the status of the Dental Corps.

It was not until the United States was actively engaged in the hostilities of

World War II that attempts were again initiated to enact legislation specifically

designed to accomplish this. The primary basis for such action was the increasingly frequent charge that the morale of dental officers and the efficiency

of the Dental Service suffered from the so-called "domination" of the Dental

18 Ltr, Hon Ambrose Kennedy, Cong from R. I. to SecWar, 12 Apr 17 with incl R. I. Dental Society

Resolutions. Natl Archives, SG : 106047, Pt 11-84.

19 Telegram, Dr. Homer C. Brown, Chairman, Legislative Committee, Natl Dent Assoc, to SecWar,

30 Jul 17. Natl Archives, SG : 106047. Pt. 11-85.

20 Hereinafter referred to as the American Dental Association, ADA.

21 Our new status. J. A. Mil. Dent. Surgs. of the United States 2 : 10-13, January 1918.

22 Act of 4 June 1920 authorized a quota of 298 dental officers which allawed 1 dental officer for

every 1,000 strength of the Regular Army Establishment; established exact peacetime promotion

schedule. Acts of 30 June 1921 and 20 June 1922, reduced strength of Dental Corps to 180 and 158,

respectively. Acts of May 1936, through 29 Jan 1938, and 3 April 1939 increased Dental Corps

strength to 183, 208, 258, and finally 316. Act of 29 January 1938 also credited to the officers of

the Dental Corps, for the purposes of retirement, any service as Contract Dental Surgeon and Acting

Dental Surgeon.
DEVELOPMENT OF THE DENTAL SERVICE 7

Corps by medical officers.23 24 Since such charges were made by responsible

persons, and since they received wide publicity, a discussion of medicodental

relations, as reflected in the subsequent legislative proposals, is necessary in

spite of its highly controversial nature.

MEDICODENTAL RELATIONS 25

A certain amount of friction between the professions concerned with health

care is, of course, nothing new. By nature the professional man is usually

independent, and the long years of training necessary to master his subject

fosters the attitude that no outsider can understand his particular problems or

be competent to exercise control over his treatment of patients. Historically,

both medicine and dentistry were originally practiced by persons of low standing in the community, but medicine attained professional status much earlier

than dentistry, which remained largely a mechanical art to the end of the 19th

century. As the health implications of dentistry were recognized, and as the

educational background of dentists improved, the latter began a rapid climb

toward professional, social, and economic equality. Nevertheless, relations

with medicine were occasionally marred by the physician's conservative tendency to regard dentists as upstarts in the health field, and by the dentist, as a

member of a profession fighting for recognition, to suspect discrimination where

none was intended. Also, the physician irritated the dentist by telling his

patients that they should have their teeth extracted, and the dentist reciprocated by advising that dental treatment would cure general medical conditions.

As both professions gained experience they realized that their patients

would receive better care if the physician and the dentist cooperated to use

their special skills to the utmost, and such teamwork has become routine. But

in the process of adjustment dentistry has rigidly maintained its independence

and has fully shared medicine's traditional objection to control from outside

the profession. As late as 1945 the Committee on Dental Education of the

American Dental Association (ADA) withdrew its approval of a large and

respected dental school because it had been integrated with a medical school

and placed under the general supervision of a medical educator, justifying

23 Articles on this subject appeared in the dental press almost continuously after 1943. The

following were typical: (1) Rank without authority. Oral Hyg. 33 : 932-937, July 1943 ; (2) Freedom

for the Dental Corps. Ibid. 33 : 960-961, July 1943 ; (3) The score of discrimination. Ibid. 33 :

1230, September 1943.

24 (1) The Army Dental Corps. J. Am. Dent. A. 32: 487-488, April 1, 1945. (2) The right to

gripe. Ibid 33 : 118-122, January 1, 1946.

26 By the very nature of the subject, documentation of this discussion must be very imperfect.

Dentists who felt that the dental service suffered from the unwise interference of medical officers

were naturally slow to put their complaints in official reports which had to pass through the hands

of those same officers. They wrote instead to the American Dental Association, to their congressmen,

or to the editors of professional journals. In the absence of official sources, the author has had to

rely heavily on information gleaned personally from dental officers in three foreign theaters and in

several major installations in the U. S., realizing fully the difficulties of an attempt to evaluate

opinions, which were by no means unanimous, on such a controversial matter.

330324 0—55 2
8 DENTAL SERVICE IN WORLD WAR II

this action with the statement that any interference by medicine in the field of

dental education was considered dangerous.26

In the Armed Forces the position of both the professional services has

necessarily been less independent than in civilian practice. All activities of a

military organization must be directed toward a common objective and subject

to the orders of a commander responsible for the results achieved. At some level

both medicine and dentistry must come under lay control since the highest

staff positions must be filled by combat officers. So far as the dental service

was concerned, therefore, the question at issue was not: "Were dental officers

under the supervision of nondentists?" but: "Was the nature of the supervision such as to hamper their activities unnecessarily ?"

On the basis of Army regulations and directives alone, the dental officer

certainly exercised less control over the dental service than officers of most

other branches did over their respective activities. This situation resulted

from the two following circumstances: (1) As a staff officer the dental surgeon

did not enjoy the usual privilege of presenting his views and recommendations

directly to the executive authority; (2) while all medical treatment was given

in installations under the direct command of medical officers, dentists did not

command dental installations.27

As a subordinate of the surgeon, the dental surgeon was limited to submitting recommendations only to that officer; if they were approved they were

submitted to the commander secondhand by an officer who might be neither

completely familiar with the matter under discussion nor personally interested in supporting the dentist's views against opposition from other staff

members. If the surgeon did not approve the dentist's proposals they could

be dropped without formality, and if he chose to substitute his own recommendations the lay commander did not necessarily know that they were not

the views of the dental surgeon.

The practical effect of this situation of course depended upon the attitude

of the surgeon. Many surgeons with long experience as staff officers gave loyal

and effective support to their dental surgeons, and in some cases their reputation and standing even enabled them to get more consideration for the dental

service than the dental surgeon could have himself obtained, especially when

the latter was a junior officer. It was also held by some that the medical

officer would generally show more understanding and sympathy toward dental

problems than would a line officer. On the other hand, it could not be denied

that the dentist was one step removed from the authority which made decisions, and this fact inevitably resulted in some delay even when action was

favorable; the dental surgeon's proposals had to be approved by two officials

rather than one. The more severe critics of the dental surgeon's status held

20 Dental Education at Columbia University. J. Am. Dent. A. 32 : 1150, 1 Sep 45.

27 In the latter part of the war certain minor units, such as the mobile prosthetic teams, were

commanded by dental officers, but these were a negligible exception to the general rule that dental

officers did not command.
DEVELOPMENT OF THE DENTAL SERVICE 9

that medical officers could not have a full understanding of dental problems

and requirements, and that at times they were actually in competition with

the dental service for personnel and funds. The fact that lack of direct staff

representation did entail some disadvantage was pointed out by The Surgeon

General in 1943 when he protested that service command surgeons were being

hampered in their duties by the necessity for presenting their recommendations

to the commanding general through a subordinate staff officer. At that time

he noted that:28

... the Medical Department has continued to function in the service commands and

to produce excellent results as a whole. I feel, however, that these results have been

obtained from extra efforts and personal contacts rather than from that at which

we are aiming; namely, simplified procedure and efficiency.

Officially, the dental surgeon was an adviser to the surgeon, without formal

authority even within the dental clinic. Here again, the actual status of the

dental surgeon depended upon the attitude of the surgeon. Many medical

officers routinely consulted the dentist on matters concerning the dental service and accepted his advice in the absence of important reasons to the contrary.

On the other hand, it cannot be denied that a determined surgeon could, by

invoking his authority to make out efficiency reports, completely dominate the

dental service, even in respect to determining treatment or assigning personnel

within the dental clinic, matters which were specifically reserved to the dental

officer by regulation.29 The dentist was not inclined to demand even his legal

rights if he could expect, as a result, to receive a poor efficiency rating and

be transferred to an undesirable post because he was "uncooperative."

The mere fact that the dental service functioned with reasonable efficiency during the war is strong evidence that medical officers generally showed

considerable restraint and good judgment in their supervision of dental activities. The editor of Oral Hygiene, who was a constant critic of the status

of the Army and Navy Dental Corps, conceded this when he wrote:

It is true that the relationship between many individual dental officers and medical

officers is characterized by cordiality, understanding, and faithful cooperation in

caring for the soldiers and sailors of the United States. It is the exceptional case

in which the medical officer actually attempts to dominate or exert authority over

the dental officer.30

However, it was too much to expect that all of the 45,000 medical officers in

the Army would have the necessary experience and judgment to administer

the dental service wisely. Some of them were junior officers who had been

promoted rapidly to important positions in connection with the expansion

of the defense forces; others were former civilian physicians who did not

understand that staff supervision did not imply detailed interference in routine

matters of internal administration. When medical officers of these types felt

s» Rpt. Conference of CGs, SvCs, ASF, 22-24 Jul 43. HD : 337.

«• AK 40-510, par 1, 31 Jul 42.

30 See footnote 23 (1), p. 7.
10 DENTAL SERVICE IN WORLD WAR II

called upon to "run" the dental service the results could only be unhappy.

The Surgeon General himself pointed out that "special problems related to the

professional dental service as well as to the special skills and techniques common

only to dentistry are best understood and administered by those trained in

that field."31

Some of the more specific aspects of the problem of medicodental relations

are discussed in the following paragraphs.

Effecf of the Administrative Status

of the Dental Service on Morale

The fact that the morale of dental officers at the end of the war left

much to be desired is discussed in chapter IV. This situation is significant

here because it was widely blamed on unsatisfactory relations with medical

officers. This subject covers a wide field, however, and it is necessary to consider complaints on a more specific basis.

One of the common causes of criticism was lack of opportunity for promotion in the Dental Corps compared with the Medical Corps. In April 1945

the proportion of medical and dental officers in each grade was as follows 32

Percentage

Grade Distribution

Medical Dental

Corps Corps

Colonel 2. 3 0. 8

Lieutenant Colonel 7. 3 2. 7

Major 21. 6 10.4

Captain 56. 6 67. 3

Lieutenant 12. 2 18. 8

It is clear that the dental officer had much less chance to reach field grades,

but the extent to which this was the fault of the Medical Department is

not so clear. The Surgeon General had only advisory authority over the

allotment of grades within the service commands, in the Air Force, in tactical

units, or in theaters, leaving a negligible part of the Army in which his influence was decisive. Also, the War Department itself was slow to approve

increases in ratings for dental officers in table-of-organization units due to

the tradition that high grades should go only with the command of large

numbers of troops. Common sense had of course forced many modifications

of this principle; the chief of staff of an army was at least a major general

though he did not command any soldiers, and the chief of the surgical service

of a large hospital was likewise a colonel, while the commander of a collecting

company, with a hundred men, was only a captain. Obviously, responsibility

should be the criterion for the allotment of grades, not mere numbers of troops

commanded. Nevertheless, this attitude cropped up whenever advanced rank

31 Ltr, Col Kobert J. Carpenter to CG ASF, 12 Apr 45, sub : Revision of AR 40-15. SG: 300.3.

52 Strength of the Army, 1 May 45.
DEVELOPMENT OF THE DENTAL SERVICE 11

for staff positions was mentioned. The Surgeon General supported successful

efforts to speed the promotion of dental lieutenants in tactical outfits; he

recommended the promotion of the chief of the Dental Division to the grade

of major general; and he made a sincere and fairly successful effort to obtain

the same grades for the chiefs of hospital dental services as were held by the

corresponding chiefs of the medical or surgical services.33 Occasionally, however, the Medical Department appeared to foster the view that dental officers

had no responsibilities beyond the rendering of treatment at the chair on an

individual basis. Thus, when a representative of the Surgeon General's Office

testified against legislation to provide additional general officers in the Dental

Corps by stating that so far as he knew no dentist ever commanded more than

one man (his dental assistant), he ignored the fact that a colonel of the Dental

Corps would have been held directly responsible for any defects of the dental

treatment rendered by more than 4,000 dental officers in Europe alone.34 It

is pertinent to note, in this connection, that the Medical Corps had itself carried

on a similar fight for increased rank for medical officers during World War I,

claiming that line officers ignored the advice of junior medical officers, and

that such increases had been opposed by line officers on the ground that physicians had no command responsibilities!35

Dental officers also complained of discrimination when they were held for

36 months of total service following the war, while medical officers were

released after only 30 months. The president of the ADA wrote:36

From time to time during the war period, there has been considerable resentment

from the dental officers due to the present Army regulations. These complaints were

minor and few compared to the protests that are arriving now. These men have

developed a bitterness toward the American Dental Association, threatening to resign

and form a new association. They are also bitter in their condemnation of the Government and the several branches of the service.

Basically, the need to hold dentists arose from a single action: the termination

of the dental Army Specialized Training Program (ASTP) in July 1944.

The War Department decided to discontinue the dental ASTP in spite of

opposition by The Surgeon General who had supported the recommendation

of the Dental Division that the ASTP be continued and that sufficient older

officers be released to create the ncessary vacancies for younger graduates.37

Nor does this decision indicate any conscious discrimination on the part of the

War Department itself. At the time it was taken the Dental Corps was at

maximum authorized strength, while the Medical Corps was desperately scrambling for manpower. The General Staff felt that in view of the critical need

33 Final Rpt for ASF, Logistics in World War II. HD : 319.1-2 (Dental Division).

34 Testimony Brig Gen Guy B. Denit on the Army Promotion Bill, H. R. 2536. J. Am. Dent. A.

35 : 447, 15 Sep 47. 3

* Army Medical Corps Legislation. J. Am. Dent. A. 5 : 635, June 1918; also Authority and Rank

for Surgeons. Ibid. 5 : 323, March 1918.

38 Ltr, Dr. W. H. Scherer, Pres ADA to SG, 17 May 46. SG : 210.8.

31 See discussion of the Dental ASTP in the chapter on Personnel and Training.
12 DENTAL SERVICE IN WORLD WAR II

for men to carry the war to an end, the dental ASTP could no longer be

justified, while the need for the continuance of the medical ASTP was obvious.

It may or may not be held that a mistake was made, but there is no evidence

of any intent to treat the Dental Corps unfairly in this instance.

Evidence is more definite that, justifiably or not, the morale of the dental

officers suffered from the belief that the Dental Service was unnecessarily subordinate to the will of medical officers. A senior dental officer who conducted

an official investigation of the Dental Service in Europe reported that:38

With the exception of one or two dental officers interviewed, all were either Reserve

or AUS. The majority of these officers were very bitter as to the treatment or discrimination towards the Dental Corps by medical officers. Most of them stated that

they would take action through their local dental societies on return to the states.

As one officer expressed it, they were "damned sick of being kicked around by medical

officers."

The editor of Oral Hygiene reported that the number of dentists who blamed

the ADA for not taking more vigorous corrective action was so large that it

threatened the future of that organization.39 The dean of one of the larger

dental schools warned that returning officers were advising young dentists to

stay out of the armed services Dental Corps,40 and the ADA charged that personnel troubles encountered after the war were largely due to the resentment

of dentists at their status during hostilities.41 This latter claim appears exaggerated since the unusually large income to be made in private practice during the period of postwar inflation was also an important factor, but it is significant that such a charge should be made by a reputable organization.

It is difficult to determine the exact extent to which this widespread feeling

of resentment was justified. Wartime conditions inevitably led to some confusion and injustices, and even the ADA admitted that some of the instances of

failure to assign officers to duty for which they felt they were fitted, or of failure

to provide warranted promotions, were probably unavoidable.42

Presumably some dentists failed to understand the need for more supervision in the Army than in private practice and suspected discrimination where

it did not exist. It is further possible that many criticisms arose over relatively minor incidents. Such was the case when a captain of the Dental Corps

and a lieutenant of the Medical Corps started for a supply center in a jeep;

the captain climbed into the front seat and was promptly ordered into the back

seat by the lieutenant because the latter, as surgeon, was the dentist's commanding officer.43 Such instances were merely exhibitions of bad judgment on the

38 Pers ltr, Col James B. Mockbee to Lt Col George F. Jeffcott, 8 Sep 46.

as They cannot speak for themselves. Oral Hyg. 33 : 1244-1245, September 1943.

40 Pers ltr, Dr. Charles W. Freeman, Dean, Northwestern Univ Dent Sch to Maj Maurice E. Washburn, 21 May 46. SG : 322.0531.

11 Dental officers pay again. J. Am. Dent. A. 33 : 755,1 Jun 46.

42 Present status of dentistry in the Armed Forces : A report from the Committee on Legislation.

J. Am. Dent. A. 31: 270-277,1 Feb 44.

43 See footnote 38.
DEVELOPMENT OF THE DENTAL SERVICE 13

part of inexperienced officers but they inevitably received considerable publicity and tended to create resentment even on the part of officers who had never

known such treatment personally.

But after discounting many claims of arbitrary treatment at the hands

of medical officers, it must be admitted that surgeons possessed the authority

to dominate the dental service if they so desired, and it seems probable that

this authority was exercised unwisely in some cases. ^Responsible members of

the organized dental profession denied categorically that the letters they received came from any minority group of malcontents.44 The fact that both

the Director of the Dental Division, SGO, and The Surgeon General recommended certain administrative changes designed to give dental officers increased

authority supports the belief that discontent was based on something more

than emotional and groundless resentment.

Effect of the Status of the

Dental Service on Efficiency

Failure to Consult Dental Surgeons on Matters Affecting Their Dental

Service. In December 1944 the Director of the Dental Division reported the

following situation to The Surgeon General:45

Information continues to reach this office that there are some stations where the

Post Surgeon does not give proper consideration to the Dental Service and, instead

of coordinating the Dental Service with the Medical Service, he places it in a subordinate position and in many instances ignores the chief of the Dental Service and

his recommendations, even to the extent of recommending dental officers for promotion without consulting the Camp Dental Surgeon. Such conditions as this should

not and would not exist if the Service Command Surgeons concerned would not

condone such action by their Post or Station Surgeons.

The Dental Corps is an integral part of the Medical Department and should always

remain as such. It is unfortunate that there are still some medical officers, who,

apparently, do not realize this and that the Dental Corps desires to assist in every way

possible and assume its share of the responsibility in carrying out the mission of the

Medical Department.

The attitude of some few medical officers, who apparently are determined to subordinate the Dental Corps, tends to offset the wonderful attitude of comradeship and

friendliness exhibited by the majority of Medical Corps officers. These acts of subordinating the Dental Corps by the few officers reach the civilian profession through

dental officers on duty, and have caused much agitation by a certain group for a

complete separation from the Medical Department. I am entirely opposed to any

such action as it would lessen the efficiency of both the Medical and Dental Corps.

I am sure The Surgeon General desires that Service Command Surgeons correct

any subordinated status of the Dental Corps which may exist at their headquarters,

and in their taking steps to pass this on down to the lower echelons.

The Surgeon General's disapproval of this undesirable situation which

did exist in some cases was confirmed by the Director of the Dental Division

"See footnote 24 (2), p. 7.

« Memo, Maj Gen R. H. Mills for Exec Off SGO, 5 Dec 44, sub : Agenda for the Service Command

Surgeons' Conference, 11 December through 15 December. SG : 337.
14 DENTAL SERVICE IN WORLD WAR II

in his remark that "General Kirk is fully cognizant of the administrative

problems in some of the lower echelons of command and accordingly plans for

a change in Army regulations are now under way." 46 He also stated that

The Surgeon General had "offered every assistance and approval for more

administrative control of dental affairs by dental officers in the lower echelons," " and further, that "General Kirk . . . has given the Dental Division

a free hand in the direction of its policies and personnel. ... If a comparable

relationship could be obtained throughout all the channels of command, the

primary objections now raised by many . . . would be erased. . . .

,,4S

Lack of Effective Control of Dental Personnel. One of the most frequent

causes of complaint by dental officers was their inability to control dental personnel. Under unfavorable conditions the surgeon could, and did, take the

following actions detrimental to the morale and efficiency of dental officers:

1. Failed to allot sufficient dental officers to the dental clinic.48

2. Failed to provide adequate grades for the dental service so as to make

possible reasonable promotion.50

3. Used dental officers in unimportant nonprofessional duties.51 At times

this latter abuse was carried to fantastic lengths. Thus when the surgeon

of a service command was directed to send 12 Medical Department officers to

the Medical Field Service School he sent 12 dental officers because he held that

medical officers could not be spared, and on their return these dentists were

used in administrative functions because they alone had the necessary training.52 Even worse, the same dentist was occasionally sent to the Medical Field

Service School twice to avoid losing the services of a medical officer.53 These

were, admittedly, extreme examples, and the misuse of dental officers was largely

eliminated in the United States by the determined efforts of The Surgeon

General. Overseas, however, it continued to exist to some degree until the

end of hostilities.

4. Granted leaves of absence to dental personnel without consulting the

dental surgeon.

5. Promoted dental personnel against the advice of the dental surgeon.54

6. Rendered efficiency reports on dental officers without consulting the

dental surgeon.55

46 Major General Mills prefers changes in regulations to legislation to correct inequalities in the

Dental Corps. J. Am. Dent. A. 32 : 489, 1 Apr 45.

47 Ltr, Maj Gen E. H. Mills to Dr. Edward J. Ryan, 17 Mar 45. [D]

" See footnote 46.

49 See discussion in the chapter of this history on Personnel and Training.

K) Ibid.

51 See discussion in the chapter of this history on The Procurement of Dental Officers.

62 Proceedings of The Surgeon General's Conference with Corps Area and Army Dental Surgeons,

8-9 Jul 42. HD : 337.

» Ibid.

«* Testimony before the House Naval Affairs Committee on bill to improve the efficiency of the

Dental Corps. J. Am. Dent. A. 32 : 364 : 374, 1 Mar 45.

CB Ibid.
DEVELOPMENT OF THE DENTAL SERVICE 15

7. Failed to assign enlisted assistants in sufficient numbers and in appropriate grades. Dental enlisted assistants were assigned to the dental clinic

by the surgeon, they were promoted by the surgeon, and they could be withdrawn at any time. Lack of a permanent corps of enlisted men, with adequate ratings, was one of the most serious deficiencies noted by the Director

of the Dental Division after the war.se

8. Kemoved enlisted assistants from the dental clinic for outside duties

on short notice. This situation was of course unavoidable in an emergency,

but practically paralyzed the dental service when it occurred.57

Professional Interference. It was reported that surgeons sometimes prohibited dental surgeons from committing patients to the hospital, using general anesthetics, or prescribing certain drugs legally used by dentists.58 It is

believed, however, that this difficulty was more commonly encountered in the

Navy; it appears to have been a matter of minor concern to Army dentists.

Extent of Medical Interference

in Dental Administration

The extent to which the efficiency of the Dental Service actually suffered

from medical supervision, if at all, is extremely hard to determine. Wartime

conditions varied so much from camp to camp that it is impossible to compare

the actual output of clinics operating under different degrees of medical control, and neither medical nor dental officers were impartial enough to render

completely unbiased opinions in the matter. Editorials in the dental press

would indicate that medical interference was almost universal, but closer contact with individual dentists revealed that many of them were angry at injustices they had heard about rather than experienced. Further, while almost

every dental officer felt that some interference had occurred, some of them were

not sure that they would not have encountered equal restrictions under line

officers. It is certain, however, that most dental officers, from the Chief of the

Dental Division down, felt that a clearer definition of the responsibilities and

rights of dental officers was imperative.59 60 61

LEGISLATIVE AND ADMINISTRATIVE ACTION REGARDING

THE ARMY DENTAL CORPS

One of the first moves to improve the status of the Dental Service was the

campaign of the ADA to get advanced rank for the Director of the Dental

w See footnote 33, p. 11.

w

Ibid.

» Ibid.

69 See footnotes 31, p. 10, 45, p. 13, 46, p. 14.

«o Ltr, Maj Gen E. H. Mills to Ed, J. Am. Dent. A., 23 May 47, quoted in "General Mills Expresses

His Opinion Regarding Army Dental Corps Regulations." J. Am. Dent. A. 35 : 231-232, 1 Aug 47.

«• Report of Activities to Change the Status of the Army Dental Corps. J. Am. Dent. A. 33 :

1030-1040, 1 Aug 46.
16 DENTAL SERVICE IN WORLD WAR II

Division who was then (April 1943) a brigadier general. When The Surgeon

General of that period stated that "the Dental Corps had all the representation

in the higher brackets to which it was entitled,"02bills were introduced in

Congress to provide that the Director of the Dental Division should have the

grade of major general and that the Dental Corps should be allotted brigadier

generals in the same ratio as the Medical Corps.63 Before these bills could be

acted upon a new Surgeon General had taken office and the ADA made new

efforts to get action informally, without legislation. The new Surgeon General was apparently somewhat lukewarm to certain aspects of the idea, but lie

agreed to make the Director of the Dental Division a major general and to consider the possibility of appointing one or more brigadier generals in the Dental

Corps.64 Attempts to pass legislation were then dropped. The promotion of

the Director of the Dental Division was announced shortly, but no brigadier

generals were appointed until 4 January 1945, and the single officer so promoted was again reduced to the grade of colonel on 1 December 1945. (A bill

to provide for a rear admiral in the Dental Corps of the Navy had become law

in December 1942. )

65

About the same time The Surgeon General personally initiated efforts to

get more administrative authority for dental officers within the framework of

the existing Medical Department organization. In July 1943 he sent the following letter to the commanding generals of all service commands:6ß

1. The Dental Corps is an integral part of the Medical Department, and must function as such. But dentistry, being a specialty of which few medical officers have ample

knowledge, can function more efficiently if members of the Dental Corps are consulted

and their advice sought on all matters pertaining to the Dental Service.

2. The chief of the medical branch of a service command is responsible to the service

commander for the efficient functioning of all branches of the Medical Department, but

due to the increased responsibility it has been considered advisable and necessary, for

obvious reasons, in order to maintain a highly efficient dental service to assign an

experienced dental officer as an assistant to the chief of the medical branch. His

duties are clearly defined in par. 5, AR 40-15, December 28, 1942. This Regulation

will be complied with, and the duties prescribed therein will not be delegated to any

other assistant. By so doing a more efficient service will be maintained and dissatisfaction and misunderstanding obviated.

3. An efficient medical service requires the complete cooperation of every branch of

the Medical Department. The efficiency of any one branch reflects credit on the entire

department.

Results of this action were not too encouraging. Protests in the dental press

grew- in volume and the Director of the Dental Division reported at the end of

1944 that conditions in the field were far from satisfactory.67

62 See footnote 42, p. 12.

«

3 H. R. 2442, 78th Cong-, introduced by Mr. Sparkman on 8 Apr 43; S. 1007, introduced by

Mr. Hill on 16 Apr 43.

64 See footnote 42, p. 12.

65 Flagstad, C. O.: Wartime Legislation. J. Am. Dent. A. 33 : 63-65, 1 Jan 46.

66 Ltr, SG to CG 3d SvC, 14 Jul 43, sub : Dental Service. SG : 703.-1.

67 See footnote 45, p. 13.
DEVELOPMENT OF THE DENTAL SERVICE 17

Early in 1944 the ADA began to consider seriously the introduction of

legislation to change the status of the Dental Service. Its Committee on

Legislation finally advised against such action, however, for the following

reasons:

1. It was believed that the new Surgeon General should be given a chance

to bring about the desired changes through administrative procedures.68

2. The Director of the Dental Division advised against legislative action

because he felt that administrative correction was preferable and possible,

and because he felt that the introduction of permanent legislation in the middle

of the war was neither appropriate nor likely to receive favorable action.69

The attitude of the Committee was expressed as follows in February

1944:70

He [The Surgeon General] has been very cooperative with the members of the

Dental Corps and [he has] stated that beneficial changes will be made.

With such cooperation, the Committee on Legislation will grant every opportunity

for the correction of inadequacies by the department itself before seeking correction

by legislation. The Surgeon General of the Army and the chief of the Army Dental

Corps are in agreement that no legislation should be sought at the present time.

This Committee is satisfied to place this responsibility for adjustment in their hands.

The aims of the ADA at this time were stated in very general terms, but

they appear to have included two principal objectives:

1. The right of the dental surgeon to take his problems and recommendations directly to the commander of any installation. It was desired that:

dental officers be permitted to present their eases and problems, without lesser

intervention, to the officer generally responsible for the activity. In a hospital, this

would be the medical officer in charge. In a line organization, this would be the

commanding officer. These officers, by virtue of their position and wider responsibility, would bring to their decisions the impartial viewpoint that now does not always

characterize such decisions.71

2. "Autonomy" for the Dental Service. This word was of course open to

many interpretations and it undoubtedly meant different things to different

persons. It was defined by the Committee on Legislation of the ADA as "the

power, right or condition of self-government, or, in its secondary meaning, as

practical independence with nominal subordination." 72

The condition of "practical independence with nominal subordination"

was the one already envisaged in Army regulations. The surgeon of an installation had "nominal" authority, but it was hopefully expected that he would

use it principally to arbitrate in matters where the interests of the Dental

Service touched those of other activities, leaving the dental surgeon free to

handle all routine administration. The fault in this conception was expressed

« See footnote 42, p. 12.

60 See footnote 60, p. 15.

m

See footnote 42, p. 12.

n Medicodental relations in the armed services. J. Am. Dent. A. 31 : 696-697, 1 May 44.

72 See footnote 42, p. 12.
18 DENTAL SERVICE IN WORLD WAR II

by the chef who said "there is no such thing as a little garlic." In view of

the accepted military tradition that responsibility must be matched by authority

there is no such thing as "nominal subordination" in the Army. As long as

the surgeon was in command of dental activities and responsible for their

success the War Department rightly objected to any efforts to diminish his

final control over those activities. It might recommend very strongly that

the surgeon consult the dental officer, but it could not logically direct him to

accept the latter's advice; nor could the surgeon excuse his errors by stating that

he had taken the dentist's recommendations, for if he felt that the dental

surgeon's views were faulty he was not only allowed, but expected, to reject

them. Even the authority to go directly to the commanding officer when the

surgeon disapproved the proposals of the dental officer would have been a

precedent-shattering departure from accepted staff procedure. On the other

hand, to give the occasional authoritarian type of officer "nominal authority"

is to give him a powerful weapon with instructions not to use it; sooner or

later the temptation to "show who is boss" becomes overpowering. It would

seem, therefore, that attempts to give the Dental Service actual independence

while keeping it under nominal supervision could not be expected to prove

uniformly successful.

The "power of self-government" was more definite, although further

qualification was needed even here. The Committee on Legislation, ADA,

generally agreed, as did the Director of the Dental Division and The Surgeon

General, that a completely independent Dental Corps was not necessary or

desirable. It was stated that "The profession of dentistry, as a unit, has no

hesitation in serving under a surgeon general who is a member of the profession

of medicine. This plan, dictated by the close association of dentistry and

medicine in the interests of general health, is satisfactory."73 Again, "From

some quarters, there is an insistent demand for a separate Dental Corps. Since

the work of the Medical Corps and that of the Dental Corps is so closely allied,

it is felt by those who have made a close study of the problem that a complete

separation of the Dental Corps from the Medical Department in both the Army

and the Navy would hinder the effectiveness of both corps." 74 On the other

hand, the Committee on Legislation did not agree with those who felt that

authority to go to the commanding officer with dental problems would be

sufficient.75 It also wanted to be assured that local surgeons would not intervene in purely dental affairs. This attitude was expressed as follows

by the head of the Canadian Dental Service, which was completely independent,

under the Adjutant General of the Canadian Defense Forces:76

We all admire the Medical Service for what it knows and what it does, but there

are two great reasons why it is difficult to understand why it should retain control

73 Ibid.

« Ibid.

TO See footnote 61, p. 15.

Lott, F. M. : Wartime functioning of the Canadian Dental Corps. Oral Hyg. 33: 1388-1391,

Oct 1943.
DEVELOPMENT OF THE DENTAL SERVICE 19

of the Dental Service. First, it has a tremendous job on its hands to deal efficiently

with the great number of medical problems of the Forces. For this reason alone it is

imperative that the Dental Service should carry its own burdens. Second, most Medical

Officers admit that they are not trained as Dental Officers and are not qualified to "run

the dental show" as is often stated.

Probably the clearest statement of the objective of the ADA was the

following:"

We can agree that The Surgeon General must be the final and overall authority in

regard to all matters having to do with the health of the soldier. However, as regards

dentistry, once certain fundamental policies have been agreed upon, the Dental Corps,

under its own chief, should be free to carry out those policies. This is our conception

of autonomy in, the Dental Corps.

Apparently the aim of the ADA was subordination to The Surgeon

General at the major policy-making level, with administrative independence

at all lower echelons. The application of such a plan involved some administrative difficulties since the dentist had to commit patients to the hospital, he

used clinic space which was generally within the area controlled by the surgeon,

and his activities could not altogether be divorced from those of the Medical

Corps in the operating installations. Also, the dental surgeon might find himself responsible for personnel administration, the procurement of supplies, and

other matters which had previously been handled by the surgeon and his assistants. Such separation of functions was administratively possible, however, and it was later actually carried out in the Navy.

Efforts to secure changes in Army regulations progressed slowly. In

April 1945 the ADA stated that unless action was soon taken it would sponsor

legislation to bring about the desired modifications.78 At about the same time

The Surgeon General submitted the draft of a revised Army regulation which

represented his views on the matter of increased responsibility for dental

surgeons.79 This draft was amended several times before it was submitted,

apparently on the basis of informal consultations with ASF, and it is possible

that it already represented some compromise between what The Surgeon General wanted and what he thought he could get. As submitted by The Surgeon

General this tentative regulation provided that matters affecting the Dental

Service as a whole would be administered by The Surgeon General, with the

assistance of the Director of the Dental Division. In lower echelons, however,

dental affairs were to be administered by the dental surgeon, though the latter

was bound to consult the surgeon and seek his concurrence before action was

taken. Any matter on which an agreement could not be reached was to be

referred to The Surgeon General, though this provision was changed in subsequent drafts to allow settlement of conflicts by the local commanding officer.

T See footnote 42, p. 12.

78 See footnote 24 (1), p. 7.

'»See footnote 31, p. 10.
20 DENTAL SERVICE IN WORLD WAR II

The War Department, in turn, eliminated some desired features80before the

regulation was finally published in August 1945.81

In its published form the regulation provided that "matters relating to

the dental service as a whole are administered by the Director, Dental Division, an assistant to The Surgeon General, through The Surgeon General,"

giving at least the appearance of greater authority for the Director of the

Dental Division than had been implied in the original phrase "by The Surgeon

General with the assistance of the Director of the Dental Division." Similar

wording was used to describe the authority of subordinate dental surgeons, as

follows: "In a theater, service command, or any other headquarters, matters

relating to the dental service are administered by the dental surgeon, through

the surgeon." All recommendations initiated by the dental surgeon were to

be routed through the surgeon, who was required to forward them to the commanding officer with his comments. The dental surgeon was also given authority to render efficiency reports on his own personnel.

The ADA claimed that the new regulation did not make any substantial

change in existing relations, asserting that "the causes of frequent complaints

by dental officers have been wrapped up with new words but considerable

care has been exercised not to remove them. The domination of the Dental

Corps by the Medical Corps may have been gently disturbed but, by and large,

it remains complete and unshaken." 82 General Mills admitted that he had "had

to make some concessions," 83 but he maintained that the new regulations were

a great improvement over the old and that they provided "more for our Corps

than we could get if we were a small, separate branch." It would appear

that there was some truth in each of these statements. The new regulations

gave official approval to a general principle for which the ADA was working,

but their practical effect was likely to be negligible. The right to present

dental problems to the commanding officer, for instance, meant little as long

as the surgeon had to be consulted and as long as the latter initiated efficiency

reports on the dental surgeon. (The dental surgeon made out the reports for

his officers, but his own efficiency report was made out by his immediate superior, the surgeon.) Only a very intrepid dental surgeon would insist on

taking a recommendation to the post commander against the expressed opposition of the surgeon when the latter would subsequently report on the dental

surgeon's efficiency, including his "cooperativeness," during the year.

At the end of hostilities it appeared that the ADA and the Army would

not be able to come to a voluntary agreement concerning changes to be made

in the status of the Dental Corps, and the former went ahead with its earlier

plan to attain the desired objective through legislation.84

80 See footnote 60, p. 15.

« AE 40-15, 8 Äug 45.

8a Editorial: New regulations for the Army Dental Corps. J. Am. Dent. A. 32: 1290-1291, 1

Oct 45.

8S See footnote 61, p. 15.

84 The legislation sponsored by the ADA in the postwar years of 1946-48 designed to change the

status of the Dental Service failed of enactment. On 27 September 1948, however, a revision of AR
DEVELOPMENT OP THE DENTAL SERVICE 21

During the above period, however, other legislation which proposed the

removal of the command restriction provision of the law of 1911,85 a limitation which had not been placed on the Medical Administrative, Pharmacy,

Veterinary, or Sanitary Corps, was approved by The Surgeon General and The

Adjutant General. On 29 June 1945, an act was passed to grant dental officers

the same command privileges enjoyed by other officers of the Medical Department.86 While passage of this legislation did not affect the provision of Army

regulations that only Medical Corps officers might command organizations

dealing with the treatment, hospitalization, or transportation of the sick or

wounded,87 it did make dental officers eligible for administrative positions which

had previously been closed to them for what seemed to be inadequate reasons.

40-15 authorized many of the modifications which had been recommended by the ADA and by dental

officers. This revision promised much for long-term improvement in the operation of the Dental

Service.—Ed.

85 See footnote 6, p. 2.

86 Public Law 94, 79th Cong., 29 June 1945.

w AR 40-10, par 2, 17 Nov 41.
CHAPTER II

Administration of the Dental Service

WORLD WAR I

Until World War I, no representative of the Dental Corps had been assigned for duty in The Surgeon General's Office (SGO). The affairs of

the Dental Corps prior to this time had been administered as part of the routine

work of the Personnel Division, SGO. However, on 9 August 1917 the Dental

Section of the Personnel Division was organized, and Major William H. G.

Logan, MC, was appointed as its first chief. Major Logan, who later became

colonel, had both the D.D.S. and M.D. degrees. The Dental Section became

the Dental Division on 24 November 1919.12

The following dental officers have served as Chief of the Dental Section

or Director of the Dental Division, SGO, from 1917 to 1942:

Colonel W. H. G. LOGAN 1917-1919

Lieutenant Colonel F. L. K. LAFLAMME 1919

Colonel EOBEET T. OLIVER 1919-1924

Colonel E. H. EHOADES 1924-1928

Colonel J. E. BERNHEIM 1928-1932

Colonel E. H. EHOADES 1932-1934

Colonel FRANK P. STONE 1934-1938

Brigadier General LEIGH C. FAIRBANK31938-1942

WORLD WAR II

Dental Division, SGO

During World War II, Army regulations prescribed that "matters relating to the dental service as a whole are administered by The Surgeon General

with the advice and assistance of the Dental Corps assistant to The Surgeon

General." In 1939 the duties of the Director of the Dental Division were

described as follows:4

The Dental Corps assistant to The Surgeon General will serve as the Chief of the

Dental Division of The Surgeon General's Office and will be responsible to that officer

1 Lynch, C, et al.: The Medical Department of the IT.. S. Army in the World War. Washington,

Government Printing Office, 1923, vol I, p. 191.

2 Logan, W. H. G. : The development of the dental service of the United States Army in this

country from 8 Apr 17 to 12 Feb 19. J. Am. Dent. A. 20 : 1951-1959, Nov 1933.

3 The rank of brigadier general in the Dental Corps was authorized by Public Act 423, 75th

Congress, 29 Jun 38.

äAR 40-15, 20 Apr 39.
ADMINISTRATION OF THE DENTAL SERVICE 23

for the recommendation of plans and policies for the progressive development of the

dental service, with special reference to measures for the preservation of the general

health of the Army by the prevention and control of dento-oral diseases and deficiencies

among persons subject to military control; for advising measures to place approved

plans and policies into effect; and for giving technical advice to The Surgeon General

on all matters pertaining to the dental service.

The Director of the Dental Division,5as an adviser to The Surgeon General, thus had no formal authority in his own right. His recommendations

were subject to The Surgeon General's approval and he could not present his

views directly to higher officers. But while the Director of the Dental Division

exercised very little legal authority over the operation of the Dental Service,

his advice on purely dental questions was accepted so routinely that from a

practical point of view he enjoyed a substantial measure of actual control over

the Dental Corps and its activities (figs. 1,2, and 3).

The decision of the Director of the Dental Division was therefore generally

accepted on the following matters which were of little concern to other

agencies:6

1. The assignment of individual dental personnel to subordinate major

commands. [He could not, however, control the assignment of dentists to specific posts or duties within those commands except in the few installations

directly under the control of The Surgeon General.]

2. The selection of items of dental supply for listing in the medical supply

catalog.

3. The development of courses of training for dental personnel, within

time limits prescribed by higher authority.

4. The establishment of professional standards of dental treatment.

5. Professional requirements for commission in the Dental Corps.

6. Types of treatment to be authorized.

However, as a subordinate of The Surgeon General the Director of the

Dental Division could exercise no powers not enjoyed by The Surgeon General

himself, and the latter's authority was by no means unlimited. The Surgeon

General exerted great influence in those matters which concerned the Medical

Department, but he had to defend his proposals against opposition from other

interested officials, and the right of final decision remained with the executive

branch in the person of the Commanding General, Army Service Forces; the

Chief of Staff; or the Secretary of War. Thus when The Surgeon General

B The Director of the Dental Division at the start of the war and during the early mobilization

period was Brig Gen Leigh C. Fairbank. At the end of his tour of duty on 17 Mar 42, General Fairbank was succeeded by Brig Gen Robert H. Mills. The latter was promoted major general on 7 Oet 43,

becoming the first dental officer to hold that rank. When General Mills retired on 17 Mar 46 his

responsibilities for postwar policies and development were assumed by Brig Gen Thomas L. Smith

(later Maj Gen) who had been dental surgeon of the European theater during the combat period.

6 The practical authority of the Director of the Dental Division was based on custom rather than

upon statute, and its extent is therefore a matter of opinion, not subject to documentation. The

statements made here are based on personal conferences with Major General Mills and with most of

the other senior dental officers who served in the Dental Division during the war.

330324 0—55 3
24 DENTAL SERVICE IN WORLD WAR II

\^'W- -J

^Vv

tx'%?««

Figure 1. Brig. Gen. Leigh G. Fairhank, Director, Dental Divisio-n, 11 March 1938-

16 March 1942.
ADMINISTRATION OF THE DENTAL SERVICE 25

Figure 2. Ma}. Gen. Robert H. Mills, Director, Dental Division, 17 March 1942-

16 March 1946.
26 DENTAL SERVICE IN WORLD WAR II

•9-i

$Sl

Figure 3. Brig. Gen. Thomas L. Smith, Director, Dental Division, 11 March 1946-

20 April 1950.
ADMINISTRATION OF THE DENTAL SERVICE 27

recommended, on the advice of the Director of the Dental Division, that dental

officers be furnished tactical units in a ratio of 1 officer for each 1,000 men, he

was overruled when tactical officers convinced the Chief of Staff that such action

would add too much to the noncombat overhead of the fighting commands.

Similarly, the recommendations of the Director of the Dental Division were

given serious consideration, though not always accepted, on the following matters which affected the Dental Service:

1. De'ntal standards for military service.

2. Personnel requirements for the Dental Service.

3. Tables of organization and equipment for dental installations.

4. Dental reports and records.

5. Plans for dental installations.

6. Personnel authorized to receive dental care.

When the United States entered the war, the Director of the Dental Division, then a brigadier general, was responsible directly to The Surgeon General. He was assisted by a staff of 5 officers and 8 civilian employees. The

Dental Division was divided into sections for Finance and Supply, Military

Personnel, Plans and Training, and Statistics, with the following assigned

responsibilities:7

Executive Officer:

a,. Supervision of mail and records.

b. Eeview and recommendations of action on inspection reports.

c. Selection and assignment of dental interns.

d. Coordination of subdivisions of the Dental Division.

Finance and Supply:

a. Recommendations on selection and distribution of dental equipment

and supplies.

b. Eecommendations on matters pertaining to construction and al-'

teration of dental installations.

c. Eecommendations on claims for dental attendance.

Military Personnel :

a. Initiation of recommendations to the Personnel Division, SGO, for

assignment and transfer of dental personnel.

b. Transcription and review of efficiency reports.

c. Classification of personnel.

d. Eeview of applications for commission in the Dental Eeserve Corps.

e. Examination of models of teeth and decisions as to dental qualifications.

7 Organization of the Dental Division during the war was very informal and subject to change

on short notice in accordance with the number and experience of the assigned personnel. Three days

after this organization was outlined Brig Gen Leigh C. Fairbank described five sections in the Dental

Division: (1) Personnel, (2) Professional Service, (3) Plans and Training, (4) Statistical, (5)

Miscellaneous.
28 DENTAL SERVICE IN WORLD WAR II

Plans and Training:

a. Preparation of manuals and films for training dental service personnel.

b. Preparation of administrative regulations pertaining to the Dental

Service.

Statistics:

a. Collection of historical data on organization and functioning of the

Dental Service.

5. Eeview of articles for publication and editing of Army Dental

Bulletin.

c. Eeview of professional reports.

d. Tabulation of statistical data.

By 30 June 1942 the staff of the Dental Division had reached its maximum

strength of 7 officers (including the Director) and 13 civilian employees. The

internal organization of the Division underwent several changes during the

war, butthey were of a minor nature.8

With the reorganization of the Army in March 1942 9all service and

supply branches were placed under a newly formed "Services of Supply"

(SOS), later called "Army Service Forces" (ASF). Under this plan The

Surgeon General was made responsible to the Commanding General, SOS,

rather than to the Chief of Staff, and medical affairs had to be cleared through

ASF headquarters. Major dental policies therefore had to be passed upon

by (1) The Surgeon General, (2) the Commanding General, ASF, and (3)

the General Staff, before they could be made effective. The formation of ASF

also proved to be the first step in a general decentralization of authority to the

corps areas (later the service commands), a policy which ultimately affected

the operation of the Dental Division to a marked degree. Previously, The

Surgeon General had had considerable control over the field performance of

medical activities, including the immediate supervision of general hospitals

and the privilege of assigning personnel to specific installations. In the Annual Eeport of Army Service Forces for 1943 it was stated that "With the creation of the Service Commands in July 1942, the Administrative Services, for

the most part, ceased to have direct control over the field performance of their

particular activity. Instead, responsibility . . . was invested in the hands of

Service Commanders." 10 The Surgeon General was thus limited to prescribing

general policies for the Medical Department, the application of which became

the responsibility of service commanders. The control of general hospitals

was delegated to the service commands in August 1942.11

«Final Rpt for ASF, Logistics in World War II. HD : 319.1-2 (Dental DivH

9 WD Cir 59, 2 Mar 42.

10 Annual Report of the Army Service Forces for the fiscal year 1943 (cited hereafter as Annual

Report . . . Army Service Forces).

" AR 170-10, par 6, 10 Aug 42.
ADMINISTRATION OF THE DENTAL SERVICE 29

The service commands were also given increasing authority over personnel. The system of "bulk allotment," in particular, practically ended any

control The Surgeon General or the Dental Division might have exercised over

the assignment or promotion of dental officers within the service commands.

This system has been described as follows: "

Under the system a . . . Service Commander is allotted a total number of officers,

nurses, warrant officers, WAAC officers, enrolled women, and enlisted men, restricted

only as to percentage in grade, or in small installations, numbers in grade. ... It

removes restrictions upon the distribution of grades among the personnel of the

several arms or services, while preserving the limitations upon the distribution of

grades within the total organization.

This policy of decentralizing the control of personnel to the service commands

relieved the Dental Division of much routine detail which could be handled

more efficiently locally, but it also made the correction of inequities more

difficult when these were found to exist.

On 26 March 1942, the Dental Division was redesignated the "Dental

Service." 13 This change was mainly a "paper transaction" and had no appreciable effect on the operations of the Dental Corps. On 1 September 1942,

however, a modification was announced which had more far-reaching results.

Up to this time the Dental Division had been an independent branch of the

Office of The Surgeon General, and its director had had direct access to that

official. Now the Dental Service was placed, with a number of other medical

specialties, under a newly organized Professional Services group. The Director of the Dental Division no longer had direct access to The Surgeon General,

and all the many decisions affecting some 15,000 officers had to be passed on

by at least three higher officers, and usually four, before they could be put

into effect." This was not an altogether new experiment since the Dental

Division had been placed under Professional Services in 1931,15 but it had

been found advisable to restore its independent status in 1935.16 The Director

of the Dental Division stated that during the war "The Dental Corps experienced greater administrative difficulties while under Professional Service, since

all recommendations and activities had to be cleared through that Service to

The Surgeon General. Such clearance through Professional Service required

too much time when time was at a premium." 17 The Dental Division was

restored to its independent status on 25 August 1944.18

The Director of the Dental Division claimed repeatedly that there was

great need for representation by dental officers in other divisions of the SGO

dealing with matters affecting the Dental Service. He stated that "The

ASF Cir 39, 11 Jim 43.

"Annual Report . . . Surgeon General, 1942. Washington, Government Printing Office, 1942.

" SG OO 340, 1 Sep 42.

15 Annual Report . . . Surgeon General, 1932. Washington, Government Printing Office, 1932.

18 Annual Report . . . Surgeon General, 1936. Washington, Government Printing Office, 1936.

17 See footnote 8, p. 28.

18 SG OO 175, 25 Aug 44.
30 DENTAL SERVICE IN WORLD WAR II

Dental Corps ... is vitally interested in all personnel problems, all supply

problems, all operations and planning, as well as all training problems," and

he recommended that dental officers be placed in the divisions occupied with

these activities.19 Under the stress and confusion of wartime it was very

difficult to keep informed of impending actions or changes of policy unless

close liaison were maintained. A dental officer was actually assigned to the

Supply Division from November 1942 to March 1943.20 Later, in May 1943,

representation was established in the Military Personnel Division and continued for the duration of the war.

DENTAL ADMINISTRATION IN CORPS AREAS

(SERVICE COMMANDS)

The administrative status of the senior dental officer in a corps area

(service command after 22 July 1942) was analogous to that of the Director

of the Dental Division in the War Department. The corps area commander

had full executive authority, while the surgeon was his adviser on matters

concerning the Medical Department. The dental surgeon was, in turn,

charged with furnishing "advisory and administrative assistance to the corps

area surgeon on matters pertaining to the dental service in the corps area."21

Specifically, he made recommendations concerning allotments and assignment

of enlisted men and officers, the proper issue and use of dental supplies, the

adequacy of contemplated construction of dental facilities, the training program for dental officers and enlisted personnel, and the publication of orders

concerning the Dental Service. The corps area dental surgeon could not issue

orders in his own name, but submitted his problems to the corps area commander through the surgeon.

Like the Director of the Dental Division in the SGO, the corps area

dental surgeon exercised considerable influence over the actual operation of

the Dental Service in spite of formal limitations on his authority. His recommendations were normalty accepted without question in respect to:22

1. The assignment of officers to subordinate installations, within the

authorized total strengths.

2. The authorization of equipment and supplies for dental installations.

3. The operation of central dental laboratories and the dental services

of general hospitals.

4. The construction of dental facilities.

M

See footnote 8, p. 28.

20 WD SO 300, par 10, 4 Nov 42.

21 See footnote 4, p. 22.

22 Statements concerning the powers of corps area dental surgeons are of course not applicable to

all service commands at all times.. Some dental surgeons enjoyed greater authority, some less. The

summary given here represents only the combined opinions of many senior dental officers interviewed

during the war.
ADMINISTRATION OF THE DENTAL SERVICE 31

5. Directives concerning clinical treatment.

His advice concerning the following was considered seriously, but not

necessarily accepted if opposed by other staff divisions:

1. Total requirements for enlisted and commissioned personnel.

2. Allotments of personnel for training.

3. The promotion of dental officers.

At the start of the war general hospitals were operated directly under

The Surgeon General, but after August 1942 they became the responsibility

of the service command surgeon, and the service command dental surgeon

exercised more or less direct control over their dental services.23 Central

dental laboratories were operated under corps area and later, service command,

supervision during the entire war.

Prior to October 1940 the duties of corps area dental surgeons were performed, in addition to their normal functions, by senior dental officers assigned

in the vicinity of corps area headquarters,24 though it was provided that full

time officers would be assigned in time of war. Dental surgeons were specifically assigned to the corps areas beginning in October 1940, and a revision

of Army regulations in December 1942 provided for routine peacetime assignment of service command dental surgeons.25

The Director of the Dental Division believed that service command dental

surgeons were somewhat hampered by their lack of direct contact with other

staff divisions. They could present their views only through the surgeon,

and they received only the information relayed to them by that officer. The

Director of the Dental Division reported that service command dental

surgeons were limited in their authority and that they had insufficient assistance to enable them to perform their office duties and at the same time maintain

the necessary supervision in the field.26

DENTAL SECTION OF THE AIR SURGEON'S OFFICE,

ARMY AIR FORCES27

Prior to 28 January 1942, dental affairs in the Office of the Air Surgeon

had been administered by the particular division most concerned, i. e., personnel affairs by the Personnel Division, et cetera. On that date a Dental Section was established and Lieutenant Colonel George K. Kennebeck was assigned

as Deputy for Dental Service.28 The need for dental representation in the

Office of the Air Surgeon had been pointed out by the Dental Division in Sep03 See footnote 11, p. 28.

24 See footnote 4, p. 22.

* AR 40-15, 28 Dec 42.

» See footnote 8, p. 28.

w Kennebeck, George R.: Dental service of the Ü. S. Air Forces. Mil. Surgeon 101: 385-392.

Nov 1947. (A more complete history of the Air Force Dental Service was (Jan 48) being written by

Lt Col Walter J. Reuter.)

as WD SO 2, par 16, 2 Jan 42.
32 DENTAL SERVICE IN WORLD WAR II

tember 194129but action was delayed by the opposition of the Air Surgeon

himself.30 The new Dental Section assumed staff functions for that part of

the dental service assigned to the Air Forces not in theaters of operations.

The Dental Division, SGO, continued to prescribe general policies and procedures applicable to the Army Dental Service as a whole, but it no longer

acted on those problems peculiar to the Air Force. The functions of the new

division were specifically outlined as follows:

1. Eeview reports of dental activities with the Army Air Forces.

2. Keview articles submitted by dental officers with the Army Air Forces

prior to publication in professional journals.

3. Initiate timely recommendations for changes in types and allowances

of dental supplies and equipment.

4. Make recommendations to the Officers' Section, Personnel Division, regarding assignment, reassignment, and promotion of dental officers with the

Army Air Forces.

5. Exercise professional supervision over dental personnel with the Army

Air Forces.

The Air Surgeon's Office did not directly control the dental services with

Air Force units in theaters of operation; these were under the supervision

of theater chief surgeons. However, Air Force commands in foreign theaters

did have dental staff officers who were responsible for the dental service of

air units, under the theater chief surgeons. Dental personnel for the Air

Force were commissioned by the Army and requisitioned as needed from The

Surgeon General.

ADMINISTRATION OF THE DENTAL SERVICE

IN CAMPS AND STATIONS

In subordinate installations in the Zone of Interior the senior medical

officer retained his status as adviser to the commanding officer, but he usually

became commander of the hospital or dispensary as well, thus exercising control not only over the making of policies, but over their direct application

at the operational level. The dental surgeon, on the other hand, did not

become commanding officer of the dental clinic, and legally he continued to

enjoy only the right to make recommendations to the surgeon concerning the

dental service. In practice he might be delegated almost complete authority

by the latter, but such authority was a privilege, not a right, and it varied

widely in different installations.

The dental surgeon of a camp or station generally had reasonably effective control over the following activities:

» Memo, Brig Gen Leigh C. Fairbank for SG, 25 Sep 41, sub: Dental Service for the Air Corps.

SG: 703.-1.

«o Memo, Col David N. W. Grant for Exec Off SGO, 1 Oct 41, sub : Dental Service for the Air

Corps. SG: 703-1.
ADMINISTRATION OF THE DENTAL SERVICE 33

1. The assignment of dental enlisted and commissioned personnel to duties

within the dental clinic.

2. The supervision of treatment given. Army regulations provided that

"except as otherwise prescribed herein, the selection of professional procedures

to be followed in each case, including the use of special dental materials, will

be left to the judgment of the dental officer concerned."31

3. Initiation of requisitions for supplies for the dental service.

4. The conduct of dental surveys.

5. The technical training of personnel assigned to the dental service.

His recommendations were customarily given serious consideration in respect to the following, but they were not always accepted, and under unfavorable circumstances they might practically be ignored:

1. Requirements for dental personnel or facilities.

2. Promotion of personnel assigned to the dental clinic.

3. Leave or furlough privileges for personnel of the dental service.

4. Efficiency reports on dental personnel.

The dental surgeon often had little to say about the following:

1. The use of clinic personnel for duties outside the dental clinic.

2. Training of dental personnel, outside of training rendered in the

dental clinic.

ADMINISTRATION OF THE DENTAL SERVICE,

ARMY GROUND FORCES

When the Army Ground Forces (AGF) was established in 1942 as a

separate command of the Army no provision was made for a complete medical

staff. A small division for Hospitalization and Evacuation was included

in Headquarters, AGF, but it was expected that most medical functions would

be performed by The Surgeon General. No dental officer was assigned to

AGF headquarters. Under The Surgeon General, the Dental Division had

authority to prescribe policies for the entire Army, including AGF and Army

Air Forces (AAF), but operation of the Dental Service for such a large

part of the Armed Forces inevitably involved emergency situations requiring

immediate action. Lack of liaison with AGF headquarters delayed solution

of some of these problems and increased the difficulty of arriving at decisions

based on full and accurate information. An attempt was made to have a

dental officer assigned to AGF in the spring of 1945, but it met with no

success. The Director of the Dental Division later claimed that lack of

liaison with AGF had hampered the Dental Service significantly.32

31 AR 40-510, par 1, 19 Feb 40.

32 See footnote 8, p. 28.
34 DENTAL SERVICE IN WORLD WAR II

ADMINISTRATION OF THE DENTAL SERVICE

IN A THEATER OF OPERATIONS33

A theater dental surgeon made recommendations to the theater chief

surgeon concerning plans and policies for the dental service of the entire area,

including the Air Forces. He advised in respect to requirements for supplies

and personnel; he consolidated and forwarded dental reports for the theater;

and he made the inspections required to assure a high standard of dental care

in compliance with the directives of his own and higher headquarters. The

theater dental surgeon was also, very often, the dental surgeon of the communications zone and in that capacity he supervised the operation of the hospital dental services in that communications zone, the dental treatment of

service personnel, and the operation of central dental laboratories.

Theaters necessarily enjoyed considerable independence of action, and the

theater dental surgeon, under the chief surgeon, had a great deal of freedom

in planning for the dental service, as long as personnel allotments were not

exceeded and major regulations and policies were not violated. As in other

headquarters, however, he was subordinate to the theater chief surgeon and he

could act only with the approval of that officer.

83 See chapter VIII.
CHAPTER III

The Procurement of Dental Officers

PROCUREMENT IN WORLD WAR I

At the time of the armistice, World War I, the strength of the Dental

Corps totaled 6,284 officers. Not all of these had been called to active duty

however, and the maximum number actually functioning with the Corps at

any one time was 4,62G.1 As nearly as can be determined, a little over 1,500

additional dentists who did not serve in their professional capacity were in

the land forces as enlisted men.2The Navy Dental Corps expanded from a

total of 30 dental officers at the outbreak of hostilities to over 500 by the end

of 1917,3but the number of dentists serving as enlisted men in that organization is not known.

The Army, alone, enlisted or inducted 1,789 dental students, and the schools

were so depleted that only 906 dentists graduated in 1920 as compared with

3,587 the year before.4

At the start of World War I, dentists were provided in an overall ratio

of 1 officer for each 1,000 troops, but this figure proved so inadequate that on 30

September 1918 an increase to 2 dentists for each 1,000 men in the continental

United States was authorized, and the allowance for hospitals was fixed at 3

officers for each 1,000 beds.5The war ended, however, before these ratios could

be placed in effect. In 1919 the War Department supported a bill to provide 1

dentist for each 500 men in the peacetime establishment, but in spite of the

backing of The Surgeon General and the Secretary of War this legislation

failed to pass.6

The grades held by Army dentists at the end of the war were as follows:7

Colonel - 9 (0.2 percent)

Lieutenant colonel 17 (0.4 percent)

1 Annual Report . . . Surgeon General, 1919. Washington, Government Printing Office, 1919,

vol. II.

a Ibid. 3 Annual Report of The Surgeon General, TJ. S. Navy, 1918. Washington, Government Printing

Office, 1918. 1 Homer, Harlan H.: Dental education and dental personnel. J. Am. Dent. A. 33 : 872, Jul 1946.

6

See footnote 2, above.

«Colonel Logan's Farewell Letter to the Dental Corps. J. A. Mil. Dent. Surg. ü. S. 3 : 78-80,

Apr. 1919.

7 See footnote 1, above.
36 DENTAL SERVICE IN WORLD WAR II

Major , 91 (2.0 percent)

Captain 292 (6.5 percent)

Lieutenant 4,101 (90.9 percent)

THE DETERMINATION OF REQUIREMENTS FOR

DENTAL OFFICERS, WORLD WAR II

Experience Prior fo World War II

In the decade preceding the Second World War, the average civilian

dentist was responsible for about 1,800 persons, including infants and the

aged who required little or no attention, though the ratio varied from approximately 1: 500 in certain urban centers to less than 1: 5,000 in some rural

districts.8 9 Dental care for the civilian population was notoriously deficient.

It was freely admitted that not over 25 percent of the public received the care

needed to preserve dental health,1011 and representatives of the dental profession estimated that it would require 1 dentist for each 524 persons just to

provide annual maintenance treatment, with no attempt to correct old, accumulated defects. It was further estimated that the fantastic figure of 1

dentist for each 295 persons would be needed to rehabilitate the entire population in one year. These figures had little significance in determining dental

officer requirements for a military population for the following reasons:

1. While the average civilian dentist actually saw only about 400 patients

a year, many of them received nothing but emergency treatment.1213 However, all of the military dentist's patients, regardless of the number, were in

the age group needing constant and extensive care.

2. The stresses of military life required that the soldier have a higher

level of dental health than his civilian contemporary.

3. The military dentist inevitably lost more time from professional duties

than the civilian dentist: he had to devote more time to training for purely

military functions, and his work was interrupted by maneuvers and tactical

exercises.

Prewar military experience failed equally to provide an answer to the

requirement problem. In the years between 1920 and 1939 the inadequate

1:1,000 ratio of World War I was liberalized somewhat, but it never exceeded

1.44 per 1,000 troops, as indicated in the following tabulation:14

8 See footnote 4, p. 35.

9 Bagdonas, Joseph B.: Economic considerations in reestablishing a dental practice. J. Am.

Dent. A. 33 : 4-2,0, Jan 1946.

m Morey, Lon W.: Dental personnel. J. Am. Dent. A. 32 : 131-144, Feb 1945.

n

Dollar, Melvin L.: Dental needs and the costs of dental care in the United States. 111. Dent.

J. 14 : 185-199, May 1945.

12 See footnote 4, p. 35.

'

3

See footnote 9, above.

" Memo, Col Albert G. Love for SG, 2 Oct 39, sub : Allowance of medical and dental officers. [D]
THE PROCUREMENT OF DENTAL OFFICERS 37

Number of Authorized

officers ratio per

Date authorized 1,000

4June 1920 298 1.00

30 June 1922 158 1. 08

15 May 1936 183 1. 26

29 January 1938 258 1. 44

3 April 1939 *316 1. 39

•This authorized strength was not reached prior to the war, and there were only about 269 dentists in the Regular

Army Dental Corps in April 1942.

Based on the estimation that a proportion of 1 dentist for each 524 persons

would be required just to provide maintenance care, it is not surprising that

the cited peacetime authorizations proved inadequate. In 1928, when the

ratio was approximately 1 dentist per 1,000 personnel, the Director of the

Dental Division, SGO, reported that:15

... a one to 1,000 proportion of dental officers to total strength is quite insufficient.

Dental diseases in our Army have been, and ... are today out of control. There

is a limit beyond which it is impossible to go without more personnel. We are today

approaching that limit, and about 50 percent remain who are continually in need of

dental service.

In 1941, at a hearing before the Committee on Military Affairs, Brig. Gen.

Leigh C. Fairbank 16 testified that even under peacetime physical standards a

1: 750 ratio had also fallen short of minimum needs.

By the start of the Second World War, therefore, experience had shown

that any ratio of less than 1 dental officer for 750 men would be grossly inadequate, but since more liberal ratios had not been tried in practice experience

was of little value in predicting the need for dental officers for the defense

forces.

Estimates Based on Actual Requirements

for Dental Treatment

Had it been known exactly how much work the average wartime inductee

would require it would have been possible to calculate the number of dental

officers needed at any stage of mobilization. Were it known, for instance,

that each new man would require 7.2 hours of treatment for the correction of

old, accumulated defects, and 1.8 hours of treatment each year thereafter for

regular maintenance care, the needs of a static force of 1,500,000 men, with a

yearly turnover of 25 percent, could have been determined as follows:

Hours

1.8 hours of care for 1,500,000 men (annual maintenance) 2,700,000

7.2 hours of care tor 375,000 recruits (rehabilitation) 2,700,000

Total 5,400, 000

Number of dentists needed 3,000 (1 per 500 men)

M Rhoades, R. H.: The Dental Service of the Army of the United States. J. Am. Dent. A. 15:

257-264, Feb 1928.

" Testimony, General Fairbank, 18-20 Mar 41, in Ü. S. Senate Hearings before Committee on Mil

Affairs, S. 783, p. 161.
38 DENTAL SERVICE IN WORLD WAR II

In this case, which might approximate actual conditions in a peacetime force

if dependents received no care, a ratio of 1 dentist for each 500 men would

prove adequate.

However, if this hypothetical force were to be increased by nearly 4,000,000

men in one year as occurred in the United States Army in 1942, the situation

would be far different. Total needs would then be as follows:

Hour»

1.8 hours of care for 3,500,000 men (average strength during year) 6, 300, 000

7.2 hours for 4,000,000 men (recruits) 28,800,000

Total 35,100,000

Number of dentists needed 19,500 (1 per 180 men)

In this situation, which also might approximate actual conditions during mobilization, the ratio which was adequate for the static force would provide only

about 36 percent of the dentists needed by the expanding Army. Later, however, after this augmented force reached stability, the need for dentists would

again be met by the 1:500 proportion, or by an even lower ratio.

Unfortunately, reliable information on which to base actual calculations

of requirements for dental personnel was entirely lacking at the start of World

War II. The figures used in the preceding illustration are only convenient

approximations, useful for the development of a general principle. In chapter VI it is shown that almost no data on the dental condition of males of military age were available when plans for the mobilization of the emergency dental service were being laid.

Even if dental needs were known with considerable accuracy, it would generally be impossible to procure and equip dental officers in strict accordance

with calculated needs. In Chart 1 the actual number of dentists on duty each

month of World War II is compared with the theoretical requirement for the

same period, based on the hypothetical figures used (1.8 hours for maintenance

care, 7.2 hours for rehabilitation). The curve on this chart which shows theoretical needs is of course not quantitatively accurate, but the wide fluctuations

which are its conspicuous feature would be found on any similar chart, regardless of the exact figures used, as long as the time required for rehabilitation of

new men greatly exceeds that required for annual maintenance. By comparison, the slowly rising curve of dental personnel on duty reflects a number of delaying factors which are likely to be operative in any emergency. The two

years from 1940 through 1941 represented a training period in which the immediate mobilization of a large force was not anticipated. With the start

of actual hostilities considerable time was required to commission the necessary

dentists, and through 1942 it was impossible even to equip fully all the dentists

actually in uniform.
THE PROCUREMENT OP DENTAL OFFICERS 39

8,000

•BASED ON 1.8 HOURS OF TREATMENT FOR YEARLY MAINTENANCE CARE

AND 7.2 HOURS FOR THE DENTAL REHABILITATION OF EACH INDUCTEE

CHART 1. COMPARISON OF THEORETICAL MONTHLY REQUIREMENTS FOR DENTAL OFFICERS

DURING WORLD WAR II WITH THE NUMBER ACTUALLY ON ACTIVE DUTY.

In contrast with the gradually rising curve of dental personnel on duty,

the curve of theoretical requirements fluctuates rapidly and within wide limits.

Nearly 30,000 dentists would have been needed late in 1942, when half a million

men were inducted in 1 month, while only 10,000 would have been needed less

than a year later, after the tempo of mobilization had slowed. To have procured, trained, and equipped 30,000 dentists in 1942, for only a few months work,

would have resulted in a gross waste of manpower and industrial capacity.

In most cases it will probably be found impractical or impossible to call to duty,

to meet peak requirements, a number of dental officers greatly exceeding the

number which will be needed when relative stability has been reached, regardless of calculated needs for short periods.

Nevertheless, reference to calculated requirements, even when based on

very incomplete information, may point out possible improvements in the

mobilization program. In particular, it will generally emphasize the desirability of building up the Dental Service as rapidly as possible after plans for

the augmentation of the Armed Forces are announced, regardless of fixed ratios

of dentists to total strength. In many respects the position of the Dental

Service is comparable to that of a training activity. If several hundred

thousand men are to be "processed" each month the necessary training centers

330324 0—55 4
40 DENTAL SERVICE IN WORLD WAR II

must be established in advance of the influx, not built up gradually on the

basis of some fixed ratio of training personnel to the number of troops already

in uniform. Similarly, the Dental Service should be in maximum practical

operation at the start of a period of expansion, ready to care for inductees

as they pass through the training camps; if, however, the rate of mobilization

of dental facilities is gauged to maintain some fixed ratio of dental officers to

total Army strength, the necessary men and equipment will be available only

at the end of the influx, after most inductees have already completed their

training and have been assigned to tactical units. This situation will occur

regardless of how liberal the accepted ratio may be.

It has already been pointed out that it will generally be impracticable to

mobilize the full facilities needed to meet temporary peak demands; it is also

possible that personnel and supply difficulties will hinder or prevent the early

establishment of dental clinics in the future as they have in the past. These

facts should not obscure the validity of the general principle that, when a

major augmentation of the Armed Forces is imminent, the Dental Service

should be built up to the total strength which will ultimately be required, as

rapidly as may be possible under the circumstances existing at the time. At

the start of World War II, for instance, it was patently impossible and undesirable to provide the 30,000 dental officers who might have been used in 1942.

Further, it would have been impossible to equip such a number of dentists even

if they could have been obtained. But 15,000 dentists were ultimately mobilized, and 10,000 were on duty by the end of 1942, while the average strength

of the Dental Corps for that year of expansion was only about 6,000 officers,

and only about 3,000 were available at the start of the year. It must be admitted that no improvement in the rate of mobilization of dentists was possible

under conditions existing in 1942, but it is equally true that the 1:500 ratio

of dentists to total strength, which was maintained fairly well, fell far short

of meeting dental demands during that year. Further, if it had been possible

to place on duty in May or June of 1942 the 10,000 dental officers who were

working in Army clinics in December, the problems of the Dental Service

would have been reduced materially.

Reference to calculated requirements for dental treatment will also reveal

not only that the application of a fixed ratio of dentists to total strength tends

to delay the mobilization of dental facilities, but that it fails to consider the

primary factor in determining how many dentists will be required—the rate

of flow of inductees. This weakness is of course based on the fact that treatment for old, accumulated dental defects has been, and may be expected to be,

greatly in excess of requirements for yearly maintenance care. If only maintenance treatment were needed by inductees the amount of that treatment would

be directly proportional to the number of men in the service, and a fixed ratio
THE PROCUREMENT OF DENTAL OFFICERS 41

of dentists to total strength, based on past experience, would be satisfactory.

But when several times as many hours are necessary for the dental rehabilitation of an inductee as will be required for annual maintenance each year thereafter, the first consideration is not likely to be "how many troops are in the

Army?" but "how many new men will be inducted during the year?" Thus,

in the discussed hypothetical illustration, the ratio of dentists which met all

needs of a static force broke down completely when applied to an expanding

organization. These weaknesses of the method of fixing dental personnel on

the basis of an established ratio in a time of emergency do not mean that such

a ratio may not represent the maximum number of dentists that may be available, or that it may not be valuable as an indication of how many dentists will

be required after stability has been reached. They do indicate, however, the

need for a critical evaluation of any proposed ratio in the light of the actual

probable demand for treatment whenever a major mobilization is planned.

It is possible, of course, that future developments in methods of waging

war may alter the mission and function of the medical services even to the

point of placing first emphasis on the care of the civilian population.

Limitations on the Number of Dentists

Available From Civilian Practice

During World War I only about 6,700 dentists were taken from private

practice and the effect on civilian dental care was scarcely noticed. Prior

to World War II very little thought had been given to the possibility that

the number of dentists who could be obtained for the Armed Forces was, in

fact, strictly limited. Nor did it seem probable that there might not be a

sufficient number of personnel left to care for the minimum needs of the

civil population.

The first attempt to determine how many dentists could be spared for

the Armed Forces was made in April 1941, when the American Dental Association (ADA) estimated that 21,000 dentists would fall within the draft age

and that only 6,700 of these would be eligible for induction.17 However, this

figure was based on induction criteria rather than on any survey of civilian

needs, and it was therefore subject to change as draft regulations were altered.

In June 1942, local complaints of shortages of dental personnel impelled

the Procurement and Assignment Service for Physicians, Dentists, and Veterinarians (PAS), of the War Manpower Commission (WMC), to sponsor a

general survey of dental manpower.18 This survey, which was carried out with

the assistance of the TJ. S. Public Health Service (USPHS), was completed in

17 Report of the Chicago meeting of the Committee on Dental Preparedness. J. Am. Dent. A. 28:

635, Apr 1941.

18 Minutes of the Directing Board, PAS, 22 Jun 42. On file Natl Archives, PAS, WMC.
42 DENTAL SERVICE IN WORLD WAR II

February 1943 and revealed the following situation (projected to the end of

1943) :

19

Dentists listed in the 1940 census 70,417

Graduates, 1940-1943 8, 928

Total 79,345

Losses by death and retirement, 1940-1942 3, 830

Dentists estimated to be in nonprofessional work with various essential

agencies 1, 021

Anticipated losses, 1943 1,624

Total 6,475

Remaining effectives, end of 1943 72, 870

PAS decided that a minimum of 1 dentist for each 2,500 persons should be

reserved for civilian care, or a total of 50,250 dentists for a civil population of

125,625,000. This left 22,620 dentists who could be utilized by the Armed

Forces, 11,617 of whom were already on active duty in the Army, Navy, and

Public Health Service.

The findings of PAS, that 1 dentist was required for each 2,500 civilians

and that 22,620 dentists could be made available to the military, were of course

open to question on theoretical grounds. In the absence of specific information

on the dental condition of the American public any such estimates were necessarily arbitrary and based on opinion rather than upon factual knowledge.

It could be pointed out, for instance, that even in peacetime many communities had never had more than 1 dentist for each 5,000 persons. Further, it was

obvious that PAS' ratio could not be applied uniformly since those regions

which had never approached the 1:2,500 ratio before the war could hardly

expect to receive additional dental personnel in a time of national emergency,

to bring them up to the authorized proportion. If these areas merely retained

their prewar ratios, and if all other districts were reduced to the recommended

quota, considerably more dentists would have been released for military service.

It was more difficult to criticize PAS' findings from the practical point of

view. No one could claim that a ratio of 1 dentist for 5,000 persons, or an

average per capita expenditure for dentistry of 9 cents a year, was adequate

for the maintenance of dental health; the fact that such conditions existed

in some unfortunate regions did not justify their extension to the entire nation.

And while neither PAS nor any other agency could state with certainty that

a given ratio of dentists was actually required for civilians, the Armed Forces

would have had equal difficulty in justifying any demand for an increased

allotment since the figure set by PAS gave them nearly one-third of the nations'

dentists for 12 million men, while only two-thirds were reserved for the remaining 125 million civilians.

» Minutes of Committee on Dentistry, PAS, 20 Feb 43. On file Nat! Archives, PAS, WMC.
THE PROCUREMENT OF DENTAL OFFICERS 43

Also, while many areas which had had less than 1 dentist for each 2,500

persons prior to the war would certainly have to continue with less than the

PAS "minimum" ratio, the number of additional dentists made available to the

military by this circumstance was very small due to peculiarities of distribution.

Dentists who were "excess" by the PAS definition were concentrated mainly

in the larger urban centers, and it was not feasible to take from 50 to 80 percent

of the men in practice in such cities as New York or Los Angeles to bring

those districts down to the recommended quota. A city of one million persons,

for instance, with a ratio of 1 dentist for each 1,000 individuals would have

1,000 dentists; of these, 600 would have to be taken into the Armed Forces to

reduce the proportion to 1 dentist for each 2,500 persons. But many of the

dentists in such a city would be too old for active duty, or physically disqualified for military life; others would be in essential occupations. The number

which would be accepted by the Armed Forces would in most cases be far below

the 600 which would theoretically be declared available. The only way in

which the remainder could be utilized would be to relocate them in less favored

districts to release younger men who would in turn be taken by the Army

or Navy. The alternative would be to leave a higher proportion of dentists

in centers which had normally enjoyed a high ratio in peacetime, offsetting

those regions which could not attain the 1:2,500 ratio.

In view of these considerations, the findings and broad recommendations

of PAS in respect to minimum requirements for civilian dental care must be

considered reasonable and justifiable, at least until such time as more definite

information is available concerning dental needs. When it is noted that the

Army and Navy, together, mobilized about 22,318 dental officers in the war

it is apparent that they were close to the bottom of the manpower barrel, and

that no significant increase in the overall ratio of dental officers to total strength

was possible. Any future mobilization plan must certainly recognize that the

essential, minimum needs of the civilian population must be met, and that the

supply of dental personnel is far from inexhaustible.

ACTUAL BASIS FOR DETERMINING DENTAL MANPOWER

REQUIREMENTS, WORLD WAR II

While formal requests for procurement objectives were generally brief,

with no discussion of the method of calculation, the ultimate goal of the Chief

of the Dental Division, SGO, and The Surgeon General was an overall ratio

of 1 dentist for each 500 men. Since information on the dental condition of

inductees was too meager to permit an accurate determination of the number

of dental officers needed to provide a calculated amount of treatment, it seems

probable that the 1: 500 ratio was based on one or more of the following

considerations:

1. When the 1:1,000 ratio proved grossly inadequate in World War I,

the 1: 500 proportion was authorized in Zone of Interior installations (except
44 DENTAL SERVICE IN WORLD WAR II

hospitals). Though this number of dental officers was not obtained before the

end of hostilities, the ratio had been approved by the Secretary of War and

the Chief of Staff, and it was probably given serious consideration by the

officers responsible for organizing the Dental Service in World War II.

2. Eatios of from 1:1,000 to 1: 700 had proved inadequate in peacetime and

a further increase to 1: 500 may have seemed to be the next logical step, especially

when dental standards for induction were being drastically lowered.

3. It is possible that a ratio of 1: 500 was considered the maximum which

would be approved by the General Staff, regardless of demonstrable needs.

While the ratio of 1 dental officer for each 500 troops would ultimately

have led to the mobilization of only a little more than the total number of

dentists which PAS had decided could be spared for the Armed Forces, there

is no evidence that this factor was originally considered in arriving at the

figure for the Army Dental Corps. The 1:500 ratio appears to have been

generally accepted during the early stages of the expansion of the defense

forces, when it was not expected that the Army would reach a strength where

its requirements for dentists would seriously threaten civilian practice. Virtual agreement between PAS and the Armed Forces in this case was apparently

a happy coincidence.

Col. Eobert C. Craven, who was responsible for personnel matters in the

Dental Division, SGO, during the early part of the war, stated that the 1: 500

ratio was first agreed upon informally between Brig. Gen. Leigh C. Fairbank,

Director of the Dental Division, SGO, and Brig. Gen. George F. Lull, Chief

of Personnel Services, SGO. When Brig. Gen. Eobert H. Mills became Director of the Dental Division, SGO, in March 1942 he attempted to have that

ratio officially recognized, but The Surgeon General felt that no definite

action should be taken until requirements were more clearly established.20

General Mills was assured, however, that he could procure all the dentists he

might need for corps area service commands, regardless of any fixed ratio,

and relying on that promise he relaxed his efforts to obtain formal approval

of the desired proportion.21 No further effort was made to have the 1:500

ratio recognized until near the end of hostilities, when postwar policies were

being considered. During the early part of the war, procurement objectives

seem to have been determined by informal agreement between the principal

personnel officers concerned, with the proportion of 1 officer for each 500 men

serving as a convenient, though unofficial, yardstick.22

In practice the 1: 500 ratio was attained only for very short intervals

during the war, and the average ratio over this period was 1 officer for 557

20 Memo, Brig Gen E. H. Mills for SG, 8 Apr 42, no sub. SG : 703.-1.

21 Proceedings of The Surgeon General's Conference with Corps Area and Army Dental Surgeons,

8-9 July 42. HD : 337.

22 The highly informal manner in which dental procurement objectives were established during the

war has been confirmed in personal correspondence and conversations between the author and Col

Robert C. Craven, Dental Div, SGO, and Maj Ernest J. Fedor, dental liaison officer with the Personnel

Service during much of the war.
THE PROCUREMENT OF DENTAL OFFICERS 45

men.23 Efforts to maintain the 1: 500 ratio were finally abandoned in September

1943, when ASF placed a ceiling of 15,200 officers on the Dental Corps.24

As the war progressed an effort was made to refine estimated requirements

for dental officers on a more definite basis than an overall ratio. In a memorandum from the SGO to ASF, dated 5 June 1944, analyzing the dental personnel situation, it was noted that anticipated needs had been calculated as

follows:25

1. For tactical units in the Zone of Interior and overseas, according to

authorized tables of organization.

2. For other Zone of Interior installations, on the basis of 1 dentist for

each 500 troops, except for replacement training centers and separation centers,

which were authorized 1 dentist for each 300 troops.

3. For general hospitals, according to tables published in War Department

Circular No. 209,26 May 1944.

4. Attrition was estimated at 50 officers monthly.

Tables of organization for tactical units mentioned in item 1 of the cited

memorandum were planned to provide an average of 1 dentist for each 1,200

men. Many adjustments were necessary before this general principle could

be applied to a host of smaller commands, and the results were sometimes

unsatisfactory (see discussion in chapter VIII), but at least these tables of

organization provided a means for calculating requirements for projected

combat forces on an exact, if arbitrary, basis.

The determination of requirements for dental officers in Zone of Interior

installations was more difficult. The following were some of the more

important problems involved:

1. While procurement was based on the general ratios outlined in item 2

of the cited memorandum, the number of dentists actually requisitioned by any

installations was established by the corps area commander, with the advice of

his staff and local officials. As a result, dentist-troop ratios might vary widely,

even in commands of the same general type. As early as December 1940, The

Surgeon General asked that mandatory tables of organization be set up for

the dental services of Zone of Interior camps and stations,26 but this request

was disapproved by The Adjutant General as being contrary to the policy of

23 Calculated by the author from data in the files of the Dental Div, SGO.

24 The manner in which the ceiling for the Dental Corps was established, and the exact date, is

not entirely clear. In a memorandum to the Deputy Surgeon General, of 7 Sep 43, Lt Col D. G. Hall

of the Personnel Service, SGO, stated that his office had "that day" been notified of a revised requirement based on changed plans in ASF. (Memo, Lt Col Durward G. Hall to Dep SG, sub : Revised

requirements for dental officers in the Army. SG : 322.0531.) Other incidental references indicate

that representatives of the Dental Division, the Military Personnel Division, SGO, and of G-l attended conferences on the matter before a decision was reached. It is also probable that PAS had a

hand in the matter, but the extent to which its influence affected ASF is not known.

25 Memo, Brig Gen R. W. Bliss for CG, ASF, 5 Jun 44, sub : Requirements for Dental Corps officers.

SG: 322.053-1.

26 Ltr, Col Larry B. McAfee to TAG, 10 Dec 40, sub : Personnel table, camp dental clinics. SG:

320.2-1.
46 DENTAL SERVICE IN WORLD WAR II

decentralizing all possible authority to subordinate facilities.2' Recommended

tables of organization for Zone of Interior installations were published from

time to time, but they were merely "suggestions" which could be ignored by

subordinate commands. In October 1943, the Director of the Dental Division,

SGO, noted that few service commands had requisitioned what was considered

an adequate number of dentists, and one service command had only 73 percent

of the recommended total.28

The first "recommended" allotment of dental officers to Zone of Interior

installations, published in December 1940, provided for 18 officers and 26 enlisted

men in each DC-1, and 11 officers and 17 enlisted men for each DC-2. These

clinics had 25 and 15 chairs, respectively, but it was anticipated that they would

be partially manned by tactical units in the Zone of Interior.29 In May 1944,

War Department Circular No. 209 recommended the following manning

levels:30

DC-1 25 officers 42 enlisted men

DC-2 15 officers 25 enlisted men

DC-3 8 officers 13 enlisted men

DC-4 3 officers 3 enlisted men

DC-5 1 officer 1 enlisted man

This directive also recommended that dental officers be assigned to general

hospitals as follows:

1,000 beds 7 officers

1,500 beds 8 officers

1,750 beds 9 officers

2,000 beds 12 officers

2,500 beds 14 officers

3,000 beds 16 officers

3,500 beds 19 officers

4,000 beds 21 officers

However, this publication failed to answer many questions, since it based its

recommendations on clinic types rather than on the number of troops served.

Thus a DC-1 might be found in a camp with 7,000 men or in a camp with 12,000;

obviously the dental needs of the two installations would not be identical.

An ASF circular of 16 October 1945 recommended that dentists be provided

Zone of Interior camps on the basis of 2 officers and 3 enlisted men for each

1,000 troops served, plus 1 officer and iy2 enlisted men for each 200 beds in the

station hospital.31 It further suggested specific grades and classifications for

both officers and enlisted men, as shown in Tables 1 and 2. The influence of

these recommendations on the determination of Zone of Interior dental allotments cannot be determined.

" (1) 1st ind, TAG, to footnote 26, 30 Dec 40. (2) See footnote 21, p. 44.

» Memo, Dir, Dent Div for Chief, Prof Serv, SGO, 1 Oct 43, no sub. SG : 703.-1.

28 See footnote 27, above.

30 WD Cir 209, 26 May 44.

» ASF Cir 389, 16 Oct 45.
THE PROCUREMENT OP DENTAL OFFICERS 47

2. It was difficult to predict the extent to which the dentists of tactical units

in training in the Zone of Interior could be utilized in camp clinics. For a

discussion of this problem see chapter VII.

3. The rate of attrition in the Dental Corps was not constant and it could

not be predicted with accuracy. During the early part of the war it was less

than had been expected, while later it was necessary to accelerate normal attrition to permit the replacement of older men with ASTP graduates.

TABLE 1. DENTAL OFFICERS RECOMMENDED FOB ZONE OF INTERIOR DENTAL CLINICS BY

ASF CIRCULAR NO. 389, 16 OCTOBER 1945

Grade Qualifications DC-l DC-2 DC-3 DC-4 DC-5

Dental staff officer _ 1

1

General 1 1 1

Oral surgeon_

Exodontist

1

1

2

1

19

1

Prosthodontist. _ 1

Periodontist

Captain or lieutenant -

Captain or lieutenant

Captain or lieutenant-.

General- 11 5

1

1

2 1

Exodontist __

25 15 8 3 1

TABLE 2. ENLISTED ASSISTANTS RECOMMENDED FOR ZONE OF INTERIOR DENTAL CLINICS

BY ASF CIRCULAR NO. 389, 16 OCTOBER 1945

Grade Qualifications DC-l DC-2 DC-3 DC-4 DC-5

AdministrativeAdministrative

1

1

Administrative. 1

Clerk -- 1

2

3

1

9

5

1

1

2

Technician, 3dgr -

Technician, 4th gr _.

Technician, 4th gr ..

Technician, 4th gr _.

Laboratory technician

Laboratory technician--

X-ray technician

Chair assistant1

1

5

3

1

9

1

3

1

1

5

1

Laboratory technician

X-ray technician. _

Chair assistant- 17

1

1

1

2 1

Supply clerk _

Basic - -

Basic _ - 1

Total enlisted men 42 25 13 3 1
48 DENTAL SERVICE IN WORLD WAR II

CHRONOLOGICAL PROGRESS OF THE MOBILIZATION

OF DENTAL OFFICERS

Table 3 shows the monthly procurement of dental officers for the period

1 January 1939 to 28 February 1946.32

Though tension in Europe mounted during the late 1930's, staff officers

responsible for the Army Dental Service showed little concern over dental

personnel problems. It was expected that the fully mobilized ground and air

forces would number only about 4,000,000 troops and that a ratio of 1.4 dentists

for each 1,000 total strength would be sufficient. This would provide for a

Dental Corps of 5,600 men.33 No difficulty had been experienced in obtaining

almost this number of dentists during World War I, even without the benefit

of a strong Organized Eeserve. Also, in spite of the termination of the dental

EOTC in 1932 (see chapter IV), 258 Eegular Army dentists, 250 National

Guard officers, and 5,197 Eeserve officers were enrolled in the Dental Corps

in September 1938; thus it appeared that if war came very few additional

dentists would be required. It was also the opinion of The Surgeon General that dental officers could be procured rapidly and put on active duty with

very little training, and it was frankly stated that no uneasiness need be felt

even if the Dental Eeserve fell to 50 percent of its authorized strength.34 At

this time it was certainly not foreseen that the Army would reach a strength

of over 8 million men, that a drastic lowering of physical standards would be

necessary, and that the 1.4 ratio, which had failed to measure up to the lesser

needs during and following World War I, would be completely inadequate for

this expanded force.

TABLE 3. OFFICERS CALLED TO ACTIVE DUTY IN THE DENTAL CORPS, BY COMPONENT,

JANUARY 1939 THROUGH FEBRUARY 1946

Component

Date

Regular

Army Reserve National

Guard

Army of the

United States

Total

1939

Total 19 25 44

1 1

July 13 2

2

15

2

32 Monthly procurement of dental officers, 1 Jan 39 through Feb 46. Info furnished by Strength

Acctg Br, AGO, 3 Jul 46.

33 Memo, Col James E. Baylis, Tng Div, SGO, for SG, 6 Sep 38. [D]

34 Ibid.
THE PROCUREMENT OP DENTAL OFFICERS 49

TABLE 3. OFFICERS CALLED TO ACTIVE DUTY IN THE DENTAL CORPS, BY COMPONENT,

JANUARY 1939 THROUGH FEBRUARY 1946—Continued

Date

i

Component

Total

Eegular

Army Reserve National

Guard

Army of the

United States

1939

3

1

9

7

3

1

15

7

6

1940

Total 29 408 145 582

.

1

1

1

4

30

14

2

23

24

21

104

136

134

89

3

30

13

2

6

17

21

42

100

103

71

1

17

Julv - 7

62

36

31

5 13

1941

Total 6 1,938 165 48 2,157

125

159

202

340

218

140

250

150

120

119

62

57

71

31

3

1

1

1

182

230

233

345

219

141

256

150

121

131

85

64

1 1

July --- --- --- - 4 1

1

12

23

1 53 10
50 DENTAL SERVICE IN WORLD WAR II

TABLE 3. OFFICERS CALLED TO ACTIVE DUTY IN THE DENTAL CORPS, BY COMPONENT,

JANUARY 1939 THROUGH FEBRUARY 1946—Continued

Component

Date

Regular

Army Reserve National

Guard

Army of the

United States

Total

1942

Total ___ _. 21 1, 134 1 5,670 6,826

1

2

126

77

85

157

149

95

259

100

56

13

15

2

179

97

34

149

292

457

966

1,038

1,171

561

356

370

306

February _ _ _ 176

March _ 119

4

1

5

4

310

May ... . 442

557

July

August _.

1,229

1 1, 139

September ...._._ 3 1,230

574

371

1 373

1943

Total . 59 4,941 5,000

January _ 5

9

4

5

4

10

11

4

2

3

162

192

277

374

910

556

679

540

347

266

364

274

167

201

March 281

379

May _ _ __ _ 914

566

690

August . 544

September _ ... 349

October __ _ _ 269

November _ 364

2 276

1944

Total _ 40 1,889 1,929

4

14

5

8

1

346

536

108

129

58

19

104

5

117

350

February _. 550

March ... 113

April 137

May 59

19

July 104

5

September. 117
THE PROCUREMENT OF DENTAL OFFICERS 51

TABLE 3. OFFICERS CALLED TO ACTIVE DUTY IN THE DENTAL CORPS, BY COMPONENT,

JANUARY 1939 THROUGH FEBRUARY 1946—Continued

Component

Date

Regular

Army Reserve National

Guard

Army of the

United States

Total

19U

2

6

233

186

48

235

192

48

1945

Total _ 2 233 235

1 49

45

47

85

1

4

50

45

March _ 1 48

85

May _ 1

4

July

1 1

December - 1 1

1946

Total 2 2

1

1

1

1

1939-1946

Aggregate _ _ _ 75 3,606 311 12, 783 16, 775

In September 1938, when the Dental Reserve had reached a level slightly

over its authorized strength,35 The Surgeon General recommended that all further procurement for that organization be suspended. This recommendation,

which reflected the then optimistic attitude of The Surgeon General, was

approved by the General Staff and, with a few exceptions (successful candidates

for the Regular Army, recent graduates desiring immediate active duty) no

new commissions were offered until October 1940.36 Between 30 June 1938 and

30 June 1941 the Dental Corps Eeserve suffered a net loss of 771 officers, in

spite of the fact that 722 commissions were given young dentists during fiscal

36 See footnote 33, p. 48.

»Ltr, ACofS, G-l to TAG, 29 Sep 38, sub:

Corps. [D]

Suspension of appointments in the Dental Eeserve
52 DENTAL SERVICE IN WORLD WAR II

year 1941.37 On the latter date the Dental Reserve numbered 4,428 officers.

Increases in the number of dentists on active duty were small prior to the

inauguration of Selective Service in September 1940. The authorized strength

of the Regular Army Dental Corps was raised to 316 officers in April 19393S

and about 50 Reserve officers were called to voluntary duty in April and September 1939.39 On 30 June 1940, 354 dentists, including 101 Reserve officers,

were on duty.40

By the end of July 1940,150 Reserve dentists had accepted voluntary active

service, but this number was 391 less than the total then required, and it was

anticipated that 1,259 dentists would be needed when expansion under the

Selective Service Act was started in October.41 On 27 August 1940 the President was empowered to call to active duty, with or without consent, any member

of the Reserve or National Guard.42 Any officer below the grade of captain,

with dependents, could resign, however, and a considerable number of Medical

Department officers made use of this privilege.43 By 26 October 1940 The

Surgeon General foresaw an early exhaustion of the Dental Reserve and he

recommended that the suspension on new commissions, which had been in effect

since September 1938, be lifted without delay.44 Three days later the ban

was lifted to the extent of permitting the corps area commanders to fill existing vacancies.45 Under current procurement objectives, however, there were

very few dental vacancies at this time, and it was found impossible in some

cases even to offer commissions to those few dentists who had been inducted

as enlisted men.4G

By 30 April 1941, 35.5 percent of all Dental Reserve officers were on active

duty, though the proportion varied from 20 percent to 59 percent in different

corps areas.47

On 5 May 1941 previous restrictions against new commissions in the Dental

Reserve were further modified to permitthe acceptance of any qualified dentists

who had been inducted as enlisted men, and the corps areas were instructed to

3

? Annual Reports . . . Surgeon General, 1938-41. Washington, Government Printing Office,

1938-41.

38 Sec 8, 53 Stat 558.

30 See footnote 14, p. 36.

«Annual Report . . . Surgeon General, 1940. Washington, Government Printing Office, 1940.

41 Ltr, SG to TAG, 6 Aug 40, sub : Shortage of Medical Department personnel. SG : 320.2-1.

«Annual Report . . . Surgeon General, 1941. Washington, Government Printing Office, 1941.

43 Ltr, TAG to all CA or Dept Comdrs, 1 Sep 40, sub : Resignation of officers of the Officers' Reserve

Corps. SG : 210.83-ORC.

44 Ltr, Col Larry B. McAfee to TAG, 26 Oct 40, sub : Appointment in the Medical, Dental, and

Veterinary Reserve Corps. AG: 210.1.

45 Ltr, Col Larry B. McAfee to all CA surgs, 29 Oct 40, sub : Extended active duty vacancy required

for approval of applicant for commission. [D]

4

» See footnote 16, p. 37.

« Ltr, TAG to all CGs, CofS, GHQ, Chiefs of all Arms and Services, 2 Jun 41, sub : Information

as to the percentage of eligibile reserve officers who are on extended duty as of April 30, 1941. AG :

210.31-ORC.
THE PROCUREMENT OP DENTAL OFFICERS 53

encourage applications from persons in this category.48 By 30 June 1941, 2,111

dental officers, predominantly Reserve, were on active duty.49

In October 1941 The Surgeon General reported some concern over the

number of resignations and physical disqualifications in the Dental Reserve,

and requested authority to reopen procurement in that branch. However, he

still recommended against any great increase in the Reserve, since to grant

commissions to men who could not be used by the Army would amount to

conferring exemption from military service, which was properly the prerogative

of the Selective Service System.50 Apparently it was still believed that the

Reserve, augmented with a few inductees and recent graduates, would be sufficient to meet anticipated needs. This optimism was not shared by the Federal

Security Administrator, Paul V. McNutt. On 30 October 1941, in his recommendation to the President for the establishment of a Procurement and Assignment Service to insure the most economical use of limited medical personnel,

Mr. McNutt also included a tentative plan for a draft of civilian professional

men, should such action prove necessary.51 The attitude of The Surgeon

General at this time is probably explained by the fact that 2,905 dental officers

were on duty, or only 6 less than the authorized procurement objective, and

Pearl Harbor was still in the future.52

Three days after entrance of the United States into the war all releases from

active duty, except for physical disability or incompetence, were suspended.53

On 19 December the Medical Department was instructed to establish pools of

medical personnel from which replacements could be made without delay. No

specific level was prescribed for the Dental Corps, but 1,500 officers were to be

maintained in such pools by the Medical Department as a whole.54

With the entry of the United States into actual hostilities the need for a

rapid expansion of the Medical Department was clear. On 1 January 1942

The Surgeon General requested authority to call to duty 1,350 additional dentists,55 but The Adjutant General approved an increase of 500 only.56

In the latter part of January 1942, it was directed that only a limited num-

« Kad, TAG to CGs all CAs, 5 May 41. AG : 210.1-OEC.

«Officers appointed in the Dental Corps from 1 January 1939 through February 1946. Info

furnished by Strength Accounting Branch, AGO, 3 Jul 46. HD : 320.2.

»Memo, Lt Col R. C. Craven for TAG, 8 Oct 41. AG : 080 (ADA).

n

Ltr, Paul V. McNutt, Federal Security Administrator, to the President, 30 Oct 41. [D]

62 Lt Col Alfred Mordecai: A history of the Procurement and Assignment Service for physicians,

dentists, veterinarians, sanitary engineers, and nurses, War Manpower Commission. HD: 314.7-2.

63 Ltr, TAG to Chief of the Army Air Forces ; Commanding General, Air Force Combat Command ;

Chief of Staff, GHQ ; and the Chiefs of all Arms and Services, 10 Dec 41, sub: Suspension of releases

from active service. SG : 320.2-1.

M Ltr, TAG to Chief of each arm or service, 19 Dec 41, sub: Officer filler and loss replacements for

ground arms and services. SG : 320.2-1.

K

Ltr, SG to TAG, 1 Jan 42, sub : Procurement objective, Medical Department officers, Army

of the United States. AG : 210.1.

M

1st ind, TAG to SG, 24 Jan 42, to ltr cited in footnote 55.
54 DENTAL SERVICE IN WORLD WAR II

ber of Regular Army dental officers, varying from 2 in the Fifth Corps Area

to 13 in the Fourth, would be allotted to corps area activities.57

On 12 April 1942 The Surgeon General was instructed by Services of Supply (SOS) to establish Medical Officer Recruiting Boards to commission officers

in the field. This action was intended mainly to speed the lagging procurement

of medical rather than dental officers, for dentists were not to be accepted unless

they were under 37 years of age or had been classified I-A by their draft boards.

By May 1942 it was evident that the Army would reach a strength much

greater than had been anticipated in prewar plans. In that month the Military

Personnel Division, SOS, estimated that 7,110 dentists would be needed by 1

January 1943, as follows:5S

Services of Supply 2,609

Operations and AGF 2,472

Army Air Force 1,755

Pools 184

As of 31 March 1942 there were 3,373 dental officers on duty and it was estimated

that only 587 more could be obtained from the Reserve; it would therefore be

necessary to make 3,150 new appointments in the Army of the United States

(AUS) during the remainder of 1942.59 On 3 July 1942 The Surgeon General

reported thatthe procurement objective of 500 officers, authorized on 24 January,

had been filled and he requested an additional objective of 4,000 dentists.60 This

time his request was approved in full within a few days.61

Some difficulty was expected in obtaining 4,000 more dentists for on 9 July

1942 The Adjutant General directed the corps areas to add dental officers to all

Medical Officer Recruiting Boards and granted authority, for the first time, to

consider applications for original appointments from the following:62

1. Dentists between the ages of 37 and 45.

2. Dentists qualified only for limited service.

3. Dentists whose training and experience justified an original appointment above

the grade of lieutenant.

Though dentists in these categories were to be accepted only by authority of

The Surgeon General, they had not previously been placed on active duty under

any circumstances. At about the same time the Dental Division, SGO, was

directed to call to active service all physically qualified lieutenant colonels

and colonels of the Reserve, a step which had been postponed as long as possible

Ltr, TAG to all CA comdrs, 27 Jan 42, sub: Allotment of Regular Army officers for duty with

the Corps Area Service Commands. AG : 320.2.

« Memo, Brig Gen James E. Wharton for Pers Off, SGO, 11 May 42, SG : 320.2-1.

5

» Ibid.

«o Ltr, Lt Col Francis M. Fitts to CG, SOS, 3 Jul 42, sub : Procurement objective, Dental Corps,

Army of the United States. SG : 320.2-1.

81 Ltr, TAG to SG, 8 Jul 42, sub : Procurement objective, Army of the United States, for duty with

Dental Corps (Surgeon General). SG : 320.2-1.

« Ltr, TAG to CGs all CAs, 9 Jul 42, sub : Dental Corps members for certain Medical Department

recruiting boards. AG : SPX 210.31.
THE PROCUREMENT OF DENTAL OFFICERS 55

due to the difficulty of assigning men in the higher grades to appropriate positions.63 Misgivings concerning dental procurement proved unfounded at this

time. On 1 September 1942 dental representatives were removed from the

Medical Officer Eecruiting Boards and the latter were instructed not to accept

any new dental applications.64 A few days later the Dental Division, SGO,

notified its liaison officer with the ADA that the objective of 4,000 officers

authorized in July 1942, had nearly been filled and that commissions would

thereafter be given only to men who had been declared Class I-A by their draft

boards.65 From September through November 1942 further procurement of

dental officers was actually discouraged.

On 16 November 1942 The Surgeon General reported that there were

9,706 dental officers on duty, a number slightly in excess of current requirements. However, with mobilization plans providing for many more men than

had been considered necessary at the beginning of the year, it was estimated

that 17,248 dentists would be needed by the end of 1943. The Surgeon General

therefore asked for a new procurement objective of 7,200 dental officers in addition to the 300 officers of the unexpended portion of the old objective.66 This

request was approved on 27 November.67 On 15 January 1943 PAS, WMC,

agreed to declare 400 civilian dentists available each month through the year,

for a total of 4,800 dentists; the remaining 2,700 dental officers were to be

obtained from the newly established Army Specialized Training Program

(ASTP) (see chapter IV), from dentists inducted as enlisted men by Selective

Service, and from students holding inactive Medical Administrative Corps

Eeserve commissions.68

During the first months of 1943, the program to meet the procurement

objective of 7,500 dental officers lagged somewhat, though difficulties of dental

procurement were overshadowed by the much more acute shortage of medical

officers. In February the Dental Division asked that PAS speed its activities

as only 269 dentists had been declared available since 1 January. In April,

the Medical Department was still short 1,042 dentists and 6,677 physicians,

but by May, when the situation in respect to medical officers was grave, some

improvement was noted in the procurement of dental officers.69 Though Selective Service placed dentists in the "scarce" category at about this time,70 this

action was intended only to prevent the waste of dental manpower in nonprofessional activities, and on 22 May representatives of the War Department

83 See footnote 21, p. 44.

« Rad, TAG to CG, 1st SvC, 1 Sep 42. SG : 210.31-1.

« Ltr, Col Robert C. Craven to Maj Kenneth R. Cofleld, 4 Sep 42. [D]

M Ltr, SG to CG, SOS, 16 Nov 42, sub : 1943 procurement objective, Dental Corps, Army of the

United States. SG : 320.2-1.

87 Ltr, TAG to SG, 27 Nov 42, sub : Increase in procurement objective, Army of the United States,

for The Surgeon General (Dental Corps). SG : 320.2-1.

68 See footnote 52, p. 53.

89 Ltr, SG to ACofS, G-l, 13 May 43, sub: Procurement of physicians and dentists. AG: 210.1.

70 WD Memo W605-23-43, 15 May 43, sub: Scarce categories of specialized skills. AG : 210.1.

330324 0—55 5
56 DENTAL SERVICE IN WORLD WAR II

and PAS found that "the dental picture was not alarming." 71 By the end of

June 1943, 12,046 dental officers were on duty, and half of the year's objective

had been obtained.72

On 7 September 1943, when about 13,500 dentists were in the service, ASF

placed an arbitrary ceiling of 15,200 officers on the Dental Corps. It was then

estimated that in addition to graduates of the ASTP and students holding

Reserve Medical Administrative Corps commissions only 1,124 more dentists

would be needed from civil life. Both PAS and the Officer Procurement Service (OPS) of the ASF were notified not to accept additional applications

from dentists who were over 38 years of age or who were not physically fit

for unlimited military service. This action is especially significant when it

is noted that at this same time The Surgeon General was seriously considering

a draft of 12,000 physicians.73 By 9 December 1943, over 14,200 dental officers

were in the military service and further procurement from civilian sources,

other than from students in the ASTP or the Medical Administrative Corps

Reserve, was stopped.74

On 16 December 1943, The Surgeon General agreed, at the request of

the Veterans Administration, to commission all dentists of that agency who

were under 63 years of age, and about 170 dental officers in this category were

ultimately accepted. These men remained in their normal duties with the

Veterans Administration.75

Peculiarly, serious difficulties in dental procurement did not arise until

the Dental Service approached its maximum strength in the spring of 1944,

and then the principal problem was not to obtain replacements, but to find

vacancies for graduates of the ASTP and for such dentists as might be inducted by Selective Service. At that time the Dental Corps numbered nearly

15,000 officers, many of whom had already been on active duty for 2 to 3 years.

Very few of these men could be returned to civilian life under existing directives, and natural attrition had proved to be much less than expected. On

the other hand, the ASTP had been established early in 1943 to provide about

825 dental officers every 9 months, and unless vacancies could be found for them

they would have to be released to private practice after the Government had

given them draft exemption and paid for a considerable part of their professional training.

The Dental Division and the War Department did not agree on the best

solution for this problem. The Dental Division was influenced mainly by the

fessional training.

71 Minutes of Conf between the Directing Board, PAS, and representatives of the WD, 22 May 43.

On file Natl Archives, PAS files, WMC.

Annual Report . . . Surgeon General for CG, ASF, (1943). HD: 319.1-2.

73 Draft of proposed call on Selective Service for the conscription of 12,000 physicians, submitted

to The Surgeon General on 9 Oct 43 by Lt Col Durward G. Hall. [D]

74 Ltr, Col Durward G. Hall to Exec Off, PAS, 10 Dee 43, sub : Cancellation of further procurement of dentists. [D]

76 Annual Ept, Procmt Br, Mil Pers Div SGO, 1943. HD : 319.1-2.
THE PROCUREMENT OF DENTAL OFFICERS 57

1. During the early stages of mobilization some men had been commissioned

who were physically or mentally incapable of performing their duties efficiently. Their presence decreased the effectiveness of the entire Dental Service.

2. Long before the start of actual hostilities many Eeserve officers had volunteered for active duty in the emergency. After 3 years of service, during

which their colleagues at home had enjoyed exceptionally high incomes, these

officers were anxious to return to their offices as soon as they could be spared.

It was believed that if ASTP graduates were released while the older men were

held in the Army the resulting drop in morale would be catastrophic.

The Dental Division therefore wished to replace older men with recent

graduates who had no family ties and who might be expected to be available

during the demobilization period.

The War Department, on the other hand, apparently attached more

importance to the following considerations:

1. Any great turnover in dental personnel would mean wasted effort in

training replacements.

2. Officers with several years of service were considered the most valuable

to the Army, and it was doubted if recent graduates of the curtailed dental

course would be equal in ability to men with 5 to 20 years of practical experience.

3. Line officers and enlisted men who had proved themselves in combat

could be replaced only at the cost of American lives; they had to be retained

until the last battle was won. To release dental officers, who generally lived a

less dangerous and rigorous life, while combat personnel had to remain in the

fighting, might seriously impair the morale of the latter.

For these reasons the War Department at first preferred to keep the older

officers in service, even at the expense of discharging recent graduates under

the Army training program. It later changed its attitude to conform more

nearly to that of the Dental Division, butthis did not occur until the graduating

class of June 1944 had been lost and the dental ASTP had been terminated.76

On 11 March 1944 The Surgeon General, at the request of the Dental

Division, advised the Military Personnel Division, ASF, that the authorized

ceiling for dental officers had been reached; in addition, that approximately

1,294 ASTP students would graduate during the remainder of the year. At

the same time he noted that many dental officers were in a "limited service"

status and he recommended that the following be relieved from active duty in

numbers sufficient to make room for the younger men:"

'" Data on reasons for War Department opposition to the discharge of older dental officers in

early 1944 have been difficult to obtain, and reliance has had to be placed on information given by

officers on duty in the War Department at the time. Considerable material has been obtained from

Maj Ernest J. Fedor, who was dental liaison officer with the Military Personnel Division, SGO, during

much of the war. There is some reason to believe that the War Department saw the advantages of

replacing the older officers, but that it wished to avoid a categorical statement of policy which would

receive wide publicity and which might lead to criticism by line personnel who could not be included.

«Memo, Col Robert J. Carpenter, Exee Off SGO, for Dir Mil Pers Div, ASF, 11 Mar 44. SG :

322.0531.
58 DENTAL SERVICE IN WORLD WAR II

1. Any dentist over 45 years of age who was classified "limited service."

2. Dentists over 38 years of age who were recommended for release by corps area

commanders. This provision was expected to authorize the discharge of men who

were not sufficiently incompetent to be released under existing criteria, but who were

of doubtful value to the dental service.

This request was disapproved on the grounds that existing directives were

adequate to assure the discharge of inefficient officers. The primary purpose of

this proposal, to create vacancies, was apparently given little consideration.78

On 1 April 1944, however, Lt. Col. Durward G. Hall, of the Military Personnel

Division, SGO, reported to The Surgeon General that he had received informal,

verbal authority to exceed the official ceiling for short periods of time to

permit the commissioning of some ASTP graduates, and that he had also been

instructed to release enough dentists over 40 years of age to maintain the

required level. G-l and ASF refused to confirm these agreements in writing,

however, and Colonel Hall was doubtful concerning the advisability of putting

them in effect.79

On 16 May 1944 the Director of the Dental Division was informed by the

Military Personnel Division, SGO, that due to a lack of vacancies no graduates of the class of June 1944 would be commissioned in the Army, though

some names would be referred to the Veterans Administration and the Navy.80

About 225 dental ASTP graduates were actually commissioned at this time by

the Navy.81 Shortly thereafter the dental ASTP was terminated, except for

senior students who would finish their courses by 1945.82 While The Surgeon

General advised against this step, even he apparently underestimated the difficulties which would be encountered in maintaining a Dental Service for a

million or more men in the postwar period, after wartime officers had been discharged and Selective Service had been terminated. On 5 June 1944 he stated

that while it "might be desirable from some points of view to grant at least

some appointments to ASTP graduates," such action was "not justified in view

of the present strength of the corps."83

A partial change of attitude on the part of the "War Department General

Staff was registered in July 1944 when the Commanding General, ASF, was

directed to commission qualified ASTP students graduating after June 1944

if they were not desired by the Navy.84 Necessary vacancies were to be created

Memo, Brig Gen R. B. Reynolds, Mil Pers Div, ASF, for SG, 25 Mar 44, sub : Relief from active

duty of temporary officers of Dental Corps over 40 years of age on permanent limited duty status.

HD: 314.

Memo, Lt Col Durward G. Hall for Dep SG, 1 Apr 44. [D]

80 Memo, Maj Ernest J. Fedor for Maj Gen R. H. Mills, 16 May 44, sub: Disposition of dental

ASTP graduates who will complete their course in dentistry during the month of June 1944. [D]

81 Ltr, Capt W. F. Peterson to SG, 10 Oct 44, sub : ASTP dental students commissioned in the

U. S. Naval Reserve. [D]

82 See discussion of the Dental ASTP in chapter IV.

83 Memo, Brig Gen R. W. Bliss for CG, ASF, 5 Jun 44, sub : Requirements for Dental Corps officers.

SG: 322.053-1.

«Memo, Maj Gen M. G. White for CG, ASF, 18 Jul 44, sub: ASTP dental program. Quoted in

semiannual report, Pers Serv, SGO, 1 Jul-31 Dec 44. HD: 319.1-2.
THE PROCUREMENT OP DENTAL OFFICERS 59

through the discharge of surplus, overage officers or by the reclassification of

the inefficient. The effectiveness of this step was largely nullified, however,

by the fact that the dental ASTP would graduate its last student in April

1945, in contrast to the medical ASTP which would continue to provide replacements until January 1948. No authority was given at this time to commission

graduates holding Medical Administrative Corps Keserve commissions or dentists who might be inducted, though the latter could be discharged under existing regulations.85 On 28 August 1944 The Surgeon General was further advised

that some 300 senior students holding Medical Administrative Corps Reserve

commissions could be placed on active duty on graduation.86

Peak strength of the Dental Corps was reached in November 1944, when

15,292 officers were on duty.87 At the end of 1944 there were 15,110 dental

officers in the service.88 Only 1,418 dentists had been commissioned during

the year, as follows:M

Graduates of the dental ASTP 897

Graduates with Reserve MAC commissions 94

Civilians (other than inductees) 324

Dentists inducted as enlisted men 3

From 1 August through 31 December, 503 officers had been discharged, mainly

to create vacancies for younger men, and at the end of the year 212 still awaited

separation under previous commitments.90

By 1945 the dental procurement picture was beginning to change. The

Dental Corps remained at just a little under, authorized maximum strength,

but the only prospective replacements were the 218 senior ASTP students who

were to graduate in April and 180 students holding Reserve Medical Administrative Corps commissions, many of whom might be rejected for physical defects. Nine hundred former ASTP students would graduate after April, but

they had been unconditionally released by the Army in June 1944 and the

Military Personnel Division of the SGO was very doubtful if G-l could be

"sold" on any new procurement program from civilian life.81

Early in February 1945 a dental officer with the Military Personnel Division, SGO, noted the possibility of a later shortage of dentists, and that office

warned the Director of the Dental Division that future procurement was press AR 615-360, 25 May 44.

89 Iitr, Maj F. B. Golembieskl to SG, 28 Aug 44, sub : Appointment of inactive Medical Administrative Corps dental graduates. Quoted in semiannual report, Pers Serv, SGO, 1 Jul-31 Dec 44, Incl

10. HD: 319.1-2.

w Memo, Mr. Isaac Cogan for Chief, Dental Cons Div, SGO, 8 Oct 46, sub: Basic data for Dental

Corps. SG: 322.0531. The figure given includes officers with the Veterans Administration, traveling,

or sick. It does not include officers on terminal leave, officers enroute home for discharge, or officers

sick in hospital, not expected to return to duty.

88 Data from Resources Anal Div, SGO. [D]

89 Annual Report, Pers Oprs Br, Pers Serv SGO, 1944. HD : 319.1-2.

« Memo, Maj Ernest J. Fedor for Chief, Procmt Br, Pers Serv SGO, 17 Jan 45, sub: Dental Corps

active duty strength. HD : 314.

81 Ibid.
60 DENTAL SERVICE IN WORLD WAR II

carious and that conservation of dental officers would be necessary.82 More

revealing was a note attached to this correspondence, in which the Director of

the Military Personnel Division recommended to his own personnel that "we

slow down on the Kelease and Separation Board in the Military Personnel

Division; take no more (dentists) in nor request any new procurement objective ; let attrition go below the ceiling and gamble on redeployment and partial

demobilization overtaking us." Apparently it was believed at this time that

most procurement troubles would be over with the expected end of hostilities,

and if dental officers were required for the postwar period they could be obtained

through Selective Service. The possibility that demobilization might actually

result in a temporary increase in the demand for dental treatment had been

mentioned as early as June 1944, but it seems not to have been considered too

seriously.93

When the war ended in Europe the Dental Corps numbered 14,700 officers,

providing an overall ratio of 1.8 dentists for each 1,000 troops, or 2.6 per 1,000

in the United States and 1.3 per 1,000 overseas.9*

Soon after V-E Day The Adjutant General suggested a review of the procurement objectives for dental officers to determine if they might not be reduced

in view of changed conditions. In reply The Surgeon General noted that

previous sources of replacements were rapidly drying up and he asked that:95

1. Present authority to commission Medical Administrative Reserve Corps graduates,

applying only to those who had been enrolled in the senior class as of 1 July 1944, be

extended throughout 1945.

2. Authority be granted to commission any dentist inducted as an enlisted man, rather

than discharge him under current instructions.

It was not expected that these measures would suffice to maintain the existing

strength of the Dental Corps, but it was believed that they would enable the

Dental Service to meet the lessened demand for treatment which might accompany a decrease in the total strength of the Army. No action was taken on

this request. By July 1945 The Surgeon General anticipated a shortage of 475

dental officers by the end of the year, and he recommended that the Dental

Corps be maintained at 15,000 officers (exclusive of those with the Veterans

Administration) until March 1946. He further advised that 805 new dental

officers be obtained, as follows:m

Students holding MAC commissions 70

Inducted dentists 35

Former ASTP students 700

"Memo, Lt Col Durward G. Hall for Maj Gen R. H. Mills, 8 Feb 45, sub : Dental Corps officers

SG : 322.0531.

M

See footnote 83, p. 58.

M

See footnote 87, p. 59.

«Memo, SG for AG, Appointment and Induction Br, Appointment Sec, 4 Jun 45, sub: Procurement objective for appointment In the Army of the United States. AG: 2101 (G-l)

» Memo, Brig Gen R. W. Bliss for ACofS, G-l, 6 Jul 45, sub: Celling and procurement objective

for Dental Corps officers. HD : 314.
THE PROCUREMENT OF DENTAL OFFICERS 61

On 18 July the General Staff approved these recommendations.97 It must be

noted, however, that the Army had no hold on former ASTP students who

did not choose to volunteer, and instructions to the service commands actually

specified that no persuasion would be used in recruiting from that category.

Nor were applications from civilian dentists, other than former ASTP students,

to be accepted.98 This limited, largely voluntary program produced very little

result.

Soon after the collapse of Japan all procurement of officers was stopped by

a blanket order issued by The Adjutant General.99 By this time the Dental

Corps was down to 13,600 men, and on 20 September the Deputy Surgeon

General requested that the commissioning of MAC students be resumed to

permit the earlier discharge of older dentists. This time no mention was made

of procuring former ASTP students then in civilian status.100 This request

of the Deputy Surgeon General was approved about a month later, but it

could have little effect in any event since there were only 173 MAC students

remaining in the schools, and rejections for physical disability were high

because a large proportion of the physically fit had given up their Eeserve

status to enter the ASTP.101 By the end of the year the strength of the

Dental Corps was down to 9,600 men.102 Serious personnel difficulties were

still not anticipated in this period as evidenced by General Mills' statement

in October that, even though dentists were being discharged in connection with

the reduction of the Army, no major procurement program was being considered.103

With the sudden end of the war, pressure for the release of veteran Medical

Department officers mounted rapidly, to a point where a congressional investigation was threatened. In particular, the Office of The Surgeon General was

flooded with letters protesting the fact that men with several years of service

were being held in the Army while students who had been given deferment and

whose education had been partially paid for by the Government were being

released to private practice.104 Nevertheless, it was found necessary to maintain considerable forces to meet unexpected postwar responsibilities.

Information on the total number of dentists to serve with the Army

Dental Corps during the war is not completely reliable. The Strength AccountOTLtr, TAG to SG, 18 Jul 45, sub: Ceiling and procurement objective for Dental Corps officers.

AG: 210.1 (G-l).

98 Ltr, CG, ASF, to CG, 1st SvC, 25 Jul 45, sub: Procurement of dental officers. AG : 210.1.

M

Ltr, TAG to all agencies having procurement objectives, 2 Sep 45, sub : Cancellation of procurement objectives. AG : 210.1.

!» Ltr, Maj Gen Geo. F. Lull to ACofS, G-l, 20 Sep 45, sub : Waiver of procurement objectives

for appointment as second lieutenants MAC-AÜS (students, interns) as first lieutenants, Medical

and Dental Corps, AUS. AG : 210.1.

101 Ltr, TAG to SG, 13 Oct 45, sub: Appointments of second lieutenants, MAC-ADS, as first

lieutenants, Medical and/or Dental Corps, AUS. AG : 210.1.

102 See footnote 88, p. 59.

10

» Ltr, Maj Gen R. H. Mills to Capt D. E. Cooper, 26 Oct 45, no sub. SG : 210.8.

IM Nearly the whole of SGO file 322.0531 for the year 1946 is taken up with complaints against

the release of former Dental ASTP students.
62 DENTAL SERVICE IN WORLD WAR II

ing Branch, AGO, reported that 16,775 dentists were called to active duty

from 1 January 1939 through 28 February 1946,105 for a total of about 17,100

men, including Regular Army and Reserve personnel already serving at the

start of the war. The Resources Analysis Division, SGO, however, estimated

that about 18,000 dentists were on duty between October 1940 and the end

of 1945.106

SOURCES AND METHODS OF PROCUREMENT FOR DENTAL OFFICERS,

WORLD WAR II

General Considerations

On V-E Day the Army Dental Corps was made up of the following

categories:107108

PerceiUage

Number of of total

Component officers strength

Regular Army 266 1. 7

National Guard 117 o. 8

Organized Reserve 3, 106 20. 3

AUS (ASTP graduates) l] 802 1L 8

AUS (from civil life) 10, 011 65. 4

Regular Army

Since Regular Army dental officers were chosen in highly competitive

examinations and received thorough training they were generally well qualified

in the broad aspects of their profession. A few of the 250 Regular Army dental

officers were unfitted for higher administrative duties by temperamental or

other defects, but the majority were well trained in that field (see chapter

IV) and they filled key positions with credit to themselves and the service.

Prewar clinical training, however, had not encouraged the development of

skilled specialists. In an era when a high proportion of posts was small, the

average Army dentist had to be able to handle a case of periodontoclasia, treat

a fractured mandible, construct a denture, or supervise a station laboratory,

and emphasis was placed on all-round ability rather than on qualification in

a single narrow field. Few dental officers had been able to limit their practices

to one branch of dentistry. With the exception of certain outstanding individuals, therefore, the Dental Service had to rely heavily on Reserve officers or

former civilians to provide the more complicated types of treatment.

The Regular Army Dental Corps was also unbalanced in respect to age

and experience. Of the 269 officers on duty in April 1942, nearly 100 had been

106 See footnote 32, p. 48.

108 Memo, Mr. Isaac Cogan for Dir, Dental Div, 29 Aug 46, sub: Dental Corps officers, historical

data. SG : 322.053-1.

> Ibid.

108 The total given here, 15,302, is slightly higher than the number actually on duty on V-E Day

as It Includes a few officers who had been released but whose discharge had not yet been reported. For

other data on race, age, and clinical qualifications see chapter IV.
THE PROCUREMENT OF DENTAL OFFICERS 63

in the service for 24 years or longer; another 100 had approximately 5 years

or less of active duty, leaving only about 70 men with from 6 to 23 years of

service. One hundred and two dental officers were in the grades of colonel or

lieutenant colonel, 146 were in grades of captain or lieutenant, and only 21

officers were in the grade of major, where maximum physical vigor was combined with at least 12 years of experience.109 This situation was unavoidable

since it had originated in the rapid expansion of the Dental Service during

and immediately following the First World War, and it would be corrected

by natural attrition over a period of years.

At best, the Eegular Army Dental Corps provided only about 1% percent

of the 17,000 to 18,000 dentists who were on duty with the land forces at some

time during the war.

National Guard

The 250 dental officers in the National Guard at the start of the war provided a nucleus of personnel who had had some service with their units in the

field and who were available on very short notice. New commissions in the

National Guard brought the total taken on active duty from that source to 311

officers,110 but like the Eegular Army, the Guard was too small to provide a

significant part of the total treatment required in a major mobilization. In

general, the training and efficiency of National Guard dentists was comparable

to that of Reserve officers, with the difference that they had generally had

the benefit of slightly more practical experience.

The Organized Reserves

On 6 September 1938, 5,197 officers were enrolled in the Dental Eeserve, a

figure exceeding the authorized total by 97 officers. At that time it was expected

that 5,100 Eeserve dentists, plus about 500 Eegular Army and National Guard

officers, would be sufficient for the force of about 4 million men which might

be mobilized in an emergency. So little concern was felt over dental procurement that the granting of new Eeserve commissions was immediately stopped,111

and it was not resumed for more than two years.112 During this period the

Dental Eeserve lost 771 officers, and 30 June 1941 it was down to a strength

of 4,428 men, distributed in the following grades:118

Colonel 7

Lieutenant colonel 96

Major 354

Captain 909

Lieutenant 3,062

MO Army Directory for 20 April 1942.

»

10 See footnote 49, p. 53.

ul See footnote 36, p. 51.

«

2

See footnote 45, p. 52.

1,3 See footnote 42, p. 52.
64 DENTAL SERVICE IN WORLD WAR II

Prior to the start of hostilities in Europe a negligible number of Dental

Eeserve officers had been on active duty with the Civilian Conservation Corps.

A few more had been taken on duty in connection with increases in the Air

Force and for reinforcement of the defenses of Panama. Thus, on 30 June

1940, 101 Eeserve dentists were on voluntary active service.114

On 18 November 1940, maximum age limits for initial active duty with

the Eeserve were established as follows:115

1. For troop duty, not more than five years above maximum prescribed

for initial appointment in the grade held.

2. For duty other than with troops:

Colonel 60 years

Lieutenant colonel 58 years

Major 54 years

Captain 50 years

Lieutenant 47 years

On 19 February 1941 it was directed that Keserve officers would be assigned

on the same basis as Regular Army officers, with no restrictions on the positions

they might nil.116

At the end of June 1941, there were 2,090 Eeserve and National Guard

dental officers on active duty.117 By the end of the year the number had reached

about 2J900.118 On 7 November 1941 it was directed that, with a few exceptions, dentists taken on active duty directly from civilian life would thereafter

be commissioned in the Army of the United States, which was the temporary

emergency force, rather than in the permanent Eeserve.119 On 15 April 1942,

when about 3,220 Eeserve and National Guard dental officers had been called,120

The Surgeon General reported that the Medical Department Eeserve was nearly

exhausted, so far as physically fit officers in usable grades were concerned, and

that emphasis would thereafter have to be directed toward the procurement

of civilians with no previous military training.

From 1 January 1939 through February 1946 a total of 3,606 Dental

Eeserve officers were called to active duty.121 However, it cannot be stated

what proportion of the 4,428 dental reservists listed on 30 June 1941 saw active

111 Ibid.

115 Ltr, TAG to CGs Hawaiian, Panama Canal, Philippine, and Puerto Rican Depts; each Chief of

Arm and Service; and each CA Comdr, 18 Nov 40, sub : Reserve officers, resident in overseas departments, for extended active duty under Public Resolution 96, 76th Congress. AG : 210.31-1.

u« Ltr, TAG to all Comdrs of CAs and Depts, each Chief of Arm and Service, and CGs 1st, 2d, 3d,

and 4th armies, 19 Feb 41, sub: Administrative status of Reserve officers on extended active duty.

AG : 210.31 ORC.

»

T

See footnote 42, p. 52.

»s See footnote 55, p. 53.

U9 Ltr, TAG to CGs of all armies, CAs, and Depts, Chiefs of Arms and Services, and chiefs of other

sections of the WD Overhead, 7 Nov 41, sub: Policies relating to appointments in the Army of the

united States under the provisions of PL 252, 77th Congress. AG : 210.1.

120Ltr, Lt Col John A. Rogers, SGO (no addressee indicated), 23 Apr 42, sub: Appointment in

the Army of the United States (Medical Department). SG : 320.2-1.

121 See footnote 49, p. 53.
THE PROCUREMENT OF DENTAL OFFICERS 65

duty, because additional commissions were granted between that date and 7

November 1941 when new commissions in the Reserve were discontinued. It

seems probable thatthe figure was close to 75 percent.

Before Selective Service and PAS could be established the Reserve

supplied trained dental officers when they were immediately needed. In

general, these officers performed their duties creditably. Their training had

not always been sufficient, however, to enable them to fill the more critical

positions, and the classification of Reserve officers had not been accurate enough

to permit assignment of specially qualified individuals to appropriate functions.

Above all, the wartime experiences of many Reserve officers led them to doubt

the advantages of belonging to that organization. Prior to the war the principal inducements for entering the Reserve, besides patriotism, had been (1)

assurance that the dentist would serve in the field for which he was trained,

and (2) the prospect that in time of emergency the superior training of the

Reserve officer wxmld put him in a favorable position for promotion and assignment. Events showed that there was little danger that any dentist would have

to serve in enlisted status, and the Reserve dentist in the grade of captain

or lieutenant seemed to have little more chance for promotion than the dentist

called directly from civil life. As previous incentives for accepting Reserve

commissions diminished in importance it seemed probable that postwar procurement for that organization would have to be stimulated by financial remuneration in the form of pay for the time expended or as retirement privileges.

Interviews with senior dental officers have brought out the following comments concerning the effectiveness of the Dental Reserve Corps :

122123

1. The patriotism, zeal, and professional qualifications of the average

Reserve dentist were above criticism.

2. The Dental Reserve supplied essential officers during the most critical

period of the mobilization for war, before the Selective Service System was

in effective operation. Officers were obtained in a more orderly way through

the Reserve than would have been possible through Selective Service, at least

until the establishment of the PAS.

3. Reserve officers in the lower grades were able to assume their military duties immediately, with little or no additional training. Some, though

not all, of the senior officers successfully filled key positions when the Dental

Service was filled out with former civilians with no previous experience.

4. Some senior officers of the Reserve were found to lack the experience

and training required in important positions, and since routine chair work was

not appropriate for their high grades their proper assignment was extremely

difficult. This was not necessarily the fault of the officer himself since he had

usually fulfilled the requirements for promotion to the field grades, but sporadic

122 Final Report of The Surgeon General. Medical Department Personnel, included in ASF report

on Logistics in World War II, 1945. HD : 319.1-2.

123 See footnote 21, p. 44.
66 DENTAL SERVICE IN WORLD WAR II

correspondence courses and occasional 2-week periods of active duty were

simply not sufficient preparation for major administrative duties which bore

little resemblance to the officer's peacetime activities. In some aggravated

cases senior officers of the Eeserve had actually given up the practice of their

profession years before and were engaged in other occupations. When such

men were called upon to instruct juniors or to operate larger installations, the

Dental Service inevitably suffered.

5. Prior to the war, classification of Reserve officers was defective and little

accurate information was available concerning their true qualifications. As

a result, most Reserve dentists were immediately assigned to tactical commands

where it was believed they could be most useful, and many clinical experts

were lost to professional centers where they were badly needed. The men themselves were discouraged when theirspecial skills were not employed.

6. In the year of the "phony" war, before Pearl Harbor had emphasized

the national danger, Reserve officers were called from their homes and practices to staff the clinics of an Army assembled primarily for training purposes.

Meanwhile, their competitors enjoyed the "boom." Under these conditions

some Reserve officers felt that they had been called upon to make uncalled-for

sacrifices for their patriotism. If they had been encouraged by the thought

that they would get quicker promotion in the coming expansion, their disappointment was even more acute when some of these same competitors demanded,

and received, higher grades as the price of volunteering for active duty, while

the Reserve officer remained assigned to a tactical unit where promotion was

stagnated. (This complaint was more frequent in the Medical Corps than

in the Dental Corps, where few initial appointments were given above the grade

of captain.) Also, the very fact that a Reserve officer had some training in

military matters often led to his assignment to a tactical organization, where

opportunities for the practice of his profession were poorest, while the man

without military experience was sent to a hospital where he maintained or

improved his skill and where he lived under much more pleasant conditions.

Finally, when it was announced in 1944 that ASTP graduates would be released

to private practice, while Reserve officers with 3 years or more of service would

be kept in the Army, criticism from Dental Reserve officers reached a new

peak, though the Office of The Surgeon General was in no way responsible

for that decision. The experiences of some of these officers led them to advise

young graduates to stay out of the Reserve and take their chances on induction,

especially since there was little probability that they would have to serve

as enlisted men in any event.124

"World War II experience also indicated the need for more comprehensive

training and more practical experience for Dental Reserve officers in the

higher grades.

>» Personal Ltr, Dr. Charles W. Freeman, Dean, Northwestern University Dental School, to Maj

Maurice E. Washburn, 21 May 46. SG : 322.0531.
THE PROCUREMENT OF DENTAL OFFICERS 67

ASTP, Medical Administrative Corps Reserve,

Enlisted Reserve

The procurement of some 1,900 dental officers through the ASTP, and of

approximately 1,200 through the MAC and Enlisted Eeserves, is discussed in

Chapter IV. These men were generally recent graduates who entered the

service in the lowest grade, directly from school. They were already obligated

to render military service, and had not been engaged in essential civilian

practice, so their procurement offered no special problems.

Selective Service and Dental Procurement

It has been pointed out that until the spring of 1942 the Dental Service

was expanded mainly with officers from the Reserve and National Guard.

The Surgeon General was able to pass on every application for these branches,

to insure compliance with professional, moral, and ethical standards, and the

number taken from civil practice did not constitute a serious threat to civilian

dental care. As these sources approached exhaustion, however, and as prospective requirements loomed larger, emphasis was switched to the procurement of dentists engaged in private practice who lacked previous connection

with the Armed Forces. By V-E Day nearly two-thirds of the Dental Corps

consisted of men taken directly from civil life.125 As it became necessary to

dip deeper into the reservoir of civilian practitioners The Surgeon General

had to rely on other agencies to assist in locating eligible men, determining

if they could be spared from their communities, and inducing them to accept

active duty.

The first official, nonmilitary agency to enter the dental procurement

field was the Selective Service System. As the only authority which could

order an individual into the Armed Forces, this organization had great

potential importance for the Dental Service, but for some time after it was

established late in 1940 its activities proved more embarrassing than helpful,

for the following reasons:

1. The Selective Service law provided for the deferment of persons

essential to the national health or welfare, but blanket deferment on an occupational basis was specifically prohibited. The responsibility for determining

which individuals were actually indispensable rested mainly on the local draft

boards. Neither the heads of the Selective Service System nor the members of

local boards were at first seriously concerned over the possibility that a shortage

of dental personnel might develop, and the latter did not hesitate to induct

dentists who were not at the moment urgently essential in their communities.

On the other hand, the ADA and The Surgeon General believed that the

dental personnel situation was cause for alarm, and that serious difficulties

could be avoided only if every dentist were employed according to his skills.126

125 See footnote 106, p. 62.

>» Memo, Brig Gen Albert G. Love for ACofS, G-l, 25 Mar 41. HD : 314.
68 DENTAL SERVICE IN WORLD WAR II

Since there were very few vacancies in the Dental Eeserve, it appeared that

dentists inducted into the Army would have to serve as enlisted men in duties

which could be performed equally well by less highly trained personnel. The

Surgeon General warned the War Department that it would be the target of

widespread criticism from the profession and from civilian communities if

the services of badly needed dentists were wasted in relatively minor activities.

2. Selective Service boards were not technically qualified to pass on questions of professional qualifications or ethics, nor were they greatly concerned

with such matters. They therefore tended to induct dentists who could not

have been commissioned by the Army, even if vacancies had existed. In some

instances, in fact, the boards apparently selected for induction those dentists

who were considered least valuable to the community, and such men were

likely to be of doubtful value to the services as well.127

The Surgeon General was powerless to prevent the induction of dentists by

Selective Service, but he attempted, unsuccessfully at first, to provide for the

commissioning of qualified inductees in the Dental Corps. On the same day

that the Selective Service System was established The Surgeon General

reminded The Adjutant General that commissions in the Medical Department

Reserve had been suspended since December 1939 12S and that professional personnel who would later be in short supply would probably be inducted as enlisted men. He recommended that commissions be offered any inducted physician, dentist, or veterinarian, and those who faced imminent induction.129 A

notation on this letter states that it was "returned informally," apparently

without action. Substantially the same request was repeated on 26 October

1940,130 and on 29 October the corps areas were authorized to resume commissioning Medical Department personnel to fill actual vacancies.131 Dental vacancies were practically nonexistent at this time, however, so this directive had

little effect so far as the Dental Corps was concerned. In November 1940 The

Surgeon General asked the corps areas to save the few available dental vacancies for men who might be inducted,132 but even this slight gain was shortlived since the granting of new commissions was again suspended on 8 December

1940.133 Procurement to fill vacancies in the Medical Department was again

resumed on 19 December 134 but The Surgeon General again reported that there

^Interv by the author with Maj Gen R. H. Mills (6 Oct 47) and Maj Ernest J. Fedor (24

Nov 47).

128 Commissions in the Dental Reserve had actually been suspended since September 1938.

129 Ltr, Col Larry B. McAfee to TAG, 16 Sep 40, sub : Appointment in the Medical, Dental, and

Veterinary Corps Reserve. [D]

n3° See footnote 44, p. 52.

131 See footnote 45, p. 52.

132 The original radiogram from The Surgeon General has not been found. It is mentioned in

"Preparedness and War Activities of the American Dental Association : A rSsumeV' J. Am. Dent.

A. 33 : 80, 1 Jan 46.

133 Ltr, TAG to CA and Dept Comdrs, 8 Dec 40, sub : Suspension of Appointments in the Officers'

Reserve Corps. [D]

U4 Ltr, TAG to each CA and Dept Comdr, and SG, 19 Dec 40, sub: Appointments in the Medical

Department Reserve. [D]
THE PROCUREMENT OF DENTAL OFFICERS 69

were almost no vacancies in the Dental Corps.135 A notice in the Journal of

the American Dental Association for December 1940, that any inducted dentist

could apply for a commission, proved premature.136 On 22 January 1941 the

Chief of the Dental Division again recommended that physicians, dentists,

and veterinarians who received low call numbers, or who were inducted, should

be offered commissions,137 but no action was taken at this time.

Meanwhile, other interests had become involved in the matter. Two days

after Selective Service was inaugurated Senator James E. Murray introduced

a bill providing that any licensed physician or dentist who met established

mental and physical standards should be commissioned in lieu of induction.138

This measure also provided for the deferment of medical and dental students,

interns, and residents. At first it was reported that the Army was not opposed

to this bill,139 but on 16 December 1940, the War Department formally registered

its disapproval, based on the following considerations:

1. It was felt that rigid regulations favorable to any one branch were not

justified. If all Medical Department personnel were given commissions on

induction, engineers, lawyers, and other groups would feel entitled to the same

treatment.

2. It was believed that deferment of persons actually essential to the preservation of the nation's health could be accomplished without legislation and that

mandatory legislation would handicap the administration of Selective

Service.140

No final action was taken on this measure before the end of the congressional

session, and substantially the same bill was reintroduced on 6 January 1941.141

Before hearings could be held, however, an amended version was introduced

which provided not only for the commissioning of inducted dentists and the

deferment of students, but for the deferment of teachers in medical and dental

schools.142 Hearings were held on this bill from 18 to 20 March 1941143 and

the Army again opposed passage, adding as another reason the fact that it

did not wish to be placed in the position of having to commission any physician

or dentist who might be inducted, regardless of his professional, ethical, or

1351st ind, SG, 20 Jan 41, to ltr from Lt Col T. W. Wren to CG, 8th CA, sub : Application for

appointment in the Dental Corps Reserve. [D]

130 Fairbank, L. C. : Dentistry in mobilization. J. Am. Dent. A. 27 : 1972, Dec 1940.

Memo, Brig Gen Leigh C. Fairbank for Brig Gen William B. Shedd, 22 Jan 41, sub : Reserve

commissions for physicians, dentists, and veterinarians subject to induction into the military

service. HD: 314.

138 S. 4396, 76th Cong., introduced 18 Sep 40.

is» Committee on Legislation. J. Am. Dent. A. 28 : 989-990, Jun 1941.

140 Ltr, SecWar (Henry L. Stimson) to Hon Morris Sheppard, Chairman, Sen Committee on Mil

Affairs, 16 Dec 40. Quoted in "Report of Hearings Before the Committee on Military Affairs, United

States Senate, 77th Congress, on S. 783, 18-20 Mar 41." Washington, Government Printing Office,

1941, p. 144.

141 S. 197, 77th Cong., introduced 6 Jan 41.

142 S. 783, 77th Cong., introduced 6 Feb 41.

143 Report of Hearings before the Committee on Military Affairs, United States Senate, 77th Congress, on S. 783, 18-20 Mar 41. Washington, Government Printing Office, 1941.
70 DENTAL SERVICE IN WORLD WAR II

moral status.1*

4

Since both medical and dental officers testified against the

measure it must be assumed that in spite of his repeated attempts to get authority to commission inducted dentists The Surgeon General was also opposed to

the Murray bill, probably because it left him no chance to reject the few men

who were undesirable because they had graduated from substandard schools

or because they had engaged in unethical practice. The combined opposition

of the War Department and of Selective Service blocked the passage of this

legislation.

Meanwhile, as The Surgeon General had foreseen, the War Department

was flooded with protests from congressmen, civilian communities, and the

profession, at the wasteful use of physicians and dentists as enlisted soldiers.

Since The Surgeon General was in agreement with these complaints, and had

been prevented from taking corrective action by higher authority, he washed

his hands of the whole matter and referred all protests to The Adjutant General as "pertaining to your office." In January 1941 the Chairman of the

Military Preparedness Committee of the ADA discussed this question with

Senator Claude Pepper, and the latter directed a letter of inquiry to the Secretary of War. When this communication was referred to The Surgeon General, he submitted an analysis of probable needs showing that the Eeserve

would be depleted by June 1942, and again proposed that procurement for the

Dental Eeserve be resumed.145 However, when the ADA in February 1941,

recommended an increase in the Dental Eeserve Corps from 5,100 officers to

8,000 officers, The Surgeon General opposed such action. It was stated later

that he felt that this number of men could not be used, and to enroll officers

in the Eeserve, beyond the number which would be called to active duty, was

equivalent to granting occupational deferment, which was a prerogative of

Selective Service.14614T It must be kept in mind that at this time the country

was still nearly a year away from active participation in the war.

As a result of the recommendations of The Surgeon General, the numerous

protests received, and the threat of legislative action if existing policies were

not changed, the War Department finally, on 5 May 1941, authorized the

granting of a commission to any inducted dentist who was found to be qualified.148 Senator Murray stated that his bill had forced consideration of the

problem, and this was implied, if not admitted, in General Fairbank's statement that the action of 5 May had "followed participation of Army representativesin hearings on the Murray bill."149

144 Ibid.

'«2d ind, SG to TAG, 18 Feb 41, on ltr, SecWar to TAG, 27 Jan 41. SG: 080 (ADA).

«• See footnote 50, p. 53.

147 Camalier, C. W.: Preparedness and war activities of the American Dental Association : A

resumed J. Am. Dent. A. 33 :80, 1 Jan 46.

148 See footnote 48, p. 53.

148 Memo, Brig Gen Leigh C. Fairbank for SG, 25 Feb 42, sub : Procurement of dentists for military

service. HD: 314.
THE PROCUREMENT OF DENTAL OFFICERS 71

The action of the Army in making it possible to offer commissions to inducted dentists solved only half of the problem, however. It still did not prevent the more or less indiscriminate conscription of men who were not immediately needed or wanted by the Armed Forces or who were in essential civilian

positions. By the spring of 1941 Selective Service itself was beginning to

show some alarm over the professional personnel situation, and on 22 April

it cautioned the local boards that a shortage of dentists might impend.150 This

tentative warning was confirmed on 30 April.151 Local boards were then reminded that (1) they still had full responsibility for determining if a dentist

was indispensable in his own community, (2) the Army did not need dentists

for the time being, and (3) if a board felt that a dentist should be inducted

anyway he should be notified that he might apply for a commission as soon as

he entered active duty. This directive had the effect of discouraging the

draft of dentists, though it did not categorically prohibit such action.

In January 1942 Selective Service advised its boards that it was essential

that all dentists be used where their services would do the most good, and it

directed that the recently formed PAS, WMC, be consulted in determining

essentiality.182 This regulation was obviously not intended to confer blanket

exemption on dentists, however, since the boards were notified at the same time

that when dependency was the only cause for deferment it should be kept in

mind that the salary of a commisioned officer was normally sufficient for the

support of a family. In February 1942 the Director of the Dental Division

reported that dentists were still being inducted, and he recommended that

Selective Service modify its regulations to prevent the conscription of Medical

Department personnel except with the advice and consent of the PAS.153 No

formal action was taken on this request, but within 2 months the ADA reported

that Selective Service boards were generally deferring dentists, at least until

the PAS could be placed in full operation.154 In December 1942 Selective

Service again advised the local boards to give careful consideration to the

occupational deferment of dentists,155 and the conscription of professional personnel was thereafter a very minor problem, though it did not cease entirely.

M» Memo, Dir, Selective Service System, for all State Directors, No. 1-62, 22 Apr 41, sub: Occupational deferment of students and other necessary men In certain specialized professional fields (III).

On file Natl Hq Selective Service System.

in Telegram, Dir, Selective Service System, to all State Directors, 30 Apr 41. On file Natl Hq

Selective Service System.

«»Memo, Dir, Selective Service, for all State Directors (1-363), 28 Jan 42, sub: Occupational

deferments of medical doctors, dentists, and doctors of veterinary medicine. In Memoranda to all

State Directors 1940-43. Washington, Government Printing Office, 1945.

168 See footnote 149, p. 70.

154 The procurement and assignment service for physicians, dentists, and veterinarians. J. Am.

Dent. A. 29 : 653, Apr 1942.

165 Selective Service Occupational Bulletin No. 41, 14 Dec 42, sub: Doctors, dentists, veterinarians,

and osteopaths. In Occupational Bulletins 1-44, and Activity and Occupation Bulletin i-35. Washington, Government Printing Office, 1944.

330324 O—55 6
72 DENTAL SERVICE IN WORLD WAR II

As noted above, during the first years of the war Selective Service was

most often blamed for inducting professional personnel who were not wanted

by the Armed Forces. During this period the War Department, WMC, and

the professions tended to deprecate the activities of Selective Service in mobilizing physicians, dentists, and veterinarians as an indiscriminate threat to

essential civilian medical care and to the economic use of scarce personnel, and

late in 1941 all of these agencies approved the formation of PAS, WMC (to

be discussed later in this chapter), as an organization which was expected to

supplant Selective Service in this field. Though liaison between PAS and

Selective Service was imperfect at first, the system was functioning by the end

of 1942, at least to the extent that Selective Service boards were inducting

very few physicians or dentists who had not been cleared by PAS.

Unfortunately, a serious weakness was revealed in this program early in

1943 when voluntary procurement for the Medical Department began to lag.

Fifty percent of all physicians and 17 percent of all dentists declared "available" by PAS refused to accept commissions, and the Medical Corps, in particular, faced a critical and mounting shortage of personnel.156137 But when

the War Department and PAS decided that the time had come for Selective

Service to exercise its powers,168 those powers were found to be inadequate, at

least under existing policies. Among the reasons for this situation, the following were most important:

1. While Selective Service had been criticized for inducting professional

personnel, it had done so only under the same policies that applied to any other

category, according to a priority based mainly on age, physical condition, and

absence of family responsibilities. It was a fundamental principle of Selective

Service that every man should be considered for military service on the basis of

such impersonal factors, and boards were now as reluctant to induct an individual merely because he happened to be a physician or dentist as they had been

to exempt him for the same reason earlier in the war. But the supply of young

professional men with few dependents was small. Because of the long period

of training required, medical personnel tended to be older than their contemporaries in industry; because they enjoyed a good income and constituted a stable

element in the community they tended to acquire families soon after entering

practice. It was now found that in spite of earlier complaints the majority of

physicians, dentists, and veterinarians were immune to induction under current

criteria.

PAS protested that from 70 to 80 percent of all recalcitrants were not subject to induction because of age or dependency.159 One state director reported

*» See footnote 52, p. 53.

157 Another author has declared that 26 percent of 7,259 dentists declared available by PAS

refused to accept commissions. See State Officers' Conference. J. Am. Dent. A. 31: 1574-1576, 15

Nov 44.

168 Ept of Conference between Col Harley L. Swift, Off Dir Mil Pers, ASF, and representatives

of PAS, 20 Mar 43. Off file Mil Pers Div, SGO, PAS file.

159 Minutes of Meeting, Directing Board, PAS, 31 Jul 43. Off file Mil Pers Div, SGO, PAS file.
THE PROCUREMENT OF DENTAL OFFICERS 73

that out of 130 physicians declared eligible, only a handful had been induced to

apply for commissions, and he complained that the remainder were not at all

impressed with the possibility that they might be inducted as enlisted men.160

Even if he were drafted, the professional man had little to fear since he would

in all probability be offered a commission without delay, and he often preferred

to take the slight risk involved when he refused to comply with PAS recommendations. When it was suggested that Selective Service take over PAS'

functions even The Surgeon General was doubtful that the situation would be

improved by such action as long as such a large proportion of professional men

were deferable for age or dependency.161

2. Selective Service regulations were generally drawn up on the assumption

that an inductee would serve as an enlisted man, with an enlisted man's pay and

allowances. In determining eligibility for induction these regulations did not

recognize that the professional man would immediately be commissioned and

enjoy an income adequate to support a family in moderate circumstances.

3. During the first part of the war the Armed Forces, the WMC, and public

officials had repeatedly warned the Selective Service System that it was taking

professional personnel from communities where they would later be needed

urgently, and that such personnel should not be inducted without strong reason.

Now it was becoming clear even to laymen that these warnings had been well

founded, and the growing shortage of physicians and dentists in his own area

made the member of a Selective Service Board extremely reluctant to approve

the induction of additional men in these categories, even at the request of

PAS.162

The only solution to this problem was for Selective Service to place a call

on its local boards for the required number of physicians and dentists on an

occupational basis. As noted above, however, this action would have been a

radical departure from established policies, and as such it was extremely distasteful to the Selective Service System. Prior to this time no man had been

inducted merely because he happened to be a cook or truck driver who was

critically needed by the Armed Forces, and any modification of this principle

was regarded with apprehension by that agency. Butthe situation in respectto

professional personnel was not entirely comparable to that of cooks and truck

drivers; unlike the latter, physicians and dentists could not be trained in a few

weeks or months in an emergency, and they could be obtained in large numbers

only from civilian life. If the normal operation of Selective Service failed

to produce the number required, more drastic steps were necessary. In October

1943 the War Department reluctantly made a formal call on Selective Service

for the conscription of 12,000 physicians.

MO Ltr, Dr. Creighton Barker to Lt Col Durward G. Hall, 27 Dec 43. [D]

181 See footnote 69, p. 55.

M

2

Interv between the author and Maj Ernest J. Fedor, Dental Liaison Off, Mil Pers Div, SGO,

25 Nov 47.
74 DENTAL SERVICE IN WORLD WAR II

The dental personnel situation, which had always been less critical than

the medical, was much improved by the summer of 1943, and dentists were

not included in the proposed draft of physicians. In fact, other developments

eventually prevented even the proposed induction of physicians, but not until

an important precedent had been established; it was finally recognized by

the Armed Forces, PAS, and Selective Service that the latter might have

to undertake the priority induction of specific groups whose special skills were

essential to the national defense if sufficient personnel could not be procured

voluntarily.163

From the end of 1942 until May 1946 Selective Service played a small

part in the procurement of dental officers and very few dentists were inducted

as enlisted men. Sixty-one applications for commissions were received from

conscripted dentists during 1943, of whom 46 were accepted.164 Only seven

officers were commissioned from the ranks from 1 January 1944 through August 1945. Thirty-five applications were rejected in the same period but this

figure means little because men who were refused commissions could, and did,

make new applications at frequent intervals; it is probable that most of the

applications received in 1944 and 1945 came from men who had been rejected

for good reasons a year or more before.165

With the end of hostilities the dental personnel picture began to deteriorate

and Selective Service again became a factor in procurement. ASTP had

graduated its last dental student in the spring of 1945. The shortage of

civilian dentists was acute, and even recent graduates could count on incomes

of as much as $10,000 yearly in private practice. Above all, effective pressure to volunteer for military service for patriotic reasons was almost eliminated. Yet the Army still had several million men scattered all over the

world who had to be furnished dental care. Under these circumstances the

military had no alternative but to ask for a draft of dentists.166 This draft

shattered all precedents for it was the first and only time during and immediately following the war that Selective Service asked its boards to induct men

from a specific occupational group.1*

57 (Very few dentists were actually

drafted in 1946 since the Army took every precaution to insure that men threatened with induction would be offered commissions with the least possible

delay.) 168

Information on the number of dentists who actually served any considerable time as enlisted men during the war is indefinite. Selective Service re188 This principle was later made the basis for the draft of dentists in 1946.

»«History of the Army Dental Corps, Personnel, 1940-43, p. 41. HD: 314.7-2 (Dental).

186 Info compiled by the author from annual procurement summaries received from the Mil Pers

Div, SGO.

188 Memo, Maj Gen Norman T. Kirk for ACofS, 6-1, 17 May 46, sub : Procurement objective for

Dental Corps officers. SG : 322.0531.

187 Info given the author by Dr. Matheus Smith, Natl Hq, Selective Service System, 24 Nov 47.

168 Col (later Brig Gen) James M. Epperly, Dental Div, SGO, estimated that only about 4 dentists

were inducted by their boards before they could be granted commissions. Personal interv with author,

10 Nov 47.
THE PROCUREMENT OF DENTAL OFFICERS 75

ports that 558 dentists were inducted and that 49 enlisted during the life of

that agency.169 Army records, on the other hand, indicate that only 263 inducted dentists and 14 who enlisted voluntarily were commissioned between

1 January 1941 and 30 June 1945.170 A few additional were commissioned after

30 June 1945, but the total number of enlisted dentists commissioned by the

Army probably did not exceed 300 officers. Since the Navy did not accept

any inducted dentists1T1 these figures, if correct, would indicate that some 300

dental graduates actually continued to serve in enlisted status.

This conclusion is open to question, however, on the following grounds:

1. A few dentists who were inducted against the advice of the Army after

the middle of 1944 were immediately discharged. In AGO records these men

would be shown to have been discharged as enlisted men, though their period

of service was extremely short.

2. It is probable that a certain number of laboratory technicians, dental

assistants, or even dental students, were mistakenly listed as "dentists" in

Selective Service forms. These men would of course not be eligible for commissions in the Army.

Col. Louis H. Eenfrow, of the Selective Service System, has said that "all but

a very few" of the inducted dentists were commissioned.172 Similarly, Maj.

Gen. Kobert H. Mills stated that only a handful of inducted dentists were

not commissioned.173 On the other hand, Maj. Ernest Fedor, formerly of the

Military Personnel Division, SGO, reported that that office received some 100

to 125 applications for commissions which were rejected for various reasons,

including the following:

1. A few unfortunates were unable to convince a board of line officers

that they possessed the superior intelligence, or met the generally higher

standards, demanded of an officer.

2. Some applicants were refugee dentists of doubtful background and

ability who had volunteered for military service as an aid to establishing

citizenship.

3. Some dentists held no state licenses, or had not practiced since graduation from dental college. Others had abandoned the practice of their profession for many years. The Army refused to commission such personnel.

4. Some dentists had been engaged in grossly unethical practice or had

been convicted of felonies.

5. A few dentists actually refused commissions because they were in locations near home which they feared to lose, because they preferred their current

1M Personal Itr, Col Louis H. Eenfrow, Selective Service Natl Hq, to the author, 10 Sep 47.

HD: 314. 1.0 Info given the author by Mr. Kirkman ,T. Rhodes, Strength Accounting Br, AGO, 8 Sep 47.

1.1 Info given the author by Comdr J. V. Westerman, Bu Med and Surg, USN, 25 Nov 47.

in Eenfrow, L. H.: Dentistry in the Selective Service System. The Mil. Surgeon 101: 423,

Nov 1947.

See footnote 127, p. 68.
76 DENTAL SERVICE IN WORLD WAR II

duties, or because they felt their opportunities for an early discharge were

better as enlisted men than as officers.

The Army could not use the above categories in its clinics, and it is doubtful

if any useful purpose would have been served by releasing most of them to

return to civilian life.

It seems probable that a little over 100 men technically classified as dentists

served as enlisted men in the Army during the war. On the other hand, there

is every indication that most dentists whose qualifications were not open to

serious question were either offered commissions or discharged. This opinion

has been confirmed by the Selective Service System,174 the Dental Division,175

and organized dentistry.176

The Procurement and Assignment Service,

War Manpower Commission

The background and activities of the Procurement and Assignment Service

are covered in detail in Lt. Col. Alfred Mordecai's "History of the Procurement and Assignment Service for Physicians, Dentists, Veterinarians, Sanitary

Engineers, and Nurses, War Manpower Commission."177

Briefly, PAS was formed in October 1941 as a Division of the Office of

Defense Health and Welfare Services. Its mission was to insure that scarce

medical personnel would be used to the best advantage of all concerned, so that

the needs of the Armed Forces and of critical defense areas could be met with

minimum hardship for the civilian population. In April 1942 PAS was transferred to the War Manpower Commission and functioned under that bureau

for the remainder of the war. From the beginning, PAS was operated in close

cooperation with the Armed Forces, IISPHS, the civilian professions, and the

Selective Service System. At the time of its organization PAS consisted of

the following:

1. A central policy board of 5 members (later increased to 8), including

Dr. C. Willard Camalier as a representative of the dental profession.

2. Nine advisory subcommittees (later increased to 15) which were concerned with the various medical branches. At first a single committee on dentistry was included, but later a separate committee on dental education was

added.

3. Nine corps area subcommittees, each consisting of 2 physicians, 1 dentist,

1 medical educator, 1 dental educator, 1 veterinarian, and 1 hospital representative. These corps area subcommittees were at first expected to be the

principal operating units, but they proved unwieldly and the state subcommittees eventually assumed most administrative functions.

m

See footnote 172, p. 75.

«s See footnote 127, p. 68.

"« See footnote 147, p. 70.

177 See footnote 52. p. 53.
THE PROCUREMENT OF DENTAL OFFICERS 77

4. Thirty-nine state subcommittees (some covered more than one state;

one state had two committees) consisting of a chairman and subordinate committees on medicine, dentistry, veterinary medicine, and, eventually, sanitary

engineering and nursing. The chairman of the state dental committee was

nominated by the state dental society and he, in turn, nominated the members

of his committee.

5. County or district subcommittees for each profession, as required.

Chairman of these committees were nominated by the district or county dental

societies, and in turn they nominated their own assistants. These committees

were advisory only, and no one but the state chairman could declare a dentist

available, but as a matter of custom the recommendations of the local chairmen

were accepted in the absence of compelling reasons to the contrary.

6. The Professional and Technical Employment and Training Division of

the War Manpower Commission. Though a separate agency, this unit assisted

PAS by maintaining rosters of medical personnel, with data on special qualifications, if any.

When PAS began to function, early in 1942, it met a definite need in the

procurement picture. As long as most physicians and dentists were obtained

from the Reserve, with very few commissions granted to men with no military

experience or training, The Surgeon General was able to contact prospective

officers, pass on their professional qualifications, and place them on active duty.

Even when larger numbers of dentists had to be procured he was able to decentralize this function to corps area Medical Officer Recruiting Boards with

fair success. But when it became necessary for the Army and Navy to take

nearly 30 percent of all the dentists in the United States it was essential to insure

not only that the Armed Forces got the officers they required, but that the reasonable needs of the civilian population, especially in critical defense areas,

were considered. Selective Service was familiar with local conditions but it

lacked the technical information for such a project, and its efforts to procure

medical personnel before the inauguration of PAS generally resulted only in

increased confusion. Very early in the war the professional societies had attempted to list all professional personnel and record essential data on specialties,

and at first they made some effort to induce younger men to volunteer for military service, but many dentists failed to return questionnaires,178 and the men

who were "selected" for Army duty by their colleagues were resentful and

inclined to question the justice of the method followed. No matter how impersonal the proceedings, when a society tried to decide which of its own members were most eligible, the resulting protests and charges of favoritism

generally made it glad to turn the whole problem over to an impartial, semiofficial agency with no axe to grind.

The PAS agreed to produce the required officers for the Army, advise

Selective Service concerning the availability of medical personnel, and assure

ira Committee on Dental Preparedness, Resume of activities. J. Am,. Dent. A. 27 : 1970, Dec 1940.
78 DENTAL SERVICE IN WORLD WAR II

the dental profession and the nation that dental manpower would not be wasted

and that the needs of local communities would be considered. To carry out

these aims it inaugurated two projects: (1) It made a strong effort to list every

dentist in the country with supplementary data on special abilities, educational

background, age, dependents, et cetera. (2) It set up the mechanism for determining how many men could be spared from any given area, selecting those who

were most eligible and declaring them available to the military.

The ADA had originally sent out a questionnaire to all dentists for whom

it could obtain addresses in October 1940,179 but lists were incomplete and the

response was not too good; over a year later only 75 percent of the questionnaires had been returned, and in some states only about half of the dentists

replied.180 The questionnaires received by the ADA were eventually turned

over to PAS and they provided useful information in the first stages of that

agency's operations, but PAS found it necessary to cooperate with the National

Eoster of Scientific and Specialized Personnel in sending out new questionnaires in February 1942.181 Data so obtained were available to the Central

Board, State Chairmen, or the military.

The question of the availability of dentists for military duty involved several factors, including the following:

1. How many dentists were in practice in the United States?

2. How many dentists would be required to meet the minimum needs of the

civilian population ?

3. Which areas could best spare the dentists needed by the Armed Forces?

An overall survey of medical personnel had been made very early in the operation of PAS, but at first local chairmen were relied upon to determine the availability of dentists.182 This policy did not prove satisfactory, however, for the

following reasons:

1. Dental manpower was distributed very unevenly over the nation. Some

cities had more than one dentist for every 1,000 persons, while some rural areas

had less than one dentist for 5,000 individuals. PAS representatives in the

latter districts felt called upon to deliver at least a few dentists, though they

could not, in fact, be spared. The representative in a big city might declare a

large number of men available and still obtain only a small proportion of the

dentists which could have been taken without endangering civilian practice.

2. The southern states, which generally had the lowest proportion of

dentists to total population, had already supplied the most dentists on a volunteer basis during 1940 and 1941.

3. No uniform yardstick had been established by which local chairmen

179 Committee on Dental Preparedness. J. Am. Dent. A. 27 : 1658, Oet 1940.

180 Procurement and assignment agency for professional personnel in the Army. J. Am. Dent. A.

28: 2026-2030, Dec 1941.

181 See footnote 52, p. 53.

183 See footnote 19, p. 42.
THE PROCUREMENT OF DENTAL OFFICERS 79

could determine how many dentists should be retained to meet the reasonable

needs of the civilian population.

In June 1942 the directing board of PAS decided to undertake a nationwide survey of dental resources as a basis for establishing state allocations,183

The Committee on Dentistry carried out this survey with the assistance of

USPHS and the results were reported on 20 February 1943.184 The findings

of this committee have already been discussed in this chapter under "Limitations on the Number of Dentists Available from Civilian Practice."

When it had been determined how many dentists were in practice in any

area, and how many were required for civilian care, state chairmen were

assigned quotas based on current military needs. When procurement reached

its fastest tempo in the first months of 1943 PAS was obligated to declare 400

dentists available each month.185

The first procedure adopted by PAS and The Surgeon General for the

procurement of medical personnel involved the folowing steps:186

1. The Surgeon General notified the central office, PAS, of his requirements for officers.

2. The central office, PAS, made up lists of names from its files and forwarded them to the SGO liaison officer with the appropriate professional

organization for ethical and educational clearance.

3. The SGO liaison officer sent the lists to the state PAS chairmen concerned. The latter eliminated all men considered essential and returned the

liststo the central office, PAS.

4. The central office, PAS, mailed individual application forms and

authorizations for a physical examination at an Army installation.

5. Physical examination reports were mailed, by the surgeons completing

them, directly to The Surgeon General. Completed applications were returned

by the individual to the central office, PAS, where they were checked for

accuracy by an SGO liaison officer, and if correct they were sent to The

Surgeon General.

6. If the applicant was acceptable to The Surgeon General all papers in

the case were forwarded to The Adjutant General, who offered the man a

commission. The Surgeon General notified any applicant whose request for

a commission was rejected.

This system proved to be very cumbersome in operation and it was simplified considerably in the spring of 1942 when the Medical Officer Recruiting

Boards were established by The Surgeon General. These boards were organized in each state, with authority to contact prospects, pass on their professional

qualifications and ethical standing, and offer commissions in the grades of

183 See footnote 18, p. 41.

184 See footnote 19, p. 42.

186 See footnote 52, p. 53.

">Ibid.
80 DENTAL SERVICE IN WORLD WAR II

lieutenant or captain on the spot. The boards often set up their offices in the

same quarters occupied by the state PAS, and cooperation was close and

informal. PAS retained the sole right to declare any man available, however,

and the boards were instructed to process no physician or dentist who was not

cleared by the state PAS chairman.187188189

When the functions of the Medical Officer Kecruiting Boards were taken

over by OPS, ASF, at the end of 1942, The Surgeon General again had to

pass on the acceptability of applicants and the procurement process again

became more complicated. The field offices of OPS then contacted prospects in

cooperation with local PAS representatives, completed applications, and forwarded them to The Surgeon General. If the prospective officer appeared to

be acceptable his application was sent to the central office, PAS, which forwarded it to the state chairman for clearance as to availability. The latter

sent the application to the SGO liaison officer with the appropriate professional

society for ethical and professional clearance, and it was then returned to The

Surgeon General for final action. The clearance of the state PAS chairman

was an essential part of the application.

When professional personnel who had been declared available by PAS

refused to apply for commissions the case was turned over to Selective Service

for appropriate action.

Opinions concerning the effectiveness of PAS, in respect to the procurement of dentists, varied. Certainly some agency was needed to determine

availability and advise Selective Service and The Surgeon General on matters

affecting medical manpower. This function PAS seems to have performed

with reasonable satisfaction. But its name suggested that PAS was expected

to go further and actually present to the Armed Forces the names of qualified

men who would accept commissions if they were physically fit, and in this

activity it was less successful. Half of the physicians declared available, and

a smaller proportion of the dentists, refused to volunteer for military service.

In the critical days of early 1943 both the Army and Navy expressed considerable dissatisfaction concerning PAS' inability to provide replacements. The

agency was accused of "pussyfooting" and it was stated that PAS chairmen

should "get tough," that younger men were needed as state chairmen, or even

that Selective Service should take over PAS functions. The shortage of dental

officers was less acute than that of medical personnel, but a representative of the

Dental Division also expressed some concern over the lagging procurement of

dentists during the first 2 months of 1943. Much of this criticism seems to

have stemmed from a misunderstanding of the limited powers of PAS and

of its proper function. If the PAS had had effective backing from Selective

Service any man declared available would have hurried to apply for a com187 Ltr, TAG to CG, 1st CA, 28 Apr 42, sub : Medical Officer Recruiting Boards. AG : 210.31.

188 Memo, SG for Medical Officer Recruiting Boards, 27 May 42, sub: Memorandum, to Medical

Officer Recruiting Boards. Natl Archives, PAS flies, WMC.

189 Ltr, SG to Medical Officer Recruiting Boards, 20 .Tun 42 : Instructions. [D]
THE PROCUREMENT OF DENTAL OFFICERS 81

mission to prevent his induction as an enlisted man, but it was apparent from

the start that professional personnel were not much worried over the possibility of being drafted.190 The Assistant Executive Officer of Selective Service

himself admitted that his organization had had great difficulty in supporting

the OPS in its efforts to obtain medical officers and that local boards often

refused to take the advice of PAS.191 PAS was an advisory body only; it had

no authority to apply official pressure to recalcitrants. It could supply technical knowledge which Selective Service did not possess, but Selective Service

had to exercise any compulsion required. It would therefore appear that the

first consideration, if an agency similar to PAS is to be established in the

future, should be a definite arrangement for effective cooperation between that

body and Selective Service.192

PAS was also criticized by a representative of the Dental Division for

failing to pass on the ethical qualifications of dentists. It was stated that local

PAS personnel were afraid to commit themselves in doubtful cases, merely

declaring the man available and leaving it up to The Surgeon General to refuse

or accept him.193 This, again, would appear to have been the proper function

of The Surgeon General's liaison officers with the professional societies, rather

than of PAS.

It was also inevitable, with so much at stake, that personalities and professional jealousy should sometimes enter the picture. PAS necessarily had to

give the directors of schools and hospitals a certain amount of freedom to determine which members of the staff were essential and which could be spared.

One hospital director was categorically accused of using his influence in this

respect to force younger physicians to play his political games under threat

of induction into the Army.194 It was also felt that methods used by local personnel were not always wisely chosen. It was reported, for instance, that in

some large cities, where individuals could not be known personally, the local

chairmen contacted the supply houses to see who ran up the largest bills, and

declared these men essential on the grounds that they were obviously doing

the most work!195 Such abuses were apparently infrequent, however, and there

seems to be no reason to believe that PAS was not as impersonal in its actions

as any human agency could be. Certainly PAS personnel gave unselfishly of

their time and energy in a thankless job.

180 See footnote 160, p. 73.

101 Ltr, Eichard H. Eanes, Asst Exec Off, Selective Service System, to Maj Gen Geo F. Lull, 21

Mar 44, sub : State Director advice No 206. [D]

102 It must be admitted, however, that local PAS representatives were sometimes suspected of

declaring medical personnel available under pressure from higher authority, and then informing

Selective Service Board members that they did not actually believe these individuals could be spared.

Information from Maj Ernest Fedor, given the author 25 Nov 47.

im See footnote 21, p. 44.

104 The confidential letter carrying this accusation has been seen by the author, but no useful purpose would be served by divulging the names of individuals and Institutions concerned.

185 See footnote 162, p. 73.
g2 DENTAL SERVICE IN WORLD WAR II

At the end of the war the Director of the Dental Division stated that PAS

had proved "workable."196

After giving PAS credit for preventing the induction of dentists as

enlisted men, to which it was not entitled, the American Dental Association

noted that:197

The Procurement and Assignment Service, through its State and local committees,

brought the selection of dentists for service down to a level where local factors could

play an important part. Admittedly, it did not work perfectly, and inequalities can

be found without too much research. But the fact remains that the Procurement and

Assignment Service did a better job than any previous similar agency. Dentists

should see to it that, in any future crisis, it is given sufficient authority to make its

program more effective.

PAS took a very minor part in dental procurement for the Army after

9 December 1943.

Medical Officer Recruiting Boards

As it became necessary to procure large numbers of medical personnel

directly from civil life in 1942 The Surgeon General was authorized to establish decentralized boards which could locate prospective officers, pass on their

professional and ethical standing, and offer them immediate commissions in

one of the two lower grades without reference to the SGO. The corps areas

were instructed to form these boards in April 194219S but they were of minor

importance to dental procurement for several months since there were very

few vacancies in the Dental Corps at that time. When The Surgeon General

was authorized a new procurement objective of 4,000 dentists in July 1942, it

was directed that a dental officer would be added to each of the 30 boards which

were then operating in 25 States.199 The Surgeon General's objective was

reached very rapidly, and dentists were removed from the remaining boards

on 1 September 1942.200 At the same time the boards were instructed to process

no more dental applications except for men classified I-A by Selective Service.

Initial quotas for physicians were also being met, and the first board had

already been closed for this reason on 26 June 1942. By 21 October 1942 most

boards had suspended operations because there was no longer a need for their

services. The OPS, ASF, came into operation in November 1942, and the

Medical Officer Eecruiting Boards did not have an opportunity to demonstrate

their effectiveness in the personnel crisis of 1943.

The Medical Officer Eecruiting Boards were more important to the Medical

Corps than to the Dental Service and they are discussed at length in other

sections of the Medical History. In general, Medical Department officers,

"• See footnote 122, p. 65.

l« The right to gripe : The fifth freedom. J. Am. Dent. A. 33 : 118-122, 1 Jan 46.

1M Ltr, TAG to CG, 1st CA, 28 Apr 42, sub : Medical officer recruiting boards. AG : 210.31.

»• See footnote 62, p. 54.

200 See footnote 64, p. 55.
THE PROCUREMENT OF DENTAL OFFICERS 83

working closely with PAS, were able to approach individuals and professional

societies more effectively than laymen, and the activities of the Medical Officer

Recruiting Boards were compared favorably with those of the nonprofessional

Officer Procurement Service Boards which succeeded them. The fact that

nearly 4,000 dentists were commissioned in less than 2 months showed that

boards operating under The Surgeon General could play an important part

in dental procurement if the need arose and they had the opportunity.

Officer Procurement Service, ASF

On 7 November 1942 the War Department directed that all direct commissions from civil life would thenceforth be handled through an Officer Procurement Service operating under ASF.201 For most branches of the Army,

officer replacements were being obtained largely from officer candidate schools

at the end of 1942, and very few men without previous military experience were

being considered. Instructions given OPS indicate that no small part of its

mission was to keep a tight rein on direct commissions from civil life, to keep

them to a minimum, and this negative attitude seems to have colored its early

operations. But the Medical Department was faced with a different problem;

it needed officers and it needed them in a hurry, and they could be obtained

only from civil practice. The Surgeon General made no secret of the fact

that in his opinion OPS hindered rather than helped procurement, and that it

was a poor substitute for his own Medical Officer Eecruiting Boards.

Soon after OPS started to function in February 1943, The Surgeon General expressed great dissatisfaction with the results attained and recommended

that if no improvement were noted by the end of March, the Medical Officer

Recruiting Boards be reestablished. On the same day the Dental Division

complained of the slow procurement of dental officers since the first of the

year, and the delay was blamed on OPS since PAS reported that the needed

dentists were available. By May 1943 the dental personnel situation was less

disturbing, but the shortage of medical officers remained so acute that the

SGO began to consider a special conscription by Selective Service.202 The procurement of medical officers continued to lag until ASTP graduates became

available, but whether the difficulties encountered were due to deficiencies of

OPS, or to the factthat civilian medical resources were approaching exhaustion,

is a matter of opinion. Since the procurement of dental officers under OPS

offered no problems not common to all Medical Department procurement,

detailed discussion of that agency will be left for the general medical administrative history.

American Dental Association

The American Dental Association was of course deeply interested in the

procurement of dental officers. Soon after the start of hostilities in Europe

P" WD Cir 367, 7 NOT 42.

«" See footnote 69, p. 55.
84 DENTAL SERVICE IN WORLD WAR II

in the fall of 1939, the Director of the Dental Division asked the ADA to

establish a committee to consult and cooperate with the military.203 At the time

no action was taken, but when the request was repeated in December a "Committee on National Defense" (later called the "Committee on National Preparedness") was appointed without further delay.204 Corresponding committees were formed in each state.

It appears that The Surgeon General initially expected the ADA to play

a major role in the procurement of dental officers, and in July 1940, he specifically requested the Association to undertake the following program:205

1. The Association to conduct a survey of the dental profession through

itsstate and local societies.

2. The local societies to canvass their members to determine which of

these would be willing to serve, which could be spared for military service,

and which should remain at home because of age, physical disability, or essentiality in civilian capacity.

3. The local societies to list those who wore selected for possible military

duty according to their professional qualifications, listing as oral surgeons,

prosthetists, etc., only those of outstanding ability. Also, to select qualified men

to serve on examination boards.

4. The state societies to maintain a roster of all available members.

5. The American Dental Association to maintain a numerical roster of

available men, by states.

6. The Medical Department of the Army to have one or more selected

officers on duty with the American Dental Association when and if necessary.

7. The War Department, corps areas, or regional officers to call upon the

American Dental Association for dentists by specialties, as and when required.

8. The American Dental Association to call upon the states according to

their quotas for the dentists required; the states, in turn, to call upon the

local societies for their quotas.

The plan discussed above would have placed almost the entire burden of

procurement on the ADA; the Army was merely to request a certain number of

dentists with the desired qualifications and the ADA was to deliver them. The

Association would have assumed the duties later assigned to PAS in that it

would have had to determine local needs, specify the dentists which could be

spared, and maintain a roster according to individual qualifications. In addition it would have accepted much of the responsibility of Selective Service

in determining individual eligibility for military duty and, presumably, in

exerting the pressure necessary to induce dentists to accept commissions in the

Army.

The ADA was apparently favorably inclined toward the plan because

it would give some assurance that dentists would not be taken indiscriminately,

203 President's Page. J. Am. Dent. A. 28 : 982, Jun 1941.

2M See footnote 154, p. 71.

205 Ltr, Maj Gen James C. Magee to Dr. Arthur H. Merritt, Pres ADA, 6 Jul 40. SO : 080 (ADA) T.
THE PROCUREMENT OF DENTAL OFFICERS 85

without regard to the needs of their communities, and because it would give

the organization an opportunity to perform a valuable service.

A program for an immediate survey and classification of all civilian dental

personnel was submitted to the Board of Trustees of the ADA in September

1940 206 n was appr0ved without delay and $20,000 appropriated for the

purpose, in addition to $5,000 for expenses of the Preparedness Committee.

Questionnaires were mailed in October of the same year.

Unfortunately, serious defects soon developed in the scheme to use the

ADA as the principal dental procurement agency. The Association lacked official status, and about 25 percent of the questionnaires sent to individual dentists were ignored. Also, the local ADA officers were too close to their membership to have the objective attitude and impersonal status required of any official

who is to determine which men will be taken from the community for military

service. There is no evidence that the endeavors of the ADA in this respect

were anything but disinterested, but some dentists objected strongly to being

picked for the Armed Forces by their competitors, and charges that political

influence was being exerted were inevitable under the circumstances. Antagonism resulted among local members, and the whole task soon proved very

distasteful to those who had to carry it out. Further, when a dentist refused

to accept a commission after being recommended by the ADA the latter had

no authority to enforce its decision.

The ADA was happy to relinquish its thankless task to PAS in 1942. It

played an important part in the inauguration of that organization, and it

maintained close liaison with it throughout the war.207 It turned over to PAS

the data it had obtained through its survey of civilian dentists, providing

that body with much valuable information on which to proceed while plans

were being made for PAS' own survey of June 1942. The ADA also cooperated

closely with the Dental Advisory Committee of the Selective Service System.208

The ADA rendered an important service to The Surgeon General by

assuming responsibility for determining the professional and ethical status

of prospective dental officers. In May 1942 209 a representative of the SGO

was placed on duty with the national headquarters of the ADA and the

Association furnished him the information on which to decide whether or

not a man's standing in the profession made him acceptable for the Army

Dental Corps. Membership in the ADA was not required, but dentists who

did not meet recognized ethical standards, who were graduates of substandard

schools (mainly foreign), who did not possess valid licenses to practice, or

who had been convicted of serious offenses, were rejected for military service

in the Dental Corps.

JM See footnote 203, p. 84.

*" Committee on Dental Preparedness: A procurement and assignment agency. J. Am. Dent. A.

28: 2057-2060, Dec 1941.

*» See footnote 147, p. 70.

«»WD SO 131, 19 May 42.
86 DENTAL SERVICE IN WORLD WAR II

The part played by the ADA in the rehabilitation programs for Selective

Service registrants is discussed in chapter VI.

The ADA consistently objected to the induction of dentists and dental

students as enlisted men. It backed the Murray bills to commission inducted

dentists and defer dental students and instructors, and it made vigorous

efforts to have the Dental Eeserve increased in 1940 and 1941 to permit the

commissioning of inducted dentists.210 It also sponsored a plan to provide

care for the patients of dentists in the Armed Forces and to keep the latters'

practices intact untiltheir return.211

ATTRITION IN THE ARMY DENTAL CORPS

In the period from 7 December 1941 through 31 December 1946, 2,107

dental officers were lostto the Army, as follows:212 213

Cause Total Cause Total

Killed in action 20 Over 38, no suitable assignment 448

Died of wounds : 5 Key man in industry or GovernDeclared dead 0 ment 3

Missing in action (subsequently re- Hardship 8

turned to duty) 1 Honorable discharge 4

Captured 38 Resignation 64

Deaths from accident, aircraft 8 Reclassification, honorable and other

Deaths from accident, not aircraft— 15 than honorable 28

Died of disease 56 Dishonorable discharge 6

Suicide 2 Conditions other than honorable 20

Other nonbattle deaths 10 Other 12

Retirement 15 Unsatisfactory service 2

Physically disqualified 1, 328 Necessary to national health 1

Overage 4

(See chapter IX for losses due to demobilization.)

From 7 December 1941 to 30 June 1945, an average of about 50 dental

officers were lost each month, for all causes. This was a rate of about 5.2 percent

a year of the average of 11,400 dental officers on duty during this period. This

rate was far from uniform, however, and was artificially stimulated in 1944

to permit replacement of some veterans by younger ASTP graduates.

In general, combat losses, or discharges for disabilities resulting from

wounds, were almost negligible so far as the overall manpower problem was

concerned. Only 20 dentists were returned to the Zone of Interior for serious

injuries during the period 7 December 1941 through 31 December 1946, and not

all of these officers were lost to the Service. Thus, losses from battle action

a

° See footnote 147, p. 70.

» Ibid.

212 Casualty data are for the period 7 December 1941 through 31 December 1946. Army Battle

Casualties and Nonbattle Deaths in World War II, Final Report, 7 Dec 41-31: Dec 46. Strength and

Acetg Br, AGO. M

Statistics for the remaining causes are for the period 7 December 1941 through 30 June 1945.

Compiled from data on file in the Personnel Stat Unit, Administrative Services Div, AGO.
THE PROCUBEMENT OF DENTAL OFFICERS 87

(killed, died of wounds, captured, or missing) amounted to 1.5 percent of the

mean Dental Corps strength overseas during the 4 war years, or about 0.38

percent per year. (See also chapter IV, p. 117, for casualty data, 7 Dec 41-

31 Dec 46.)

Administrative discharges accounted for 624 separations, or 30 percent

of the total. Of these, 448 were men over 38 years of age who were released to

create vacancies for younger ASTP graduates, and to the extent that these

separations were optional they need not be considered in the personnel problem.

By far the largest proportion of all losses, 63 percent, were due to physical

disqualification. The 1,328 dentists discharged for this reason in the period

reported amounted to 12 percent of the average of 11,400 officers on duty, or

about 3.5 percent each year. It has already been pointed out that few physical

discharges resulted from battle injuries; most represented normal attrition

under the stresses of wartime conditions. These losses were understandably

higher than in peacetime when retirements for physical disability had amounted

to about one-half of 1 percent a year.

About 45 dentists, or 0.4 percent of the average strength for the period,

were released under conditions "other than honorable." This was only 0.25

percent of about 18,000 dentists on duty at some time during the emergency.

During the first 2 years of the war the Dental Corps was primarily concerned with obtaining enough officers to staff its expanding installations and

some dentists were accepted who, for physical or other reasons, had a less than

average work capacity. By 1943, however, the Army was approaching relative

stability and it was possible to place greater emphasis on physical fitness

and efficiency. Also, the ASTP was expected to supply a large number of

graduates who had been given deferment from military service and had received

at least a part of their training at Government expense. It was highly desirable thatthese men be taken into the Dental Corps rather than released to return

to civilian practice. Finally, a certain amount of "turnover" in the Dental

Service was necessary to provide a balanced force from the standpoint of age

and total service. Efforts to improve the efficiency of the Dental Corps and to

create vacancies for young replacements took two main directions: (1) to

relieve from active duty those officers whose physical condition limited their

assignment or prevented them from working normal hours, and (2) to eliminate

those few officers whose efficiency was below accepted standards.

Release of Limited Service Officers. As early as July 1943 the War

Department had directed that line officers qualified only for limited service

might be released, but physicians, dentists, and chaplains had been specifically

excepted.2" A similar order of 1 November 1943 applied to dentists,215 but

2" Radiogram, Maj Gen M. G. White, ACofS G-l, 10 Jul 43, quoted verbatim in History of the

Army Dental Corps, 21 Feb-1 Apr 44, Bi-weekly Dental Service Reports. HD : 024.

a« Ltr, TAG to CGs AAF, AGF, ASF, 1 Nov 43, sub : Instructions relative to retention of officers

on active duty for limited service. AG : 210.85.

33032:4 0—55 7
88 DENTAL SERVICE IN WORLD WAR II

was again modified in January 1944 to exclude physicians, dentists, and chaplains.216 In February 1944 the Director of the Dental Division recommended

that dental officers once more be included in the category which could be separated when found eligible only for limited service, but at the time no action

was taken. In March 1944, with the urgent need for creating vacancies for

prospective ASTP graduates (see discussion this chapter, pp. 56-59), this recommendation was resubmitted, and on 18 April 1944 The Adjutant General

published a directive providing that dental officers were to be released if:

(1) they had been commissioned for general service and were later found to be

qualified only for limited service, or (2) if they had originally been accepted

for limited service but had suffered deterioration of their physical condition

while in military service.

Some difficulty was encountered in persuading all concerned to give effective support to the policy of April 1944. In August 1944 ASF complained that

even retiring boards were returning limited service dentists to active duty with

the recommendation that they be used in administrative functions when they

could not work at the chair.217 ASF pointed out the lack of administrative

positions in the Dental Service and advised that since plenty of physically

qualified young dentists were available from ASTP the retention of limited

service officers was not desired. About 2 months later, however, the policy of

ASF was modified by the War Department to permit major commands to

retain limited service dental officers if it could be certified that their services

were required and could be used efficiently.218

Except for a few senior students the dental ASTP had been terminated by

the end of 1944 and replacements were more difficult to find. The Surgeon

General therefore abandoned the attempt to have all limited service dentists

released,219 and on 23 December 1944 220 the ASF directive which made the

separation of such officers mandatory was rescinded. It cannot be determined

how many dental officers were released under this program since they were

included in the larger category separated for physical disabilities. Also, many

officers classified for limited service only were separated under other provisions, especially those pertaining to the discharge of personnel for whom

no suitable assignment could be found. At any rate the number of limited

service dental officers released as such was unimportant in the overall personnel

picture.

Release of Officers for Whom, no Suitable Assignment Existed. The first

general attempt to separate the less efficient officers, other than those in the

limited service category, was made in December 1943 when The Adjutant

210 Ltr, TAG to CGs, AAF, AGF, ASF, 13 Jan 44, sub : Instructions relative to retention of officers

on active duty for limited service. AG : 210.85.

217 ASF Cir 272, 24 Aug 44 ; ASF Cir 274, 23 Aug 44.

»s WD Cir 403, 14 Oct 44.

2,9 Memo, Maj Ernest J. Fedor for Dir Mil Pers Div, 28 Nov 44, sub : Belief from active duty of

Dental Corps officers. HD : 314.

ASF Cir 420, 23 Dec 44.
THE PROCUREMENT OF DENTAL OFFICERS 89

General authorized major commands to release officers over 45 years of age

"for whom no suitable assignment could be found."221 In January 1944 the

age limit for such separations was reduced to 38 years.222 It was pointed out

that a number of officers in all branches had rendered valuable service during

mobilization, but that due to physical defects or other circumstances over

which they had no control they could not be placed in appropriate positions

now that the Army was entering a new phase of the war. Such of these men

as were surplus in their commands, who did not come under other regulations

permitting their discharge, and whose service had justified separation under

honorable conditions, were to be released without prejudice.

The separation of dental officers under this directive proceeded very

slowly and eventually more specific action was initiated. In May 1944 the War

Department noted that recommendations for the release of dentists had been

based primarily on personal desires rather than the good of the service, and

ordered a general survey of all dental officers with a view toward selecting

for discharge those who were least effective.223 The Surgeon General ordered

replacement pools, where dental officers awaited assignment, to refer to a general hospital for disposition any dentist unable to do a full day's work. Other

officers in these pools, who were over 38 years of age and could not be assigned

to appropriate positions, were to be interviewed to determine if they would

accept voluntary separation. By the end of 1944, 121 dentists were released

on the basis of such individual recommendations, but that number was far short

of the figure required to permit the commissioning of available ASTP

graduates.224

In order to reduce the dental replacement pools which then numbered 811

officers, and to permit the commissioning of an anticipated 900 ASTP graduates, ASF directed The Surgeon General, on 10 August 1944, to recommend

specific quotas to be separated by the various major commands.225 Order of

priority for discharge, without regard to age, was to be:

1. Officers who were not physically capable of doing a full day's duty operating at

a dental chair.

2. Officers marked "limited service" who required special consideration as to climate,

diet, type of work, or who were qualified for assignment within the United States only.

3. Officers in the lower efficiency rating brackets.

4. Officers in a limited service status, other than those in "2" above.

5. Officers in other categories whose relief from active duty could be accomplished

under current War Department directives.

221 Ltr, TAG to Divs of WDGS, 8 Dec 43, sub : Belief from active duty of officers for whom no

suitable assignment exists. SG : 210.8. 222 Ltr, TAG to Divs of WDGS, 12 Jan 44, sub: Kelief from active duty of officers for whom no

suitable assignment exists. SG : 210.8.

223 WD Memo W605-44, 25 May 44. 224 Semiannual Rpt Proemt Br Mil Pers Div SGO, 1 Jul to 31 Dec 44, pars. 1 o, p. q. HD.

225 Memo, Brig Gen Kussel B. Reynolds, Dir Mil Pers Div ASF, for SG, 10 Aug 44, sub : Belief from

active duty of Dental Corps officers. Filed as incl 11 to rpt cited in footnote 224.
90 DENTAL SERVICE IN WORLD WAR II

The authority to release officers in the categories listed, regardless of age, was

an exception to War Department policy and at the time was applied only to

the Dental Corps.

In order to protect officers eligible for separation under this policy but

who had rendered faithful and valuable service, the aforementioned directive

was, at the suggestion of the Assistant Chief of Staff G-l, later modified to

eliminate any reference to inefficiency. As finally published it provided for

the release of: m

1. Officers who were not physically capable of doing a full day's duty operating at a

dental chair.

2. Officers marked "Limited Service" who required special consideration as to

climate, diet, type of work, or who were qualified for assignment within the United

States only.

3. Officers whose relief from active duty could be accomplished under current War

Department policies.

4. Officers selected by The Surgeon General who could be released with least detriment to the service. This category was to be used after exhausting categories "1"

through "3" above. . . .

In compliance with the 29 August 1944 directive, The Surgeon General

recommended on 2 September 1944 that 1,209 dental officers be separated in the

United States as follows :

227

Service Commands (10 to 15 percent in each area) 516

Surgeon General (to be released from pools) 376

Army Air Forces 200

Army Ground Forces 75

Office, Chief of Transportation 35

Military District of Washington 7

A second list covering officers overseas was submitted on 28 September.228 It

recommended the release of 5 percent of the dentists in each theater, for a total

of 212 officers. The Adjutant General approved in toto the overseas request but

in the United States a preliminary quota of only 250 dentists was authorized

for separation.229 This was subsequently increased to 290230 and it was expected

that new allotments would be announced between January and May 1945. By

the end of 1944, 239 dental officers had been released under this program in the

Zone of Interior231 and the overseas quota of 212 officers was being processed,

228 Memo, Brig Gen Rüssel B. Reynolds for SG, 29 Aug 44, sub : Relief from active duty of Dental

Corps officers. Filed as incl 11 to rpt cited in footnote 224.

Memo, Col J. R. Hudnall for CG ASF, 2 Sep 44, sub: Relief from active duty of Dental Corps

officers. Filed as incl 11 to rpt cited in footnote 224.

«" Incl 12 to footnote 224, Memo, Maj Gen R. H. Mills for CG ASF, 28 Sep 44, sub : Relief from

active duty of Dental Corps officers. HD.

228 See footnote 224, p. 89.

»o 1st ind, TAG to CofT, 4 Nov 44, on Ltr, Lt Col A. Kojassar, OCT, to TAG, 12 Oct 44, sub :

Relief from active duty of Dental Corps officers. SG : 210.8.

231 See footnote 224, p. 89.
THE PROCUREMENT OF DENTAL OFFICERS 91

but by that time the personnel situation had changed considerably and no

further "mass" quotas were announced. On 29 December 1944 a new War

Department circular summarized and liberalized earlier provisions for the relief

of officers for whom no assignment could be found, who were essential to national

health and interest in a civilian capacity, or who suffered unusual hardships

because of their military service, and future releases for causes other than

physical disability were generally carried out under that circular.232 No further

pressure was applied to speed the separation of older or less efficient men. (See

pp. 87-88).

Release of Dentists Needed in their Local Communities. For some time

before the end of 1944 the Procurement and Assignment Service had tried

to have released from active duty Army physicians who were urgently needed

in their communities. Results had been insignificant, however, both because

The Surgeon General could spare very few officers and because PAS at first

showed little critical judgment in drawing up its recommendations.233 As a

result of a conference early in January 1945, PAS notified its state chairmen

for physicians that the Army would consider separating a few medical officers

though no men would be released who were under 39 years of age, who were

qualified for general service, or who were practicing a specialty in the Medical

Department. Great care was recommended in selecting only the most worthy

cases.234 Dental officers were not mentioned in the instructions to PAS state

chairmen, but before the end of demobilization some 18 officers were actually

separated as essential to national health or interest.235

Release of Dental Officers for Hardship. Release of dental officers for

hardship, also authorized by War Department Circular 485, 29 December 1944,

took place slowly prior to the end of the war. By the end of June 1945 only

eight dentists had been separated for this cause. In August 1945, however,

the War Department directed that increased consideration be given this factor

as a cause for release from active duty before eligibility was established under

normal separation criteria.236

Slowed "Turnover" Immediately Prior to V-E Day. At the end of 1944,

the dental ASTP was approaching its termination and it appeared that in the

future very few replacements would be available from this source. On 17

January 1945, a representative of the Military Personnel Division, SGO, warned

that unless conservation of dental officers was practiced the procurement of

dentists from civil life would have to be resumed by the end of June.237 Alerted

*>2 WD Clr 485, 29 Dec 44.

»A note accompanying a report of a conference between Army and PAS representatives in

January 1945 states that "They (PAS) threw everything at us before; lists were meaningless. On

file with Ltr, PAS to state chairmen for physicians, 27 Jan 45, sub : Kelease of physicians from the

Army Medical Corps to return to practice. SG : 210.8.

234 Basic communication referred to in footnote 233.

235 Data given to the author by the Strength Accounting Br AGO, 13 Feb 48.

»• By the end of August 1947 a total of 45 dental officers had been discharged for hardships. See

also footnote 235, above.

237 See footnote 90, p. 59.
92 DENTAL SERVICE IN WORLD WAR II

by this warning, it was announced on 8 February 1945 that dental officer personnel then on duty would be considered as being within a critical and scarce

category.238 Further, that separations for causes other than those authorized

by the provisions of War Department Circular 485 (see p. 91) would be limited

insofar as practicable.239 While the application of this rigid conservation policy

enabled the Dental Corps to maintain its strength at the level required, it also

slowed down the "turnover" of its officer personnel. This created a personnel

situation which was far from favorable, and which at the end of the war (see

chapter IX, Demobilization), was subject to a great deal of criticism.

STANDARDS FOR COMMISSION IN THE ARMY DENTAL CORPS

Physical Standards

With minor exceptions (e. g., dental standards for Medical Department

officers and chaplains early in the war) physical standards for commissioning

in the Dental Corps were the same as for all other branches.240 Approximately

one-third of all applicants were rejected for physical defects.241

The Dental Division was very reluctant to commission dentists who could

not work a full day, who could not serve in unfavorable climates, or who were

otherwise unavailable for general assignment. The first deviation from this

policy came in July 1942 when Medical Officer Recruiting Boards were directed

to accept dentists in the limited service category, apparently anticipating that

sufficient officers could not otherwise be obtained.242 By September 1942, procurement objectives were being filled without difficulty and The Surgeon

General directed that only men threatened by induction would be commissioned,

automatically eliminating limited service applicants.243 With the granting of a

new procurement objective for 7,200 dental officers in November 1942, restrictions on the commissioning of dentists were temporarily lifted and those in limited service categories again accepted, though The Surgeon General passed on

all applications and it is probable that the number approved was kept as low

as possible. On 8 September 1943 the PAS was asked not to declare available

any dentists who were classified for "limited service" only. No additional dentists were accepted in that category during the remainder of the war, and with

the first of 1944, efforts were concentrated on eliminating such officers already in

the Dental Corps (see discussion this chapter, pp. 87-88).

E3S See footnote 92, p. 60.

238 Ibid.

240 See AR 40-105 for physical standards for military service at. different periods of the war.

Also, MR 1-9, 31 Aug 40. HD.

211 Ltr, Col Robert C. Craven to Dr. John W. Leggett, 1 Sep 42. [D]

242 See footnote 62, p. 54.

243 See footnote 65, p. 55.
THE PROCUREMENT OF DENTAL OFFICERS 93

Age restrictions for dental officers varied considerably from time to time.

In November 1940 it was directed that Keserve dentists would be called to active

duty only when they were under the following maximum ages:244

First lieutenant 47 years

Captain - 50 years

Major - 54 years

Lieutenant colonel 58y

ears

Colonel 60 years

In August 1941 these provisions were modified to require that dentists on duty

with troops be not over 56 years old, or 58 years if they were on Army staffs.

Age-in-grade requirements were simultaneously removed.246

But while trained Eeserve officers were generally accepted for active duty

as long as they were not over the prescribed maximum age, the principal need

was for young, vigorous men who could be assigned to combat units or to overseas areas with unfavorable climates. Most of this group were taken directly

from civil life, without previous experience, and commissioned in the lowest

grade. For these reasons the Dental Division desired to limit, as far as possible,

procurement outside the reserve to men under 37 years of age who were eligible

for general military duty and for whom the grade of lieutenant or captain

would be appropriate. But the Dental Corps also wanted to be able to offer a

commission to any dentist who might be threatened with early induction, so the

maximum age limit went to 39 years during the periods when the Selective

Service age limit was set at that figure. For brief periods when procurement

threatened to lag, the upper age limit was raised to 44 or even 45 years.

When The Surgeon General established his Medical Officer Recruiting

Boards in April 1942 he was instructed to accept older physicians to the extent

necessary to permit him to obtain men with the necessary professional qualifications, but applicants for the Dental Corps were still to be accepted only if

they were under 37 years of age.246 The following month this directive was

modified to allow the commissioning of dentists over 37 who were classified I-A

by their Selective Service Boards,247 and in June 1942 The Surgeon General

informed The Adjutant General that a few men between the ages of 37 and 50

would be commissioned, but only with the express approval of The Surgeon

General in each case.248 It was implied that such exceptions to general policy

would be made only to permit the commissioning of outstanding individuals,

and the records support that inference. As a matter of fact, routine instruc2

" See footnote 116, p. 64.

« Ltr, TAG to CGs of all Armies, Army Corps, Dlvs, CAs, Depts, Def and Base Comds, COs of

Exempted Stas, Chiefs of Arms and Servs, Chief of Armored Force, Chief AAF, CG, AF Combat Comd,

and Chief of Staff, GHQ, 23 Aug 41, sub : Extension of tours of active duty, reserve officers. SG:

210.31-1.

«• See footnote 198, p. 82.

»' Ltr, Lt Col J. R. Hudnall to Lt Col A. R. Nichols, 16 May 42, sub: Medical officer recruiting

board, letters of appointment and related forms. [D]

2« Ltr, Lt Col Francis M. Fitts to Off Procmt Div, AGO, 24 Jun 42, sub: Officer procurement for

the Army of the United States. SG : 320.2-1.
94 DENTAL SERVICE IN WORLD WAR II

tions to the Medical Officer Recruiting Boards a week later again directed that

dental officers were to be appointed only if they were under 37 years of age.249

With the authorization of a new procurement objective of 4,000 dentists on

8 July 1942, the boards were temporarily instructed to accept applications from

dentists up to 45 years of age, though applications from men over 37 still had to

be approved by The Surgeon General.250

In January 1943 The Surgeon General directed that only dentists under 38

years of age would be considered, but on 19 May the Secretary of War was

notified that dentists would be accepted up to age 42, or age 44 if classified I-A.

In June 1943 the service commands were authorized to accept dentists between

the ages of 38 and 44 if they had been declared available by the PAS, had

refused commissions, and had been recommended for induction by Selective

Service, but it is believed that this procedure was followed in very few cases.251

In September 1943 the PAS was requested not to declare available any dentists

who had reached the age of 38. By the end of 1943 The Adjutant General had

authorized the release of dentists over 45 years of age for whom no suitable

assignment could be found,252 and this age limit was subsequently lowered to

38.253 In March 1944 the Dental Division recommended that all dentists over

40 years of age be released, but this request was denied by ASF.254 255

On V-E Day the age distribution of the Dental Corps was as follows:2S8

Number of Percentage

Age officers of all officers

Under 30 3,902 25.5

30-34 4,086 26. 7

35-39 4,958 32. 4

40-44 1,423 9.3

45-49 581 3. 8

50 or over 352 2. 3

Professional and Ethical Standards

Educational requirements for dental officers were relatively simple; the

applicant had to be a graduate of a standard school acceptable to The Surgeon

General. All American schools were approved, including those limited to

Negro students. The question of foreign schools was troublesome to the Medical

'»Telegram, TAG to Medical Officers' Recruiting Board, 9th CA, 2 Jul 42. AG : 210.31.

*> See footnote 62, p. 54.

251 Ltr, TAG to CG, 5th SvC, 8 Jun 43, sub: Induction of physicians and dentists 38 years of age

and over. SG : PAS flies, Mil Pers Div.

252 Ltr, TAG to Divs of WD Gen Staff, CGs AGF, AAF, ASF, Def Comds, Overseas Theaters and

Depts, 8 Dec 43, sub : Belief from active duty of officers for whom no suitable assignment exists.

SG : 210.8.

263 Ltr, TAG to Divs of WD Gen Staff, CGs AGF, AAF, ASF, Def Comds, Overseas Theaters and

Depts, 12 Jan 44, sub: Relief from active duty of officers for whom no suitable assignment exists.

AG : 210.85.

254 Memo, Exec Off, SGO, to Dir Mil Pers Div, ASF, 11 Mar 44. HD : 314.

268 The original of the communication rejecting The Surgeon General's request of 11 March 1944

has not been found. This letter, dated 25 March 1944, is quoted verbatim, however, in a report of

the Dental Division for the period 21 Feb-1 Apr 44, on file in Bi-weekly Reports file. HD: 024.

« • See footnote 106, p. 62.
THE PROCUREMENT OF DENTAL OFFICERS 95

Corps, but the number of graduates of foreign schools applying for dental

commissions was negligible.

During the first year of the war an applicant for the Dental Corps was

required to have a valid license to practice in a state or territory, but in January

1943 this requisite was dropped, as far as recent graduates were concerned, to

make it possible to accept the latter immediately, without waiting for them to

take a board.

The enforcement of ethical standards involved some knotty problems.

It was of course directed that only dentists in good standing in the profession

would be commissioned, but the definition of ethical practice, and its application in specific cases, was not always easy. In the absence of evidence to

the contrary, membership in the ADA was a prima facie indication of acceptability, but approximately one-third of the dentists in the United States were

not members of the ADA and these men had to be considered on their own

merits. In some cases it was charged that actual membership had been required locally. In New York City, for instance, the Allied Dental Council

complained that its members had been asked if they belonged to the 2d District

Dental Society (ADA) when they applied for commissions at the city recruiting board.257 It was not specifically stated that they would otherwise be

rejected, but rightly or wrongly that inference was drawn. The Surgeon

General immediately replied that membership in any society was not a requisite

for a commission in the Army.258 But the ADA was allowed to set the ethical

standard for acceptance by the Dental Corps, and to pass on the standing of

individuals through the SGO liaison office at ADA national headquarters,

resulting in occasional protests from groups having less rigid requirements.

In May 1943, for instance, a number of members of a New York society met

with representatives of the Dental Division to protest refusal of the 2d District

Dental Society to certify them to the Army, mainly on the grounds that they

were "advertisers." They were informed that "dentists in New York City . . .

must conform to the code of ethics laid down by the 2d District Dental

Society." 259 A few days later the protesting dentists were called to a joint

meeting with representatives of the 2d District Society and they were informed

that if they met the requirements of that organization (i. e., removed the offending signs) they would be certified. Many dentists followed this advice and

were accepted.

The practice of allowing the ADA to pass on the ethical status of nonmembers may be questioned, but it is difficult to see how the problem could have

been solved in any other way. The ordinary citizen is assumed to be honest

if he is not convicted of a crime, and the merchant who gains an advantage in

267 Ltr, Dr. M. J. Futterman, Chairman, National Victory Committee, Allied Dental Council, New

York, to SG, 24 Jun 42. [D]

» Ltr, Maj Gen E. H. Mills to Dr. M. J. Futterman, 30 Jun 42. [D]

259 Statement, Col Robert C. Craven to Co-chairman of Mil Affairs Committee, 2d District Dental

Society, 17 May 43. [D]
96 DENTAL SERVICE IN WORLD WAR II

a business deal is considered to be a smart operator, but the ethics of the commercial world are not applicable to dental practice; if the merchant delivers

goods other than those specified the fact is readily apparent and redress can

easily be made, but the quality of the dentist's work can be determined only

after many years have elapsed, and after irreparable damage may have been

done. The dentist is therefore in a unique position of trust in that he must

consider not only his own interests but those of his patients as well. To protect

its patients, and its own good name, the dental profession has found it necessary

to set for itself standards which are materially higher than those prescribed

by law, which are generally drawn up to meet commercial requirements. This

has been accomplished through the only organization representing any large

proportion of American dentists, the ADA.

Not all of the criteria established by the ADA have been accepted by

nonmembers of that body. Advertising, for instance, tends to substitute the

press agent's skill for a laboriously acquired professional reputation, but in

itself it may not indicate gross moral deficiency. It was therefore held in

some quarters that the fact that a dentist had advertised for patients was not

an adequate reason for barring him from the Army Dental Corps. As a matter

of past experience, however, advertising had so often been associated with

other, more objectionable practices that it was certainly a danger signal to be

given considerable weight in determining whether or not a dentist was of the

type wanted for Army installations. In general the ADA standards had been

found satisfactory in operation, and their acceptance by the Dental Corps

would appear to have been justified. Moreover, The Surgeon General had

neither the information nor the organization with which to undertake the

evaluation of thousands of dentists, and the ADA was the only body which

had both. It has been suggested that the PAS should have assumed responsibility for determining ethical and professional standing, but if it had been

given that task it would almost certainly have had to go to the ADA for the

information on which to act.

COMMISSIONS ABOVE THE GRADE OF FIRST LIEUTENANT

During the war the Dental Division generally disapproved of granting

initial commissions above the lowest grade, and even when an allotment of

higher grades was authorized it was seldom filled. This policy was voluntarily adopted without pressure from higher authority in either the SGO or

the War Department. The first major procurement objective of the war,

granted in January 1942, provided for the procurement of 5 majors, 20 captains,

and 475 lieutenants, but it was filled almost entirely in the grade of lieutenant.260

When the Medical Officer Kecruiting Boards were established in April 1942

The Surgeon General was permitted to offer sufficient commissions above the

2

*> See footnote 56, p. 53.
THE PROCUREMENT OF DENTAL OFFICERS 97

lowest grade to attract qualified applicants, but a few weeks later the boards

were specifically directed that dentists would be commissioned in the grade

of first lieutenant only, except in special cases, and with the approval of The

Surgeon General.261 In June 1942 The Surgeon General notified The Adjutant

General that a few dentists above the age of 37 would be given commissions

as captains or majors with the approval of the Chief of the Dental Division,

but implied that such cases would be very rare.262 In September 1942 an officer

of the Dental Division stated that captaincies would be given only to men

over 40, with special qualifications. A few appointments above the lowest

grade were made in 1943, but by 1 January 1944 only 2 dentists had been

commissioned as majors and 163 as captains.263 At least one of the above

majors was commissioned for the Veterans Administration, and most subsequent commissions above the grade of captain were for that organization.

The policy of the Dental Division in respect to granting higher original

commissions was criticized by PAS, which felt that its task would have been

easier if it could have offered captaincies or majorities to hesitant applicants.

Some dental societies also felt that qualified specialists or older men with

families should be given grades above that of first lieutenant. The position

of the Dental Division was that for each dentist appointed as a captain or

major some officer who had volunteered a year or more before would be deprived

of promotion. It was felt that men already in the service generally had as

much to offer as the dentists who were holding out for advanced grades, and

there could be no question but that the former were better qualified from the

military point of view. Only in exceptional cases did clinical proficiency

justify giving a dentist without military background a commission in a higher

grade than had been offered the man who volunteered immediately after Pearl

Harbor. The situation was also complicated by the absence of definite standards

for determining clinical qualifications; as long as there were no recognized

boards to say whether or not a dentist should be classed as a specialist, claims

to special ability were made very freely, and to have granted dentists advanced

grades on the basis of their own statements would in many cases have resulted

in an injustice to the Government and to the officers already commissioned.

There can be no doubt, however, that qualified oral surgeons or prosthetic

specialists were not attracted by the grades they were offered in the Dental

Service, and this fact was noted in personnel summaries submitted at the end

of the war.264 If the policy of assigning dental officers to units in the grade

of either captain or lieutenant is followed in the future it will be possible to

offer captaincies to the more experienced dentists without jeopardizing the

aM Ltr, SG, no distribution indicated, but apparently directed to Medical Officer Recruiting Boards,

23 Apr 42, sub: Appointment in the Army of the United States (Medical Department). SG: 320.2-1.

2m See footnote 247, p. 93.

2

»3 Brown, P. W.: Procurement of dental officers from civil life, p. 32. HD: 314.7-2 (Dentistry—

Army Dental Corps).

2

" See footnote 122, p. 65.
98 DENTAL SERVICE IN WORLD WAR II

rights of earlier volunteers. The establishment of recognized specialty boards

will also make it possible to commission qualified dentists as captains or

majors on an equitable basis, with a minimum of protest from nonboard

members. But only a limited number of vacancies exist in the higher grades,

and if they are used carelessly, to lure reluctant dentists when procurement

becomes more difficult, the earlier volunteers will suffer, and morale may be

expected to drop.

THE DEFERMENT OF INSTRUCTORS IN DENTAL SCHOOLS

(See Chapter on "Personnel and Training.")

THE NONPROFESSIONAL USE OF DENTAL OFFICERS

The number of dentists in the United States has never exceeded the bare

minimum required to meet the most urgent requirements. When the Armed

Forces took nearly a third of all civilian dentists the remainder were able to

care for the nonmilitary population only with the greatest difficulty. No more

men could be spared without endangering the health of war workers, school

children, and the general public. It was therefore imperative that the available

supply of dental officers be used with the utmost economy.

Under some circumstances a military dentist had to be prepared to assume

nonprofessional duties. A dental officer with a small task force attacking a

Pacific island, for instance, could not hope to accomplish much dental work

during the assault phase, and he could generally render the most valuable

service by acting as assistant to a medical officer. Also, during the first part

of the war, medical organizations, and even tactical units, were sometimes so

short of trained personnel that any officers with military experience had to fill

key positions until replacements could be trained. In these situations dental

officers were used as executives or even as detachment commanders. Eegulations provided that dentists could not command any unit, but these directives

were often ignored.265 When the Dental Division recommended in 1942 that

an order be published prohibiting the use of dentists for other than their proper

clinical or administrative duties, the Military Personnel Division of the SGO

flatly refused approval on the grounds that dental officers were at that time

indispensable in many auxiliary positions.268

There was less justification for the tendency to use dental officers in minor

duties which could have been performed by administrative personnel with a few

months of training. In the case of tactical commands this abuse often resulted

from the circumstances surrounding the formation of new units in the Zone

of Interior. As new organizations were assembled there was usually an interim

period during which most dental care was furnished by the permanent station

266 See footnote 21, p. 44.

* Ibid.
THE PROCUREMENT OF DENTAL OFFICERS 99

dental clinic. At this time assigned dental officers often lacked their equipment,

and the full complement of enlisted personnel had not yet arrived. A field

hospital, for instance, had little clinical work to perform until it went overseas, yet it had a full quota of administrative positions to be filled by inexperienced officers. Under these conditions it was almost routine practice to assign

the three dental officers to nonprofessional tasks since they had free time and

the other officers were busy coping with unfamiliar jobs.

But when such a unit arrived overseas the situation changed completely.

The dentists were immediately overwhelmed with demands for treatment, but

the assignment to outside duties often continued. The dental surgeon of the

Middle East theater found that two dentists in one hospital were together

acting as mess officer, supply officer, transportation officer, finance officer, censor

officer, and sanitary officer.267 The dental surgeon of the China-Burma-India

theater reported that "We really have plenty of dental officers en route to

and in the theater if they could be properly placed and put on their proper

duty, but we still have plenty with supply units, messing with minor staff jobs,

censoring mail, running messes, etc." 268

The improper utilization of dental officers during the first years of World

War II also derived in part from the prewar doctrine that the dentist's normal

duty in combat was to assist the surgeon. This conception had in turn resulted

from the admitted circumstance that under the World War I organization the

Dental Service could not function too effectively in a forward area and some

other duty had to be found for the dental officer of a unit in action. The

period of actual combat in World War I was too short to reveal the danger

of this policy, but as the Second World War progressed it was found that

evacuations for dental emergencies soon reached important proportions when

routine treatment was neglected over any considerable period of time; the

dental officer could render the most important service to his command by giving all his time to his proper professional duties. The dental surgeon of

the European theater reported that "the dental officers were used purely as

auxiliary medical officers in most instances . . . until the medical officers realized that men were getting into the chain of evacuation for dental reasons only,

showing that the best utilization of dental officers was not being made." 269 A

conference of senior dental surgeons, called by The Surgeon General in February 1945, recommended that:270

The utilization of dental officers as auxiliary medical officers, as a routine procedure,

is condemned. . . . the dental needs of a division require the full and most efficient

utilization of its dental personnel in dental activities at all times.

287 Jeffcott, G. F.: Dental problems In the Middle East Theater of Operations. Mil. Surgeon 96 :

54-58, Jan 1945.

268 Personal ltr, Col Dell S. Gray to Col Rex McK. McDowell, 1 Jul 44. [D]

*> Ltr, Col Thomas L. Smith, Dental Surg, ETO, to SG, 6 Feb 45, sub: History of the Dental

Division, Headquarters, ETOUSA, from 1 Sep through 31 Dec 44. HD: 730 (Dentistry) ETO.

Memo, Maj Gen R. H. Mills to Brig Gen F. Ä. Blesse, 8 Feb 45. [D]
100 DENTAL SERVICE IN WORLD WAR II

It was ultimately clear that if dental officers could not render regular dental

care under the existing organization, that organization would have to be

changed. (See discussion of the division Dental Service in chapter VIII.)

Until the middle of 1942, dental officers' services were also misused to some

extent in permanent installations of the Zone of Interior. (See chapter I,

page 14.) This practice was prohibited in the Zone of Interior by a War

Department directive of 31 July 1942 which provided thatin the future dentists

would be used only in the operation or supervision of the Dental Service, and

that dentists currently performing other functions would be replaced as soon

as substitutes could be trained.271 The Air Force issued a similar directive on

7 September 1942.272

World War II experience supported the following conclusions in respect

to the proper use of dental officers:

1. The number of dentists available in an emergency will normally be

strictly limited. It will be sufficient only if they are used with the greatest

economy.

2. If the dentists assigned to combat units are used for other than professional duties, except for very short periods of time, evacuations for dental

emergencies may be expected to result in an excessive loss of manpower when

itis most urgently needed.

3. It is essential that the Dental Service be organized to permit dental

officers to function with a minimum of interruption due to tactical operations.

If dental officers cannot treat the soldiers of their commands during combat

they should be removed and used for the care of units in reserve.

4. Some line officers who do not appreciate the need for regular dental

care in their commands will probably continue to use dentists in nonessential

activities until prevented by a specific official directive or by a reorganization

of dental facilities.

Early steps to prevent the misuse of dentists were reasonably effective in the

Zone of Interior, but they had no direct application outside the United States.

Changes in the organization of dental facilities in tactical units and the development of the mobile operating and prosthetic units improved the situation

overseas to some extent, but the nonprofessional use of dentists was not

altogether eliminated before the end of hostilities. Finally, in October 1945,

the War Department directed all commands, Zone of Interior and overseas,

that no medical, dental, or Army Nurse Corps officers would be used in positions

which could be filled by officers of other corps of the Medical Department.273

2,1 Ltr, TAG to CGs all Svcs, 31 Jul 42, sub : Utilization of dental officers for professional duties.

ÄG : 210.312 (Dental Corps).

2

'

2 AAF Reg 25-4, 7 Sep 42, sub : Utilization of dental officers with the AAF. On file in the Office

of the Air Surgeon, USAF.

2,3 WD Cir 307, 6 Oct 45.
THE PROCUREMENT OF DENTAL OFFICERS 101

THE RELOCATION OF CIVILIAN DENTISTS

The program to relocate civilian dentists who were excess to the needs of

their communities, so that they could provide dental treatment in areas where

they were more critically required, was of course not a responsibility of the

Armed Forces. It did affect the overall utilization of dental manpower, however, and the Army was even more directly concerned when it had to furnish

dental care at such locations as the Oak Ridge atomic bomb plant. Actually,

the relocation program seems to have received very little attention during the

war, either because it was considered unnecessary or because it was considered

impractical by those who would have had to enforce it.

Early in 1944 Congress appropriated $200,000 to be used to encourage

dentists and physicians to move to districts where health care was precarious.

Volunteers were to be paid $250 a month for 3 months to enable them to get

a start in the new location, and all moving expenses were to be paid. Local

communities were to carry one-quarter of the total expense in each case.274

The small amount of money appropriated indicates that the effort was experimental, and practical results of the voluntary relocation program were actually

negligible. Only 7 applications were received, and 3 dentists were moved;

1 other moved with Federal assistance but with no expenditure of funds. The

project was abandoned in June 1944.275

In theory PAS could have brought about the relocation of dentists by

declaring them nonessential in their own areas, making them subject to conscription if they did not move to critical districts. But such action depended

upon effective support from Selective Service, and it has already been seen

that such support was lacking. Moreover, PAS itself showed little interest

in the matter. Dr. C. Willard Camalier, who was Chairman of the War Service

Committee of the ADA, and also a member of the Directing Board, PAS, had

reported that:27e

. . . while we have no figures on the matter, I am inclined to feel that very little,

if any, of this (relocation) was done.

As a member of the Procurement and Assignment Directing Board, I was quite

well aware of the fact that the Armed Services were taking so many dentists from

civil practice that those left were kept so busy that it would not have been profitable

for them to locate in other sections of the United States. They would have all they

could possibly look after in their own areas. In several instances, such as Michigan,

near the war plants, and a few points down South, officers of the U. S. Public Health

Service were detailed to care for the needs of the population. Dentists under the

auspices of the Army were utilized at Oak Ridge, Tennessee.

Whether or not the relocation program was necessary, or whether it would

have produced more tangible results if a more sustained effort had been made

1,74 Congress provides fund (or relocation of civilian dentists. J. Am. Dent. A. 31 : 166, Jan 1944.

Relocation program for dentists halted June 30. J. Am. Dent. A. 31 : 1021, Jul 1944.

«• Personal ltr, Dr. C. Willard Camalier to the author, 16 Oct 47. [D]
J02 DENTAL SERVICE IN WORLD WAR II

by all concerned, is not a matter for consideration here. It seems clear, though,

that dentists who are very busy in their home communities will not voluntarily

move to other locations; if such redistribution becomes unavoidable in a future

emergency some compulsion or extra remuneration must be provided.

UTILIZATION OF FEMALE DENTISTS

Three bills to authorize the commissioning of female dentists were introduced in Congress between June 1943 and March 1945.277 278 279 The Dental

Division and the Army opposed enactment of all of these bills on the grounds

that there was no shortage of male dentists in the Armed Forces and that to

commission females would raise special problems of housing and assignment.280

After 1944 it was also noted that the Army was already being criticized because

it could not accept all ASTP graduates. Another consideration, which was

implied but not stated in these protests, was that the factor which limited the

number of dentists available to the Armed Forces was not a numerical shortage

of male dentists but the necessity for leaving sufficient personnel to meet the

minimum needs of the civilian population. It would have served no useful

purpose to commission women and then leave a corresponding number of ablebodied males to care for their patients. Probably as a result of Army disapproval, none of the bills to commission female dentists was passed by Congress.

POSTWAR PROCUREMENT FOR THE DENTAL CORPS

On 10 August 1945 the War Department announced that it was considering

a plan for increasing the Kegular Army Dental Corps by offering commissions

to dental officers who had demonstrated their capabilities during the emergency

period.281 The necessary legislation was passed by Congress on 28 December

1945,282 and the procedure to be followed was published by the War Department on the following day.283 The integration program was designed to bring

the total number of officers in the Regular Army to 50,000, an increase of a

little under 34,000 officers. The Dental Corps was authorized an additional

476 officers, to bring its total strength to 743 dentists.284

277 H. R. 2892, 78th Cong., introduced by Representative John J. Sparkman, on 7 Jun 43.

278 H. R. 1704, 79th Cong., introduced by Representative John J. Sparkman, on 23 Jan 45.

2,9 S. 731, 79th Cong., introduced by Senator Claude Pepper, on 13 Mar 45.

280 For criticism of the bills to commission female dentists see: (1) Ltr, SecWar to Hon Andrew

J. May, 22 Jul 43. (2) Ltr, SecWar to Hon Elbert D. Thomas, 8 May 45. (3) Memo, Maj Gen R. H.

Mills for Mil Pers Div SGO, 27 Mar 45. All in HD : 314.

281 WD Cir 243, 10 Aug 45.

ass Public Law 281, 79th Cong., 28 Dec 45.

m WD Cir 392, 29 Dec 45.

284 Data given the author by Col James M. Epperly of the Dental Div SGO, on 15 Jan 48.
THE PROCUREMENT OF DENTAL OFFICERS 103

SUMMARY, DENTAL OFFICER PROCUREMENT PROGRAM

The dental officer procurement program of World War II was successful

in that more than 15,000 qualified dentists were obtained for the Army under

very difficult conditions. The principal defects revealed were:285

1. During the early part of the war applicants were accepted without

regard to their true availability, endangering civilian dental practice in some

areas.

2. The policy of commissioning almost all applicants in the lowest grade

protected earlier volunteers but it lost the services of some expert clinicians,who

might profitably have been accepted as captains or majors in spite of their

lack of military experience. Deviation from World War II policy, in a limited

number of selected cases, will probably prove advisable in any future

mobilization.

3. The classification of officers according to special skills was not accurate

enough, especially during the first years of the war, to permit the most efficient

assignment and utilization of personnel. Clinical specialists were sometimes

assigned to small tactical units rather than to hospitals or other large installations where theirservices could best be used.

4. Experience at the end of hostilities, when dental officers had to be held

in the service after other officers were released, and when conscription was necessary to procure even a part of the replacements needed, clearly demonstrated

the need for a slow but constant turnover of dental personnel during a long

war. Older men with families and with established practices will be willing

to serve in the Army during the early stages of an emergency, but they will

bring strong and effective pressure to bear if, after they have served for 2 or 3

years, they see recent graduates of the dental schools returning to civilian life

to take over their practices. The situation of a dental officer in this respect is

different from that of a line officer. No able-bodied young man who is eligible

for service in the infantry, for instance, will be allowed to evade military duty

after he graduates from high school or college; he will be taken into the Army

without delay, and his status will generally be inferior to that of the man

who came on duty at an earlier date. But the shortage of dentists in the

United States is such that recent dental graduates will not ordinarily be taken

into the Armed Forces for nondental duty. If they cannot be used as dental

officers because of a lack of vacancies they will be allowed to set up offices in

civilian communities to provide badly needed dental care. It is easy to understand the older dentists' position that the younger men should be given their

share of military service, releasing officers who have already had several years

of active duty. When Dr. X, who had served 3 years in the Army, with 2

years overseas, received a letter from his wife saying that young Dr. Y, who

had graduated the year before, had now taken over most of Dr. X's practice

288 See footnote 122, p. 65.

330324 O—55 8
104 DENTAL SERVICE IN WORLD WAR II

his morale took a severe dip. When Dr. X was later held in the Army after

other officers with similar service were being released, his general distaste for

all things military was converted to an active resentment which would color

his future actions as a member of the dental profession and as a citizen.

If the Army Dental Corps consists almost entirely of officers with several

years of service when hostilities end, these men will have to be released without

delay; at about the same time compulsory procurement may be terminated, resulting in a critical personnel crisis. By the very nature of their business, dentists cannot afford to give up the practices which they have taken years to

build to accept temporary, voluntary, military service in the postwar period.

If the older men are gradually replaced by recent graduates during the war a

more balanced Dental Corps will result, demobilization at the end of hostilities

will be more orderly, and personnel difficulties will be minimized during the

difficult period of transition from war to peace.

5. The procurement program was characterized by frequent changes of

policy which confused and irritated cooperating agencies and the dentists

themselves. The ADA complained of this situation as follows: ***

When war came, the Army opened and closed commissions in the Dental Corps with

such eccentric rapidity that dentists and state Procurement and Assignment chairmen

were in a perpetual quandary. On one day a large procurement objective would be

set and on another the Dental Corps would be closed and dentists in the process of

getting commissions, having closed their offices would be sent back to civilian life. The

Army Specialized Training Program was initiated with the proper flourish of military

trumpets as the answer to the problem of providing the Army with a continuing

supply of dental personnel. This program was barely in full motion when one entire

class of dental graduates was sent into civilian life because "procurement objectives"

allegedly had been reached. . . . Under this mistaken knowledge of its own needs

the Army eventually shut down the entire dental ASTP and permitted many potential

dental officers to return to civil life instead of completing their training as replacements for veteran officers. So certain was the Army that the matter of dental personnel was well in hand that, at about this time, the Dental Corps was again closed.

This criticism was of course extreme, and not fully justified. So far as is

known, dentists in the process of being commissioned were always accepted for

service if they met physical requirements. The frequent changes in policy

complained of generally paralleled War Department changes in estimates of

the forces needed to meet new developments, and the extent to which the flow

of dentists into the Armed Forces could have been smoothed out is a matter

of opinion. Procurement objectives were admittedly changed on short notice,

however, and a more consistent program would certainly be desirable, to the

extent it could be achieved under emergency conditions.

286 Dental officers pay again. J. Am. Dent. A. 33 : 755-757, 1 Jun 46.
CHAPTER IV

Personnel and Training

COMPOSITION OF THE DENTAL CORPS

Important items in a discussion of officers of the wartime Dental Corps are

background, age, and previous military preparation. Information is not available concerning all of the 18,000 dental officers who served in the Army between

1 October 1940 and 31 December 1945,1but a cross-sectional view of the 15,302

officers who were either on duty 31 May 1945 or had been released shortly before

that date2reveals the following:3

Distribution by Age

Approximate

years of practice

before entering

Age Number Percent the Army*

Under 30 3,902 25.5 0-2

30-34 4,086 26.7 3-7

35-39 4,958 32.4 8-12

40-44 1,423 9.3 13-17

45_49 581 3.8 18-22

50-over 352 2.3 23-over

•Years of practice based on average age at graduation of 25-26 ' and assumption that men on duty in 1945 averaged 2

years of military service.

Distribution by Race

f>ace Number Percent

White 15,131 98.89

Negro 132 0.86

Chinese 25 °- 16

Japanese 8°-05

Others , 6 0- 04

Distribution by Component

Component Number Percent

Regular Army 266 1. 7

National Guard 117 °-8

Organized Reserve Corps 3, 106 20. 3

AUS (obtained through ASTP) --- 1.802 11.8

AUS (obtained from civilian life) 10,011 65.4

1 Memo, Mr. Isaac Cogan for Dir, Dent Cons Div, SGO, 29 Aug 46, sub: Dental Corps officershistorical data. SG : 322.053-1. 3 The number of dental officers actually on duty on V-E Day was about 14,700. When the data

given here were calculated in June 1945 reports of separations during the preceding month were

Incomplete.

3

See footnote 1 above.

i Strusser, H.: Dental problems in postwar planning. J. Am. Dent. A. 32:991-1003,1 Aug 45.
106 DENTAL SERVICE IN WORLD WAR II

Distribution by Specialty

Specialty Number Percent

Oral Surgeon (MOS 3171) 65 0. 4

Exodontist (MOS 3172) 325 2. 1

Periodontist (MOS 3174) 20 0. 1

Prosthodontist (MOS 3175) 255 1.7

Staff Dentist (MOS 3178) 170 1. 1

No specialty (MOS 3170) 14, 467 94. 6

The "average" dentist was about 33 when he entered the Army (assuming

2 years of service in 1945) and had been in private practice nearly 8 years.

Though well-qualified as an operative dentist, he was not likely to have had

extensive training as a specialist. Only 4 per 1,000 were oral surgeons and

only 1 per 1,000 was a periodontist. Nearly two-thirds had entered the Army

with no previous experience in the Armed Forces, and though professionally

competent, almost all of this group needed more or less additional military

training before they were fitted to fill responsible positions. This was the

"raw material" from which the Army Dental Service was assembled.

ASSIGNMENT OF DENTAL OFFICERS

The proportion of dentists in service command installations in the United

States, in the Air Forces, and in tactical organizations in the United States

and overseas fluctuated with the progress of mobilization and with changes

in the course of the war. The greatest number of dentists on duty at any

time was 15,292 in November 1944.6Subsequent strength reductions were

not significant until after V-E Day. The maximum figure in the United

States was reached a year earlier, in November 1943, with a total of 11,544

men (Air Forces, service commands, and tactical units).6 The largest number

on duty with the Air Forces (United States and overseas) was about 3,739

in May 1945. The number of Army dentists overseas increased from about

1,000 (10 percent) in December 1942 to 3,221 (22.5 percent) in December

1943 and 6,017 (39.8 percent) in December 1944. The maximum number

abroad was reached in March 1945 when 7,111 dental officers, or 48.1 percent

of all Army dentists, were on foreign service, but the highest ratio was not

reached until May 1945 when the 7,103 dentists overseas were 48.3 percent

of the total on duty. At the end of 1945 only 2,886 (30.0 percent) of all

dentists were overseas. The maximum number of Air Forces dentists overseas

was 1,103 (29.5 percent) in May 1945.7

B Memo, Mr. Isaac Cogan for Chief, Dent Cons Div, SGO, 8 Oct 46, sub: Basic data for Dental

Corps. SG: 322.0531.

6 Unpublished data from the Resources Analysis Division, SGO, given to author in Oct 1946.

'Unpublished data from the Personnel Division, Office of the Air Surgeon, given to author on 1

Oct 46.
PERSONNEL AND TRAINING 107

The approximate authorized percentages of dentists in different types

of assignments on 31 March 1944 were as follows:8

Percent

Tables of organization units (U. S. and overseas) 36.9

Army Service Forces, U. S. (Exclusive of T/O Units) 32. 3

Army Air Forces, U. S. (Exclusive of T/O Units) 21.1

Theater overhead (Exclusive of T/O Units) -7

Replacement pools 6- 8

Other 2-

2

This ratio was of course subject to constant change as emphasis was transferred from training activities in the United States to combat operations

overseas. During the early part of the war a majority of dentists were

required for work on new men in Army Service Forces and Air Forces

installations in the United States. Later they were needed in the units

actually engaged in operations (T/O units overseas and in the United States).

PROFESSIONAL CLASSIFICATION OF DENTAL OFFICERS

At the start of mobilization there was no effective plan for the classification of dental officers according to special qualifications. Some attempt

was made locally to assign dentists to appropriate work but these efforts were

hampered by the absence of any standardized system by which the specialized

abilities of an officer could be determined at a glance. Too much reliance had

to be placed on the dentist's own estimate of his qualifications, so that men

with not much more than a desire to do a certain type of work were designated

as specialists, while other trained officers were placed in routine jobs.9

On 21 October 1943 The Adjutant General directed that dental officers

would be evaluated in respect to professional qualifications on the basis of

questionnaires to be sent to The Surgeon General.10 At about the same time

a War Department Technical Manual (TM 12-406) described six classifications

for dentists, as follows:ai

MOS 3170 (Dental officer) general practitioner.

MOS 3171 (Oral surgeon, dental) fully qualified oral surgeon. Should have extensive

experience in oral surgery and have been a member of a hospital staff.

Internship, residency, or fellowship desirable.

MOS 3172 (Exodontist) qualified as extraction specialist. Extensive training in

exodontia, and internship or residency desirable.

MOS 3174 (Periodontist) qualified to treat investing tissues of teeth. Extensive training or experience very desirable.

» Memo, Chief, Oprs Br, SGO, for CG, ASF, 5 Jun 44, sub: Requirements for Dental Corps officers.

SG: 322.0531-1.

• Final Rpt for ASF, Logistics in World War II. HD: 319.1-2 (Dental Division).

»Ltr SPX 220.01 (6 Oct 1943) OC-E-SPGAP-MB-A, 21 Oct 43, sub: Correct classification and

assignment of Army Service Forces officers and enlisted men. AG : 220.01 (19 Sep 43) (1).

u

TM 12-406, Officer classification, commissioned and warrant, 30 Oct 43.
108 DENTAL SERVICE IN WORLD WAR II

MOS 3175 (Prosthodontist) qualified to construct bridges and dentures. Extensive

training or experience essential.

MOS 3178 (Dental officer, staff) qualified to advise surgeons of major units on the

operation of the dental service. Must have previous military experience.

(All dentists were required to be graduates of accepted schools, licensed to practice

dentistry, and actually engaged in ethical practice at the time of entry into the Army.)

Early in 1944, TM 12-406 was amended to authorize the use of modifying letter

symbols in connection with the MOS numbers, of medical officers only, to

indicate relative ability within a specific field. Thus a surgeon of moderate

skill might be designed "MOS D 3150," while a surgeon with outstanding background and experience would be listed as "MOS A 3150."12

This refinement,

however, was not applied to other Medical Department officers, possibly because there were then in existence no recognized civilian standards for dental

and veterinary specialists.

Original classifications of medical, dental, and veterinary officers were

made from information contained in the "Classification Questionnaire of Medical Department Officers."13 Later adjustments in classification were made

from reports of "Eeevaluation Data for Medical Department Officers." " In

the case of dental officers, the assignment of an MOS number was carried out

in the Dental Division, SGO.

The Director of the Dental Division, SGO, found that these measures

aided in the appropriate assignment of dentists, but that they were not a complete solution of the problem. He stated after the war that:15

. . . the system is very weak because there is no "measuring rod" and no "official"

check or follow-up to determine an officer's true classification . . . There are too many

officers classified as oral surgeons and as prosthodontists who in reality have had

no formal training in those specialties and whose experience in these fields has been

very limited. . . . The fact that a man's MOS states that he is an oral surgeon does

not really mean that he is a qualified oral surgeon. . . . Although the present mechanics set up for the classification of dental officers is a definite advancement over that

used at the beginning of the war, it definitely is not an effective instrument in the

assignment and utilization of manpower.

The solution recommended was a "clearer definition of the meaning and intent

of the several classifications as well as the setting up of additional criteria for

selection; a dental classification section in Personnel Service, SGO, with

sufficient personnel, which can currently follow up on all changes of classification, and which can check effectively on qualifications as well as on assignments of Dental Corps personnel."16

12 TM 12-406, C 1, 10 May 44.

13 WD AGO Form 178-2, 1 Jan 45.

" WD AGO Form 178-3, 1 Aug 45.

35 See footnote 9, p. 107.

M

Ibid.
PERSONNEL AND TRAINING 109

PROMOTION

In time of peace, promotion in the Dental Corps of the Eegular Army

was based on the same regulations which governed promotion in the Medical

Corps, providing for original appointment in the grade of first lieutenant, with

periodic advancement thereafter on the basis of total service.17 Total service

required for promotion to the various grades above that of lieutenant was as

follows:

Captain 3y

ears

Major 12y

ears

Lieutenant colonel 20 years

Colonel 26 years

For reasons which are not clear, Reserve officers could be promoted even more

rapidly, after the following periods of total service:18

Captain 4 years

Major 9y

ears

Lieutenant colonel 15 years

Colonel 22y

ears

Regular Army dental officers were required to pass examinations on both

professional and military subjects, except that candidates for advancement to

the two highest grades were examined only on military problems.19 Reserve

officers had to pass examinations in military subjects or complete specified

correspondence courses appropriate to the higher grade.20 In addition, they

had to attend at least one summer camp of 2 weeks duration prior to each

promotion.

Original commissions in the grade of first lieutenant helped to equalize the

status of the professional officer, who generally entered the service at an older

age, with that of the line officer who started his career several years earlier and

who generally obtained his education at Government expense. Promotion

solely on the basis of time-in-grade was criticized because it did not reward the

outstanding officer nor provide an incentive to special efforts. It did, however,

eliminate political influence as a factor in advancement and left the officer

more opportunity to exercise his own judgment without fear of reprisal as long

as his performance, and behavior met accepted standards.

With mobilization, key positions in a rapidly expanding Army had to be

filled quickly by procedures which could be applied to Regular, Reserve, and

temporary officers. On 1 January 1942 most of the peacetime promotion regulations were suspended, and advancement was thereafter based on the following

factors:21

" AR 605-50, 30 Jul 36.

18 AR 140-5, 16 Jun 36.

18 AR 605-55, 11 Oct 35.

M

See footnote 18, above.

21 WD Cir 1, 1 Jan 42.
HO DENTAL SERVICE IN WORLD WAR II

1. Completion of a minimum specified time-in-grade.

2. Recommendations from superiors, attesting to the officers' qualifications.

3. Existence of a vacancy in the desired grade. Under these provisions

dental officers enjoyed the same promotion status as members of other branches,

at least in theory. In practice, unfortunately, stagnation of promotion in the

Dental Corps soon became so serious that it was the cause for frequent criticism

during the latter part of the war.22

A minor reason for the lack of opportunity for advancement in the Dental

Service was of course the relatively low rate of attrition among dental officers.23

Another factor was the difficulty encountered, under emergency conditions,

in determining which officers were best qualified for promotion. Little effort

was made to transfer eligible officers from posts where no vacancies existed to

installations where opportunities were better. At the worst, an officer's efficiency might actually reduce his chances for advancement since he was more

likely to be held at the old, established installation, while the less desirable

officer might be transferred to a new facility where more vacancies could be

expected. A considerable element of chance was thus introduced into the promotion program, and men who were lucky enough to be in the right place at the

right time advanced rapidly while equally competent men held the same grade

for the duration of the war.

By far the most important reason for slow promotion in the Dental Corps,

however, was the lack of positions in the Dental Service calling for grades above

that of captain.

In the Zone of Interior, where the size and mission of installations varied

widely, local commanders were given considerable freedom to determine what

grades would be allotted to individual activities, as long as prescribed totals

were not exceeded. The commanding general of a service command, for

instance, received a total authorization of grades for his entire area, and he

could distribute them among the respective corps pretty much as he pleased,

according to their relative strength, his own estimate of responsibilities involved,

or any other factors which seemed important. Similarly, the commander of a

post or hospital might or might not allocate to the Dental Service enough of

the field grades at his disposal to make reasonable promotion possible. Only in

the case of very gross and obvious discrimination was the local commander likely

to be called upon to justify his actions in this respect. The advantage of this

policy was that promotion was placed in the hands of officials who were familiar

with duties and responsibilities in the installation concerned; the disadvantage

was that personal factors might play a considerable part in determining who

should be advanced. Also, under regulations then in effect the dental officer

could not personally support his recommendations concerning the grades needed

by his activity, and he had to rely on the good will and aggressiveness of the

surgeon, who alone served on the commander's staff.

22 See chapter I.

23 See chapter III, p. 56.
PERSONNEL AND TRAINING 111

Under such circumstances it was perhaps inevitable that opportunities for

promotion in the Dental Service varied greatly in different commands and

installations in the Zone of Interior, and that serious inequities were possible.

The normal allotment of dentists for a 25-chair clinic, for example, was considered to be 1 lieutenant colonel, 5 majors, and 19 captains or lieutenants,24

but this ratio was seldom attained. One general hospital was reported to have

no dental officer in field grade in spite of the fact that it had 15 majors in other

branches.25 Since the senior dentist was always a subordinate of the senior

medical officer the former's grade tended to be set below that of the surgeon, and

this lower grade of the dental surgeon was in turn reflected in lower grades for

his subordinates throughout the Dental Service. At the end of 1943 only 1.6

percent of all service command dentists were colonels, 3.3 percent were lieutenant colonels, and 11.6 percent were majors; the proportion of medical officers

in these top grades was approximately twice as great.28

The composition of tactical commands was not left to the discretion of

commanders, but was prescribed by rigid "tables of organization." An infantry regiment could have two dentists in the grade of captain or lieutenant,

and no deviation in number or grade was permitted. A captain in such a regiment could be promoted only if he could be transferred to another organization

where a vacancy existed. Some limitation on promotion was obviously required to prevent a top-heavy accumulation of officers in grades not justified by

their duties and responsibilities. As constituted during World War II, however, tables of organization provided few field grade vacancies in tactical

commands.

In an infantry division, only 1 of the 12 dental officers was a major. Even

a field army, with from 300 to more than 600 dentists, provided relatively few

positions for field grade officers. In a "type" army of three corps and supporting troops, there were only 9 majors and 1 full colonel (the army dental surgeon)

among about 244 dental officers in troop units. Among the 70 dentists with

army hospitals the situation was better since this group included 16 majors

and 3 lieutenant colonels, but of the total of about 314 dentists in this "type"

army only 1 (0.3 percent) was a colonel, 3 (1.0 percent) were lieutenant colonels,

and 25 (8.0 percent) were majors.

Hospitals in the overseas areas generally fared better than combat commands. Field hospitals, evacuation hospitals, and the smaller station hospitals

(under 250 beds) provided no field grades for dentists in the first part of the

war, but a 250-bed station hospital had a major, and all station hospitals with

over 500 beds included both a lieutenant colonel and a major among their 4 or 5

dental officers.27 A 1,000-bed general hospital had a lieutenant colonel, and a

1,500-bed or 2,000-bed general hospital had a full colonel, a lieutenant colonel,

M ASF Cir 389, 16 Oct 45.

25 The Surgeon General's Conference with Service Command Surgeons, 10 December 1943. HD : 337.

26 Info from Strength Accounting Br, AGO, given to author on 6 May 46.

w Data extracted from the T/O's for combat and medical units.
112 DENTAL SERVICE IN WORLD WAR II

and a major on its staff of dentists. The larger number of these medical installations in the communications zone raised the proportion of field grade

dental officers in that area, but not to a sufficient degree to assure reasonable

promotion in overseas areas as a whole.

Because the Air Force had very few hospitals the limitations imposed by

tables of organization worked an especial hardship on its overseas dental personnel, and the ratio of Air Force dentists in the two top field grades (United

States and overseas, combined) was only about half the meager ratio allotted

to the Dental Service as a whole.28

The fact that dental officers had less opportunity to reach the grades above

that of captain is shown in the following tabulation which lists the percentage

of all officers of the Dental Corps, Medical Corps, and total Army in each grade

as of 30 April 1945:»

Dental Medical

Grade Corps Corps Total Army*

General 0. 18 ( )

Colonel 0.83 2.35 1.24(1.69)

Lieutenant colonel 2.71 7.34 3.36(4.56)

Major 10.38 21.61 8.24(11.20)

Captain 67.25 56.50 23.33(31.70)

First lieutenant 18.83 12.20 37.42(50.85)

Second lieutenant 26.23 ( )

•Figures in parentheses provide a distribution of the total Army officers excluding generals and second lieutenants. The percentages for the total Army (not in parentheses) are based on total commissioned officers including generals as well as second lieutenants.

In August 1945 the Medical Corps had 9 major generals and 46 brigadier

generals, while the Dental Corps had 1 major general and 1 brigadier general.

Comparisons between the proportions of medical and dental officers in

the grades of lieutenant and captain slightly favor the latter, but cannot be considered significant since any lieutenant could be promoted captain as soon

as he had spent the required time in grade. It is more difficult to explain the

wide discrepancy in the general grades, but this situation probably had little

effect on morale as very few dentists could hope to become general officers

under any circumstances. It is in the range of the field grades that the dental

officer was at the greatest disadvantage, and inability to reach those grades

was the greatest cause for dissatisfaction with promotion policies. The ratio

of colonels and lieutenant colonels in the Dental Service was about one-third

that in the Medical Corps, and about one-half that in the Army as a whole if

generals and second lieutenants are not considered. The ratio of maj'ors in

the Dental Corps was about half that in the Medical Corps, and less than the

ratio for the Army as a whole if generals and second lieutenants are not

considered, in spite of the fact that most dental officers started one grade

higher than most officers of branches outside the Medical Department.

28 See footnote 7, p. 106.

" Strength of the Army, 1 May 45.
PERSONNEL AND TRAINING 113

The unfortunate results of slow promotion in the Dental Corps were

described as follows by the dental surgeon of the Middle East theater:30

A condition which had a very adverse effect on the morale of dental officers . . .

was relative discrimination in the grades to which'dentists could hope to attain. This

is a familiar complaint, but it was well founded. When twenty-five percent of medical

officers were in field grade, for instance, only seven and one-half percent of dental

officers could reach field grade. The inevitable result . . . was that dental officers

found themselves passed at regular intervals by men of other branches with less

experience and ability. I do not wish to imply that the discrimination existed only

between the Medical and Dental Corps, nor can the blame be placed on medical officers

commanding in this theater. ... I merely draw attention to the condition as it

undoubtedly existed. Dental officers, like the rest of the Army, recognized that in

time of national emergency individuals must be prepared to sacrifice their own

personal welfare for the successful prosecution of the war. They had given up their

practices and their homes because they felt they could make an important contribution

toward winning that war, and as long as they had this conviction they were glad

to give their best efforts, with or without promotion. But when a dental officer

was passed again and again by men of other branches who were less experienced,

no more intelligent, and certainly no harder working, he inevitably arrived at the

conclusion that his own work was not considered important. I need not elaborate on

the danger of such an attitude.

The Director of the Dental Division, SGO, stated in 1945 that:31

There is no doubt that proportionately there are more position vacancies for brigadier generals, colonels, and lieutenant colonels in the Medical Corps by virtue of the

fact that the medical officer commands the hospitals. . . (but) it is believed generally

in the Dental Corps that the ratio of Medical Corps officers to Dental Corps officers,

in accordance with strength figures, is not equitable. It was extremely difficult for

officers of the Dental Corps to understand such a vast difference in all field grades,

and there was only one general result—lowered morale.

During the war a number of efforts were made to improve the status of

dental officers in respect to promotion. In 1943 the American Dental Association claimed that failure to insure equal promotion for dentists violated the

act of 6 October 1917 (40 Stat. 397) which provided that officers of the Dental

Corps would have the same grades, proportionately distributed, as officers of

the Medical Corps.32 These Gharges were based on the contention that Section

10 of the National Defense Act, as amended by Section 10, act of 4 June 1920

(41 Stat. 766), which prescribed promotion by length of service, had merely

amplified the principle established in the act of 1917, but The Judge Advocate.

General ruled that the law providing for promotion by length of service had

rescinded the earlier legislation, and that there was no legal requirement that

30 Address by Col George F. Jeffcott before the Association of Military Surgeons in New York on

2 Nov 44. This paragraph was omitted from the version of that talk which was published in The

Military Surgeon, Jan 1945.

a See footnote 9, p. 107.

" Ltr, Dr. J. Ben Robinson, Pres ADA, to Maj Gen James C. Magee, 5 Feb 43, no sub. SG : 080

(American Dental Association).
IH DENTAL SERVICE IN WORLD WAR II

the Medical and Dental Corps should have the same proportion of officers in

each grade.33

In January 1943 the Director of the Dental Division, SGO, initiated important steps to speed the promotion of lieutenants. Prior to this time tables

of organization or tables of allotment had prescribed specific numbers of

lieutenants for the Dental Service of units or installations, and in many cases

the result was complete stagnation of promotion, regardless of length of

service. The situation was particularly serious in the smaller tactical commands, where the lieutenant of an infantry regiment was practically "frozen"

in grade since changes in personnel were infrequent after the unit was once

organized. The Director of the Dental Division requested that tables of

organization which included dental lieutenants be amended to read "lieutenants

or captains," thus making it possible to advance dentists out of the lowest

grade when they met other requirements for promotion, regardless of the

existence of a position vacancy. This recommendation was adopted for both

medical and dental officers of table-of-organization units in May 1943.34 It was

extended to include Zone of Interior installations in July of the same year.35

The effect in tactical units was immediate, but some difficulty was encountered

in Zone of Interior installations since service commands were operating under

maximum ceilings in each grade, and they hesitated to advance Medical Department officers when such action would use up position vacancies previously earmarked for other activities.36 By January 1944, however, the proportion of

captains in the Dental Corps had risen from about 25 percent to over 48 percent,

and by V-E Day 68 percent of all dental officers were captains and only 19 percent were lieutenants.37

Partially successful efforts were also made to increase the grades held by

dentists in hospitals, which provided almost the only opportunity for promotion to field grade. In 1942, for instance, a 300-bed station hospital was

authorized only a captain and a lieutenant, but by 1944 the allotment was a

major and a captain. Similarly, the major, captain, and lieutenant of a 750-bed

evacuation hospital were each authorized the next higher grade. A major was

added to the tables of organization of the 1,000-bed general hospital. In general, an effort was made to have the senior dental officer of any hospital given

the same grade held by the chiefs of the medical or surgical services.38

The Deputy Surgeon General39stated in October 1943 that brigadier

generals would be appointed in the Dental Corps to act as dental surgeons of

the three principal theaters, but no such action was taken until February 1945,

33 1st ind, Chief Mil Affairs Div, JAGD, 2 Nov 43, on ltr, Chief of Legal Div, SGO, to JAG, 28

Oct 43, sub : Rank of dental officers. SG : 322.0531-1.

3

* WD Cir 122, 18 May 43.

3B WD Cir 169, 24 Jul 43.

38 See footnote 25, p. 111.

37 See footnote 29, p. 112.

38 See footnote 9, p. 107.

» Memo, Brig Gen George F. Lull, for Pers Div, G-l, 26 Oct 43. SG : 322.053-1.
PERSONNEL AND TRAINING 115

when Col. Rex McDowell, of the Dental Division, SGO, was promoted.

In 1945 the Director of the Dental Division, SGO, asked for legislation to

authorize 1 major general and 4 brigadier generals for the Dental Service, with

1 each of the latter to be assigned to the Air Forces, the Ground Forces, and

the Service Forces, but no action was taken on this request.40

Efforts to increase the authorization of field grades for dentists in tactical

commands, outside of hospitals, were generally unsuccessful. A single dental

officer in a battalion was unlikely to be granted a grade higher than that held

by a company commander who was responsible for over 200 men. It is probable

that some improvement would have been possible if the Dental Service of the

larger elements, such as the division, could have been organized into larger

detachments, in which higher grades for those officers having increased professional or administrative responsibility would have been justified. Such an

organization had more important advantages than the possibility of increasing

the allotment of field grades (see chapter VIII), but it was attempted only

on an experimental basis during World War II.

In general, the opportunities for promotion in the Dental Corps were

increased during the war, especially in respect to the company grades, but the

Director of the Dental Division, SGO, stated at the end of hostilities that the

measures taken had not been adequate, and that "there was no real solution

reached with reference to field grades." 41

MORALE

Official wartime reports seldom mentioned morale problems among dental

officers, suggesting that deficiencies were not considered serious. From the

practical point of view, dentists certainly rendered loyal and effective service

during the period of hostilities. Unfortunately, there is good evidence that

many dental officers left the Armed Forces, including the Army, with the feeling that they had not received fair treatment, and relations between the Dental

Corps and the civilian profession left much to be desired as the Medical Department faced the postwar era.42 The ADA, in particular, was called upon to

defend itself from the bitter criticisms of members who felt that their interests

had not been adequately guarded,43 and these criticisms were passed on to the

Dental Services of the Armed Forces with interest.

Many complaints could of course be ascribed to the age-old military

privilege of "griping." Also, it would be too much to expect that wartime

40 Memo, Maj Gen R. H. Mills for Col B. C. T. Fenton, 21 Sep 45. This memorandum has been seen

by the writer, but it was not placed in permanent files of SGO.

« See footnote 9, p. 107.

42 Series of editorials In Oral Hygiene from July to October 1943. See also (1) The Army Dental

Corps. J. Am. Dent. A. 32: 487-488, 1 Apr 45. (2) Sauce for the goose. J. Am. Dent. A. 32:

888-889, 1 Jul 45. (3) New regulations for the Army Dental Corps. J. Am. Dent. A. 32: 1290,

1 Oct 45. (4) Theory and fact in dental legislation. J. Am. Dent. A. 32 : 1301-1308, 1 Oct 45. (5)

The right to gripe : The fifth freedom. J. Am. Dent. A. 33 :118, 1 Jan 45.

«Ibid. (4).
116 DENTAL SERVICE IN WORLD WAR II

service should be pleasant, and in the haste of mobilizing the nation's defense

resources it was probably inevitable that some men should get more favorable

assignments than others, that promotion should not always be equitable, and

that misassignments should be made. Such injustices will probably continue

to exist under emergency conditions in spite of all efforts to end them. On the

other hand, some criticisms were undoubtedly justified, and even those which

appear to have been exaggerated deserve consideration since imagined deficiencies were often as detrimental to morale as those which were real.

Among the more important causes of dissatisfaction were the following:

1. Unfavorable promotion status. (See discussion, this chapter.)

2. A fairly widespread opinion that the Dental Service was unnecessarily

dominated by medical officers. (See discussion under "Medicodental Eelations"

in chapter I, pp. 7-15.)

3. Unfavorable assignments and lack of opportunity for promotion for

members of the Keserve called to active duty early in the war. Keserve officers

were among the first to be brought into the service, before other dentists were

being taken from civilian life in large numbers. Because they had had some

military training they were often placed in tactical units where dental practice

was limited to routine, minor operations, and where promotion was notoriously

slow. The inexperienced man, on the other hand, was more likely to be placed

under supervision in a large clinic or hospital where military knowledge was

less important. Here his opportunities for improving his professional skill

were better, probability of advancement was increased, and the chance of being

shipped overseas to a combat theater reduced. The Keserve officer tended to

feel that he had been "sold down the river" because he had taken sufficient

interest to prepare himself for military service before war broke out. This

matter is discussed in greater detail in chapter III.

4. The establishment, especially during the early part of the war, of

"amalgam mills" where long hours were spent at the chair doing routine operative work which offered little stimulation to professional interest. The situation

was sometimes complicated further by the prescription of daily "quotas" which

each officer had to meet. Insofar as "production line" procedures contributed

to efficiency and assured that the best qualified men would render specialized

treatment, they were probably unavoidable. At best, approximately 90 percent

of all dental care required by recruits consisted of routine restorative work, and

the understandable desire of dentists to widen the scope of their experience

could be gratified only to a limited extent in wartime. (See the discussion of

quota dentistry in chapter VI, pp. 223-225.)

5. The handling of the dental ASTP, and related demobilization policies.

First protests in this field came in June 1944 when ASTP graduates who had

received part of their training at Government expense were discharged to enter

private practice. (See discussions in chapters III, pp. 56-59 and IX, pp.

340-342.)
PERSONNEL AND TRAINING 117

The serious drop in the morale of dental officers during the war, as expressed in postwar personnel difficulties and criticism in the professional press,

was of course regrettable. At the same time it served a constructive purpose in

that it emphasized defects which urgently needed attention.44

COMBAT ACTIVITIES, AWARDS

Dental officers shared the risks and hardships of the units to which they

were assigned. They participated in Pacific landings, in assaults on Europe's

fortified lines, and in airborne attacks in the Mediterranean. One dentist served

as commanding officer of an infantry regiment,45 and another was dropped by

parachute into Greece late in 1943, aiding the Greek guerillas and organizing

a medical service for them until that country was liberated in 1945. After

liberation of Greece this officer was instrumental in obtaining the release of

British officers held as hostages by leftist Greek forces. For his efforts he

received the Order of the British Empire as well as Greek and American

awards.46 Recognized and unrecognized instances of heroism and exceptional

devotion to duty were too numerous to be discussed in detail. In addition to

those receiving the Purple Heart for wounds received in action, 384 dental

officers received other awards as follows: Legion of Merit, 24; Silver Star for

gallantry in action, 10; Soldier's Medal, 2; Bronze Star, 347.47 In October

1945 Maj. Gen. Robert H. Mills, who had been Director of the Dental

Division, SGO, during more than 3 years of war, was awarded the Distinguished Service Medal, the highest award for outstanding administrative duties.

From 7 December 1941 through 31 December 1946,48 116 dental officers

died from all causes. In this period, 20 dental officers were killed in action;

60 dentists were wounded, 5 of whom died; 38 were made prisoners of war, of

which number 12 died (including 2 shown among the 20 killed in action), and 1

reported missing in action who subsequently returned to duty. (There were

a total of 91 nonbattle deaths, 10 of which occurred while in a prisoner of war

status.) Capt. Howard A. McCurdy, Dental Reserve, who lost his life in

"By the end of 1948 the Dental Corps had been given new administrative status, temporary

promotion policies were being revised, and the military were showing an increased willingness to take

the representatives of the civilian professions into their confidence when problems concerning members

of those professions were encountered. "Quota" dentistry was dead, probably for good, and the more

knotty question of giving individual dentists greater freedom in military practice without reducing

efficiency was being considered. These changes would probably not eliminate all complaints in any

future mobilization, but they promised much for long-term improvement in the efficiency and morale

of the Dental Service.—Ed.

45 Colonel Roy A. Green to return to private practice. J. Am. Dent. A. 33 : 379, 1 Mar 46.

48 Iowa dental officer receives honor from Britain. J. Am. Dent. A. 32 : 1350, 15 Nov 45.

47 HTM-14, 1 Aug 46, Decorations and awards awarded by the War Department and overseas

theater commanders, for period 7 December 1941 thru 31 May 1946. In Decorations and Awards

Br, AGO.

48 Army Battle Casualties and Nonbattle Deaths in World War II, Final Report, 7 Dec 41-31 Dec

46. Strength and Acctg Br, AGO.
118 DENTAL SERVICE IN WORLD WAR II

the Philippines in January 1942, was the first dental officer killed by enemy

action in World War II.49

TRAINING OF DENTAL OFFICERS

World War I

During the First World War, over 4,000 inexperienced dental officers were

called to duty in a relatively short period of time. Initially, no provision had

been made for training these men, but fortunately, many had been members

of the Preparedness League of American Dentists and had received some instruction in both military dentistry and military administration. The Preparedness League was formed in March 1916 to provide free dental service

for men wishing to enlist in the Army and, later, to prepare potential draftees to

meet induction requirements.50 51 It had also extended its activities to sponsor

study clubs for dentists who expected to enter the Reserve, a program which was

started even before the United States entered the war. A standard course of

study was drawn up .by the League and approved by The Surgeon General.

This included instruction in anatomy, dental and oral surgery, pathology,

x-ray, fractures, anesthesia, prosthetic restoration, bone grafting, first aid,

military law, and military administration.52 The Association of Deans of

Dental Schools approved the plan and after June 1917 most schools made their

facilities available without cost to the Government or individuals. Colonel

Logan, head of the Dental Service, stated that the majority of schools cooperated in the program and that from 4,000 to 5,000 dentists completed the

training.53

The first effort by the Army to train dentists came with the establishment

of the section on Surgery of the Head in the SGO. This office sponsored classes

in maxillofacial surgery for selected officers at Washington University, St.

Louis; Northwestern University, Chicago; and the University of Pennsylvania,

Philadelphia (Thomas W. Evan Institute). From October 1917 to March

1918 these courses provided instruction along the same lines as that given in

the Preparedness League program.54

In March 1918, a field service school was established at Camp Greenleaf,

Fort Oglethorpe, Georgia, for the instruction of dental officers and their

enlisted assistants.55 The course at Camp Greenleaf included a month of in-

« Dental officer killed In action. Army Dent. Bull. 13 : 149, Apr 1942.

s« Beach, J. W.: Preparedness League of American Dentists. J. Nat. Dent. A. 4 : 176, Feb 1917.

M Beach, J. W.: Preparedness League of American Dentists—Our first birthday. J. Nat. Dent.

A. 4 : 363-370, Apr 1917.

62 Synopsis of study club course in war dental surgery for the sectional units of the Preparedness

League of American Dentists. J. Nat. Dent. A. 4 : 795-797, Jul 1917.

53 Logan, W. H. G.: Development of the dental service during the present war. J. Nat. Dent.

A. 5 : 993-1004, Oct 1918.

M

Ibid.

55 Ibid.
PERSONNEL AND TRAINING 119

struction in basic military subjects, followed by a month of study in anatomy,

oral surgery, the effects of focal infection, and the fixation of fractures. Every

effort was made to have new officers sent to this school, and 1,200 had been

enrolled when the war ended in November 1918.

Training for Regular Army Dental Corps

Officers Prior to World War II

Candidates for the Regular Army Dental Corps in the period between

World Wars I and II were required to be graduates of accepted civilian dental

schools and to have at least 2 years of experience in the practice of dentistry.

Many were without previous military experience, however, and required both

basic military training and additional professional instructions before they

were qualified to assume complete responsibility for the Dental Service of a

camp or post. As they reached the higher grades, dental officers also required

additional training to fit them for positions of greater responsibility. The

Army was therefore called upon to provide graduate instruction of all types

from the most elementary to the most advanced, both military and professional.

Basic Graduate Course, Army Dental School. The first step in the preparation of a new dental officer was to supplement his previous education in oral

surgery, operative dentistry, and prosthetics; subjects in which he would need

to be especially proficient if called upon to take over the operation of the

Dental Service at an isolated post. In a 4-month basic course at the Army

Dental School in Washington (postgraduate only) the new officer received

training in these specialties as well as refresher instruction in those subjects

which he might have forgotten since graduation from dental school. Unfortunately, a chronic shortage of officers made it impossible to schedule these

courses regularly and the last class was given in 1935. An average of seven

officers took this course annually between 1930 and 1935.56

Officers'' Basks Course, Medical Field Service School. After the professional education of the new dental officer had been brought up to date at the

Army Dental School, he was sent to the Medical Field Service School (MFSS)

at Carlisle Barracks for an additional 5 months of basic military instruction. With other officers of the Medical, Veterinary, and Medical Administrative Corps he studied the organization of military units, the organization

and function of medical field units, preventive medicine, first aid, the evacuation of wounded, records and returns, supply procedures, and military law.

He learned about Army regulations and customs of the service and he practiced

close-order drill in the ranks. During 2 weeks of field maneuvers he put into

practice the fundamentals he had studied in the classroom and served as part

of the staff of a battalion aid station, a collecting station, and a medical regi58 Annual Reports of Technical Activities, Army Medical Center, for the years 1930-35. HD :

319.1-2.

330324 0—55 9
120 DENTAL SERVICE IN WORLD WAR II

ment. In separate classes for dentists the new officer became familiar with

dental field equipment and the administration of a dental clinic. One hundred

and forty-one dental officers graduated from this course from the founding

of the school in 1921 through 1939.57

Advanced Graduate Course, Army Dental School. As the Army dental

officer approached field grade he might be sent to the advanced graduate course

of the Army Dental School where he received 4 months of instruction in oral

surgery, x-ray technique, prosthetics, operative dentistry, preventive dentistry,

and periodontal diseases. This course was not expected to qualify the dentist

as a specialist but it gave him the general background he needed to act as

chief of the Dental Service at a larger post or hospital. Outstanding civilians

were brought in to lecture on special subjects and all the facilities of the Army

Medical School, Walter Reed General Hospital, the Dental Research Laboratory, the Army Institute of Pathology, and the Central Dental Laboratory

were utilized to make this training the most effective possible. The potential

value of the course was limited, however, by the small number of officers able to

attend, and only 27 men graduated in the 11 years from 1930 through 1940.58

In 1936 the Army Dental School provided a course for professional

specialists which was attended by four officers,59 but with this single exception

it did not attempt to furnish extensive instruction leading to qualification in

a dental specialty.

Advanced Officers'1 Course, Medical Field Service School. After attaining field grade, usually before examination for promotion to lieutenant colonel,

dental officers might be sent to the 3-month advanced course of the MFSS.

This course was designed to fit the officer for staff duties and the administration of the Dental Services of large units. A relatively small proportion of

eligible officers were able to take the course, however, and from 1923 to 1939

there were but 21 graduates.60 A larger proportion of senior officers took the

special extension course of the MFSS which covered essentially the same

material and exempted the candidate from solution of a field problem in his

examination for promotion to the grade of lieutenant colonel.

Instruction in Civilian Institutions. A limited number of dental officers

were authorized to receive instruction in civilian institutions for periods of

from a few weeks to a year. In the 11 years from 1930 to 1940 (inclusive)

32 received such training, though from 1937 to 1940 only 3 courses were

authorized.61

Nonmedical Service Schools. Dental officers were theoretically eligible for

courses of instruction at such advanced Army schools as the Command and

"' Special Rpt, undated, from Col Neal Harper, DC, received in 1945. HD : 314.1-2.

68 Annual Reports of Technical Activities, Army Medical Center, for the years 1930-40. HD:

319.1-2.

60 Annual Reports of Technical Activities, Army Medical Center, for the year 1936. HD: 319.1-2.

Annual Reports, Medical Field Service School, 1923-39. HD : 319.1-2.

«Annual Reports of The Surgeon General. U. S. Army, 1930-1940, Washington, Government

Printing Office, 1930-1940 (cited hereafter as Annual Report . . . Surgeon General).
PERSONNEL AND TRAINING 121

General Staff School and the War College. In practice they were not ordered

to these schools until after the start of hostilities in World War II, and then

in almost negligible numbers.

Extension Courses. At any time in his career the dental officer was eligible

to take correspondence courses published by the MFSS. These were primarily

designed for Eeserve officers, however, and the number of regulars enrolled

was small. Command and General Staff extension courses were also open to

dental officers with appropriate background, but enrollment was limited and

few dentists in the peacetime establishment were able to get advanced training

in general staff procedures.

Dental Internships. Dental internships were first authorized in February

1939.62 Eight graduates of the class of June 1939 were selected and trained for

1 year in 1 of 6 major hospitals. (Walter Reed General Hospital, Letterman

General Hospital, Fitzsimons General Hospital, Army-Navy General Hospital,

William Beaumont General Hospital, and the Station Hospital, Fort Sam

Houston.) Interns were regarded as potential candidates for the Regular

Army Dental Corps and were selected on the basis of scholarship, physical

fitness, and adaptability for military service. They were eligible for appointment in the Dental Corps without the 2 years of private practice required of

other applicants and without competitive professional examination.63 They

received $60 monthly plus quarters and subsistence. Only about one-fifth of

all applicants were accepted and the qualifications of successful candidates were

high. A total of 27 interns were taken into the Dental Corps out of 28 receiving this training between 1940 and 1942. The last class of nine interns

graduated in June 1943, but none of this group were taken into the permanent

establishment due to the suspension of all Regular Army procurement during

the war. An earnest effort was made by the Dental Division, SGO, to have

these men commissioned at the end of hostilities, but the request was rejected by

higher authority. Tentative plans for resumption of the dental intern program after the war called for the granting of reserve commissions to accepted

candidates, who would then be called to active duty for the required period of

training, with the pay and allowances of their grade.

Summary. The prewar training of the Regular Army dental officer was

generally effective, but the fact that the permanent Dental Corps numbered

only about 260 officers at the start of World War II meant that this source

could supply only key personnel, a negligible proportion of the 15,000 officers

needed to staff the Dental Service.

Training for Reserve Officers Prior to World War II

On 30 June 1941 the Dental Reserve Corps numbered 4,428 officers in the

following grades: 7 colonels, 96 lieutenant colonels, 354 majors, 909 captains,

62 SG Ltr 6, 14 Feb 39.

« AR 605-20, 19 Aug 42.
J22 DENTAL SERVICE IN WORLD WAR II

and 3,062 lieutenants.64 From 1 January 1939 through 28 February 1946,3,606

Reserve dentists were called to active duty,65 including a few who were given

commissions after 30 June and before 7 November 1941, when procurement for

the Eeserve was terminated.

Immediately following World War I the Reserve was made up largely

of officers who had had some active military experience. In the period between the two World Wars, however, the Dental Reserve was maintained and

augmented with men who either had had no military training whatever, or

who had received limited training in connection with their professional education. These new officers required additional instruction and practical experience to fit them for the duties they would perform on mobilization.

Reserve Officers' Training Corps. For 10 years, until 1932, eight dental

schools cooperated with the Army to offer courses which would qualify students

for commissions in the Dental Reserve on graduation. Regular Army personnel were loaned as instructors, and students attended 30 hours of class

yearly. (Credit for 60 additional hours was given for courses such as maxillofacial surgery, taken by the undergraduate as part of his regular professional

training.) The course was divided into basic and advanced sections of 2 years

each. Enrollment in the basic class was usually obligatory and entitled the

student to no pay. A smaller number of selected students took the senior

course on a voluntary basis and received a "ration allowance" of about $9 a

month. Advanced students were required to attend one 6-week summer camp

during which they received the pay of an enlisted man of the lowest grade ($21

monthly). Instruction was given on the organization of the Army and the

Medical Department, dental reports and records, the care of maxillofacial injuries, and the operation of dental field facilities. In the summer camp the

candidate drilled, set up field installations, and observed military organizations in actual operation. Of 6,854 officers commissioned in the Dental Reserve

from 1922 to 1935, 2,274 or 33.2 percent were graduates of the ROTC senior

course.66 Unfortunately, the dental ROTC program was drastically curtailed as an economy measure in 1932 and the last class graduated in 1935.

Extension Courses for Reserve Officers. Before the war, the Army sponsored a series of graduated correspondence courses designed to meet the needs

of Reserve officers of all degrees of experience and in all grades. Extension

courses began with such basic military subjects as map reading, military law,

customs of the service, and organization of the Army. They advanced to specialized instruction in sanitation, evacuation of wounded, medical reports, and

the tactics of medical organizations in the field. Completion of the appropriate

courses was practically a prerequisite for promotion, and the Reserve officer

«Annual Report . . . Surgeon General, 1941 (1941) p. 143-147.

* Officers appointed in the Dental Corps from 1 January 1939 through February 1946. Strength

Acctg Br, AGO, 8 Jul 46. HD : 320.2.

« Annual Reports of the Secretary of War, 1922-1940, Washington, Goyernment Printing Office,

1922-1940 (cited hereafter as Annual Report . . . Secretary of War).
PERSONNEL AND TRAINING 123

was able to develop his knowledge as his responsibilities increased with each

higher grade. From 1935 to 1938 an average of 8,000 Medical Department

Keserve officers, or a little over one-third of the total strength, were continually

enrolled in extension courses.

Summer Camps for Reserve Officers. The Medical Field Service School

routinely devoted the summer period to training programs for Eeserve officers.

A 2-week camp was scheduled for the instruction of junior Keserve officers,

another was held for those assigned to units. A 6-week camp, designed to train

key personnel for larger medical units, was held for senior captains and field

grade officers. Eeserve dentists all over the United States were also given occasional 2-week tours of active duty at nearby posts where they received "on-thejob" training. In the 12 years before 30 June 1940, 6,034 dental officers received

some type of summer camp training, though there is considerable duplication

in this figure since it includes those who attended more than one camp during

the period.67 In addition, between 200 and 300 National Guard Dental officers

annually attended camps conducted by that component.

Following the war, senior dental officers stated that, in general, prewar

Reserve training had been adequate for the company grades, but that it had not

always been extensive enough to prepare men in the higher grades to hold key

positions in the Dental Service. In particular, Reserve training was found to

have placed greater stress on didactic instruction rather than on practical

experience. The completion of correspondence courses, plus 2 weeks of active

duty every few years, was often insufficient preparation for a former small town

dentist who might be called upon to operate a camp dental service for 25,000

men. These comments on the deficiencies of prewar Reserve training should

not be construed as blanket criticism of the Reserve program; thousands of

dentists were able to step into routine military duties without delay because

they had received some preliminary training as civilians, and some Reserve

officers administered major dental services with distinction. But the utilization of field grade dentists who, through no fault of their own, were inadequately trained for the duties appropriate to their grades, was a problem for the

Dental Service and for the officers concerned.68

Training for Dental Officers During World War II

At the start of World War II the Regular Army Dental Corps and auxiliary components could together provide less than one-third of the 15,000

dental officers needed for the expanding military establishment. The remainder had to be obtained directly from civil life. Most of these new officers

needed intensive professional and administrative training before they were

qualified to assume unfamiliar duties in a military organization. This necessi-

** See footnote 66, p. 122.

68 Pers interv by the author with Maj Gen Robert H. Mills, 6 Oct 47. Also pers ltr to the author

from Brig Gen Leigh C. Fairbank, 9 Oct 47.
124 DENTAL SERVICE IN WORLD WAR II

tated a large-scale expansion of all prewar programs and the initiation of

extensive new facilities.

Basic Training, Medical Field Service School. The Medical Field Service

School at Carlisle, Pa., assumed an important role in the training of dental

officers mobilized for the emergency. Though the courses varied somewhat to

meet changing conditions, the school continued throughout the war to instruct

new officers in military organization and administration, the functions of field

units, and the operation of the Dental Service. Before 1942 special dental lectures had been given as an incidental duty by the senior officer of the post, but

in June of that year the dental representative received full faculty status.69 At

the height of the training program in 1944 the dental representative had five

assistants. In the 6-week course which was in effect during most of the war,

dental officers received 22 hours of special dental instruction in addition to 250

hours on general military subjects with officers of the Medical, Veterinary, and

Medical Administrative Corps. The dental course covered the organization,

functions, and administration of the Dental Corps, the duties of dental officers

in fixed and mobile installations, dental property, the training of assistants,

dental surveys, first aid to and evacuation of jaw casualties, approved splinting

methods, and the relations of dental officers to other arms and services.70

The first change to a wartime schedule at the MFSS came late in 1939

when the normal 5-month basic course was reduced to 3 months so that an

extra class could be started in the spring of 1940. In December 1940 the course

was cut to 4 weeks and called the "Refresher Course." Up to this time the

basic course had been intended for new Eegular Army officers, but by the end

of 1940 Eeserve officers with some military experience were being called to

active duty and it was felt that 1 month of training would be sufficient to

supplement their previous preparation. Summer classes for Reserve and National Guard officers were dropped in 1940 since all officers were then being

prepared for extended active duty. Extension courses were carried on until

the summer of 1941. By September 1941 the pool of Eeserve officers was becoming exhausted and dentists without any previous training were being called

to active duty, leading to the decision to lengthen the course to 8 weeks. A

critical shortage of officers in July 1942 caused the basic course to be temporarily reduced to 4 weeks but as soon as possible (December 1942) it was

restored to 6 weeks and remained at that figure for most of the remainder of

the war. In February 1945 the course was further extended to 8 weeks.71 In

February 1946 activities of the MFSS were transferred to Brooke Army Medical Center, Fort Sam Houston, Texas.

"«History of the Army Dental Corps, 1941-43, p. 82 of Personnel Section. HD: 314.7-2 (Dental).

70 The training of dental officers. Bulletin of the U. S. Army Medical Department, 80 : 14, Sep

1944 (cited hereafter as Army Medical Bulletin).

71 History of training, World War II, vol X, Chart 3. HD : 314.7-2.
PERSONNEL AND TRAINING 125

From 1 January 1941 to 30 June 1945, 4,473 dental officers completed the

basic training courses at the Medical Field Service School, as follows:72 73

1941 421

1942 440

1943 1.

508

1944 1.574

1945 (January to June, incl.) 530

A little over 25 percent of all dental officers on duty during the war received

Medical Field Service School training.74 It was not until May 1945 that the

War Department was able to direct that all dental officers would thereafter

complete field training before being assigned to a unit.75

Basic Training, Medical Department Replacement Pools. About the middle of 1942, training programs were instituted for officers in replacement pools

at the MFSS, 4 officer replacement centers, 14 named general hospitals, several

medical supply depots, and at the Gulf Coast Air Corps Training Center.76

These pools had an authorized capacity of 200 dental officers. While officers

were available for varying lengths of time, the courses were planned on a

1-month basis and were mainly "on-the-job" training in medical facilities of the

installation. Since these courses were informal in nature, and since the flow of

officers through the pool determined the instruction each man received, it is

impossible to state how many dental officers completed this training.

Professional Training, Army Dental School. In the year ending 30 June

1940 the Army Dental School gave no professional courses for officers. In the

year ending 30 June 1941 the basic graduate class, which until 1935 had been

given as a 4-month course, was revived as a 3-month "Special Graduate Course"

and given to two classes totaling 40 Regular Army officers. In addition, refresher courses of from 1 to 4 weeks were commenced in February 1941.77 These

were designed to train dentists in oral surgery, prosthetics, or operative dentistry in preparation for assignment as chiefs of such services in dental clinics.

Refresher courses were continued until June 1942, when they were dropped

after a total of 166 officers had completed the training. Four other general hospitals and the station hospital, Fort Sam Houston, also gave refresher courses

during this period but the total number of officers attending these classes

cannot be determined.

After 31 August 1941 the Army Dental School cooperated with the Army

Medical School and Walter Reed General Hospital in giving maxillofacial

« Summary of Dental Corps officers graduated from the MFSS, 9 September 1940 to 3 August

1946. HD: 353 (1946).

73 In addition to the figures given here, a few dental officers may have graduated in a special

class of 802 Medical Department officers which passed through Camp Barkley In 1944. Reports do

not break down the composition of this class by corps, but since it was scheduled to meet the needs

of a large number of medical interns it is probable that few dentists were included.

74 See footnote 9, p. 107.

?

5 WD Cir 144, 16 May 45.

'« SG Ltr 48, 23 May 42.

« SG Ltr 32, 5 Apr 41.
126 DENTAL SERVICE IN WORLD WAR II

plastic courses to train teams qualified to care for these difficult injuries. Until

the end of 1942 these courses were of 4 weeks' duration. They were then

lengthened to 6 weeks. The last course ended in September 194378after a

total of 139 dental officers had been qualified.

After 1943 no courses for officers were given at the Army Dental School.

Maxillofacial and Plastic Training, Civilian Institutions. In September

1942 maxillofacial training at the Army Medical Center was supplemented by

courses given at selected civilian schools. Twelve-week courses were given at

Columbia University and 6-week courses at Harvard, University of Pennsylvania, "Washington University (St. Louis), Mayo Foundation (Minn.), and

Tulane University (New Orleans). The last class ended in August 1944, after

287 officers had been trained, including about 148 dental officers. The number

of classes given at each school varied from two to seven. During the war a

total of 287 dental officers received maxillofacial training at military and

civilian installations.79

Maxillofacial Training in Hospitals. In February 1942 it was directed

that all general hospitals except Darnall General Hospital would institute

training programs for maxillofacial plastic teams.80 It was expected that

these would mainly provide experience in teamwork for previously qualified

individuals, but if trained personnel were not already available, authority for

instruction in civilian institutions was granted.

Refresher Courses, Army Hospitals. In May 1945 refresher courses in

Army general hospitals were authorized for a limited number of dental officers

who had been on extended administrative duty during the war.81 Instruction

was to be for a period of 12 weeks in the clinics of the selected hospitals under

the guidance of permanently assigned personnel. Since the program was

still under way at the end of the war it is not known how many dental officers

may have benefited from this training, but the initial response was not so

large as was expected since most dentists preferred to return to their practices

without delay.

Unit Training. Dental officers assigned to tactical units took part in the

training programs of their organizations, learning by actual field operations

the duties which they would be called upon to perform in combat. In order to

provide the time for this unit training the bulk of the dental work for tactical

organizations in the United States was performed by station dental clinics

operating under the service commands. However, unit dentists were also assigned to these permanent station clinics for part-time duty, both to help

with the rehabilitation of their personnel and for professional training. In

January 1941 it was directed that: (1) unit dental officers would receive train78 Annual Reports of Technical Activities, Army Medical Center, for the years 1942-44. HD

319.1—2.

"Unpublished data obtained from the files of the Training Division, SGO, by the author.

80 AGO ltr, 27 Feb 42, sub: Training in auxiliary surgical groups. AG : 353 Med (2-19-42).

« AGO ltr, 1 May 45, sub : Refresher professional training for Dental Corps officers. SG : 353.
.PERSONNEL AND TRAINING 127

ing in medical tactics as auxiliary medical officers and in emergency treatment

of jaw casualties within their respective organizations, and (2) they would

receive professional training in camp or hospital dental clinics under direction

of the camp or station surgeon.82 After frequent disputes over how much time

should be spent in each type of activity it was finally directed that about half

of the unit dentists' time would be devoted to field training and the remainder

to clinic training and duty.83 Clinic dentists also took part in local training

schedules which provided instruction in military courtesy and customs, conduct

of the clinic, property, and reports and returns.84

Dental Consultants. In September 1944 the Dental Division was authorized to contract for the services of qualified civilian consultants to assist in

training and to advise less experienced men in oral surgery and prosthetics.

Fourteen dentists were made available at various times, including 10 prosthodontists and 4 oral surgeons. These men visited dental installations, advised

local dental officers on procedures and the treatment of cases, and made recommendations to the Dental Division, SGO, concerning general conditions noted.

Dental consultants were required to demonstrate the utmost common sense and

tact, in addition to high professional qualifications, in the performance of their

duties. Until they convinced local dental officers of their sincere desire to be

of assistance, the latter tended to regard the consultants as "snoopers" or inspectors, rather than as educators. A few consultants also tended to recommend

lengthy procedures which were admittedly superior to accepted practices, but

which were not consistent with the necessary policy of "the greatest good for

the greatest number." In spite of these difficulties the dental consultants

showed an understanding of the problems of the Army and of the local dental

officers, and their constructive advice helped materially to raise the standards

of the Army Dental Service.

Film Strips and Moving Pictures. Libraries of film strips and moving

pictures were maintained at each service command headquarters, in some sublibraries at large posts, and in threater headquarters. These training aids were

available on call from any installation. Moving pictures of importance to

dentists were "Endotracheal Anesthesia for Dental Operations," "Harelip and

Cleft Palates" (three films), "Ankylosis of the Mandible" (arthroplasty),

"Eetruded Chin" (cartilage graft), and "Dental Extraction under Pentothalsodium." 85 A film on "Dental Health," for the general instruction of military

personnel, was completed early in 1945. The basic outline for the film was

developed by the Dental Division in cooperation with the Bureau of Public

Eelations of the ADA. The scenario was written by Signal Corps specialists,

82 AGO ltr, 14 Jan 41, sub: Organization, training, and administration of medical units. AG :

320.2.

83 AGO ltr, 31 Jul 42, sub : utilization of dental officers for professional duties. AG : 210.312

(Dental Corps) (7-12-42) QD-A-PSM.

s* Training. Dental Bulletin, supp. to Army Medical Bulletin 11: 175-177, Oct 1940.

85 TB MED 4, 14 Jan 44.
128 DENTAL SERVICE IN WORLD WAR IT,

and filming was completed in Hollywood under Signal Corps supervision. In

25 minutes the film described, in nontechnical language, the need for oral

hygiene, the proper care of the teeth and gums, provention of caries, and the use

and care of dentures.86 Film strips were supplied on first aid for wounds of

the face and jaws, bandaging, control of hemorrhage, traction appliances,

clearing of the airway, and the construction of splints.87 88 At the end of the

war a new series of film strips was being prepared covering diseases of the

mouth, dental anomalies, dental caries, periodontal diseases, cysts, and tumors.

These strips were to be accompanied by descriptive booklets elaborating on the

conditions depicted.89

Publications. Three technical manuals pertaining to the Dental Service

were published during the war. A handbook for dental assistants and technicians was printed in 194190

and revised in 1942.91 This manual contained

chapters on the anatomy of the teeth and mouth, prosthetic procedures, dental

x-ray technique, oral hygiene, duties of the dental assistant, and the keeping of

dental records. Another publication on the repair and maintenance of handpieces was issued in September 1944.92 A third manual on the dental x-ray

machine was printed in January 1945.93

A symposium on the treatment of maxillofacial wounds was prepared by

the Army Dental School in 1941, and published under the auspices of the

Preparedness Committee of the American Dental Association.94 This booklet,

entitled "Lectures in Military Dentistry," was purchased by the Surgeon General's Office for general distribution among dental officers, and it was also made

available to interested civilian dentists through the ADA.

Until July 1943 the Dental Corps sponsored publication of the quarterly

"Dental Bulletin, Supplement to the Medical Bulletin," containing instructions

and information on matters of interest to the Dental Service. After October

1943 such material was carried in the monthly Medical Bulletin and publication

of the separate Dental Bulletin was discontinued. The Army took an active

part in publication of the "Atlas of Dental and Oral Pathology," a volume containing descriptions of all of the more important dental lesions, with microphotographs and case histories. It had originally been prepared at the Army

Institute of Pathology and published under auspices of the ADA before the

war. A revised edition was published in 1942.95

sa New training films and film bulletin available. Army Medical Bulletin 88 : 44, May 1945.

87 Film strips approved for release. Army Dent. Bull. 13 : 57, Jan 1942.

88 Training aids. Army Dent. Bull. 13 : 138, Apr. 1942.

80 Dental film strips. Army Medical Bulletin 88 : 56, May 1945.

"> Handbook for the dental assistant and mechanic. Washington, The Surgeon General, 1941.

01 TM 8-225, Dental Technicians. Washington, Government Printing Office, 1942.

«a TM 8-638, Engine, Handpiece, Straight; Engine, Handpiece, Angle. Washington, Government

Printing Office, 1944.

03 TM 8-634, Dental X-ray Machine. Washington, Government Printing Office, 1945.

94 Lectures on military dentistry. Chicago, Preparedness Committee of the American Dental

Association, 1942.

" Committee on dental museum. J. Am. Dent. A. 29 : 2260, Dec 1942.
PERSONNEL AND TRAINING 129

THE WAR AND UNDERGRADUATE DENTAL EDUCATION

In time of peace the Army has customarily relied upon established

civilian institutions for the undergraduate education of professional officers for

the Medical Department. In both World Wars, however, the Army and Navy

have felt it necessary to initiate special programs to insure the continued operation of the professional schools and to provide readily available replacements

of officer personnel.

In World War II the Army and the Navy became deeply involved in the

field of professional training, and for a period of approximately 1 year the

majority of the nation's dental students were in military status, studying under

military contracts with the dental schools. Conflicting needs of the Armed

Forces for young manpower on one hand, and for a steady supply of professional replacements on the other, indicate that the Army, Navy, and Air Force

must be prepared at least to advise on the deferment of students in the health

sciences in any future emergency, whether or not they plan to take a more direct

part in medical education.

Selective Service and Dental Education

In drawing up legislation for compulsory military service Congress consistently refused to provide for blanket exemption of any group on the basis of

occupation. During discussions preceding passage of the Selective Service Act

of World War II strong pleas for the deferment of professional students were

made by representatives of schools and professions, butthe only concession made

was to "permit all university students to complete the current academic year,

with no general deferment authorized beyond 1 July 1941.96 (KOTC students

were permitted to finish the last 2 years of their courses.) Within 2 days

after the Selective Service Act became law, Senator James E. Murray introduced a bill specifically deferring medical and dental students,97 but it failed

to receive favorable attention. The Army itself opposed the measure because

it was considered contrary to the spirit of the Selective Service Act, which

contemplated deferment only on the basis of individual essentiality to the war

effort.98 Between January and May 1941, similar student deferment legislation was introduced "

10°101102 but all such bills were defeated.103 The unfavorable response to these measures indicated that failure to grant blanket deferment

to professional students was not an oversight, and that the Selective Service Act

» Selective Service in Wartime. Washington, Government Printing Office, 1943, p. 232.

91 S. 4396, 76th Cong., introduced 18 Sep 40.

»Ltr SecWar (Henry L. Stimson) to Hon Morris Sheppard, Chm Senate Committee on Mil

Affairs, 16 Dec 40. Quoted in Reports of Hearings before the Committee on Military Affairs, U. S.

Senate, 77th Congress, on S. 783, 18-20 March 1941. Washington, Government Printing Office, 1941.

99 S. 197, 77th Cong., introduced 6 Jan 41.

109 S. 783, 77th Cong., introduced 6 Feb 41.

101 H. R. 4184, 77th Cong., introduced 26 Mar 41.

*» S. 1504, 77th Cong., introduced 13 May 41.

«"Selective Service in Peacetime. Washington, Government Printing Office, 194A p. lit.
130 DENTAL SERVICE IN WORLD WAR II

correctly interpreted Congress' determination to avoid legislation which could

be construed as favorable to any special group.

On the other hand, educational facilities for the vital health professions

had long been barely adequate to meet minimum needs in normal times, and

it appeared that the long-range interests of the nation required the maintenance

of the medical, dental, and veterinary schools, not only to meet the expanded

immediate needs of the Armed Forces, but to insure adequate health care of

the civilian population following the end of hostilities. Also, the schools of

arts and sciences could keep in operation with student bodies made up largely

of women and physically rejected men, while professional schools with their

predominantly male student bodies faced probable closure if all men eligible

for military service were removed. Once these complex organizations were

broken up their reconstitution would be a difficult and time-consuming task.

Efforts to comply with the letter of the Selective Service law and at the same

time to safeguard essential professional training led to some confusion and

uncertainty during the early stages of mobilization.

Early Selective Service directives concerning deferment for essentiality

did not specifically mention professional students, and determination of their

eligibility was left to the discretion of local boards. In February 1941, however, those boards were reminded that automatic deferment for university

students would end in July, and they were directed to consider the cases of men

in training for critical occupations before that time.10* On 7 March 1941 boards

were again reminded that certain students were eligible for deferment under

existing regulations, and were directed to consider each applicant on the

basis of the importance of the occupation, the length of time already spent

in training, and the probability that the student would actually engage in

the activity after his education had been completed.105 The ADA promptly

advised the deans of all dental schools to seek delay in the induction of dental

students on the basis of these instructions.106 So far as dental students were

concerned, however, the effectiveness of both of these early directives was

lessened by the fact that dentistry had not been declared a critical occupation.

On 22 April 1941 Selective Service notified its local boards that the Office of

Production Management (OPM) had warned that a shortage of dentists

might be imminent,107 and the position of dental students was materially improved when this tentative information was confirmed a week later.108 On

1 May 1941 the official Selective Service news magazine emphasized in very

104 Unnumbered memorandum for State Directors of Selective Service, 13 Feb 41, sub : Classification of students. In Memoranda to All State Directors 1940-43. Washington, Government Printing Office, 1945.

105 See footnote 96, p. 129.

100 Ltr, C. Willard Camalier to deans of all dental schools, 26 Apr 41. SG : 327.22-1.

11,7 Memo, Dir Selective Service, for all State Directors (1-62), 22 Apr 41, sub: Occupational

deferment of students and other necessary men in certain specialized professional fields (III).

Washington, Government Printing Office, 1945.

108 Telegram, Dir, Selective Service System, to all State Directors, 30 Apr 41. On file Natl Hq,

Selective Service System.
PERSONNEL AND TRAINING 131

strong terms the need for deferring dental students,109 and a directive of 12

May 1941 stated: "It is of paramount importance that the supply [of dentists]

be not only maintained but encouraged to grow, and that no student who gives

reasonable promise of becoming a qualified dentist be called to military service

before attaining that status."110

Under these policies a considerable number of medical, dental, engineering,

and physical science students were deferred from military duty after the end

of automatic deferment in July 1941. A survey made late in 1941 showed that

81 percent of all dental students 21 years of age or over were continuing their

-education under occupational deferment, a higher proportion than in any other

group.111 Deferment for other students ranged from 80 percent in the medical

schools to 46 percent in courses in biology. In February 1942 the ADA

reported that an affidavit of the dean of a dental school that an individual was

a bonafide student was generally being accepted by local boards as sufficient

reason for delaying induction.112

In March 1942 Selective Service outlined requirements for the deferment

of persons in training as follows:113

The applicant for deferment must be in training for a critical occupation essential

to the war effort.

A shortage of persons engaged in that occupation must exist.

There must not be sufficient persons already engaged in training for the occupation

to meet future requirements.

The trainee must have advanced sufficiently in his course to give promise of

successful completion.

Since it was ruled that no student could be held to "give promise of successful

completion" of a university course with less than 2 years of previous instruction,

deferment for professional students was automatically limited to those who

had completed preprofessional training. In December 1942 Selective Service

again emphasized the need for allowing dental students to continue their education, and authorized deferment after completion of the first preprofessional

year.114 On advice of the War Manpower Commission, Selective Service provisions covering the deferment of preprofessional students were further liberalized on 1 March 1943 to permit delaying the induction of any individual

who would be qualified to enter a professional school by 1 July 1945 and who

held a firm acceptance for admission to such school.115

Deferment of students in specialized fields sanctioned to meet national defense needs. Selective

Service, vol I, No. 5, 1 May 1941.

110 Memo, Dir Selective Service, for all State Directors (1-99), 12 May 41.

U1 See footnote 103, p. 129.

»" Dental students and instructors. J. Am. Dent. A. 29 : 291, Feb 1942.

«

3 Memo, Dir, Selective Service System, for all State Directors, No. 1-405, 16 Mar 42, sub : Occupational classification. On file Natl Hq, Selective Service System.

»* Selective Service Occupational Bulletin No. 41, 14 Dec 42, sub : Doctors, dentists, veterinarians,

and osteopaths. In Occupational Bulletins 1-44, and Activity and Occupation Bulletins 1-35. Washington, Government Printing Office, 1944.

Selective Service Occupational Bulletin No. 11, as amended 1 March 1943, sub: Student deferment. In Occupational Bulletins 1 to 44 and Activity and Occupation Bulletins 1 to 35. Washington,

Government Printing Office, 1944.
132 DENTAL SERVICE IN WORLD WAR II

The deferment of actual dental students remained fairly certain during

the remainder of the war, and it will be noted later that total enrollment

in dental schools materially exceeded peacetime registration. In April 1944,

however, deferment of predental students was restricted to those who would be

able to enter a dental school by 1 July 1944.116 The ADA vigorously protested

this action,1" and the Director, WMC, asked the Director, Selective Service,

to reconsider the order, but the request was refused. The Director, WMC,

then asked the Armed Forces to give military status to enough preprofessional

students to assure continued full operation of the schools, but the latter

replied that the immediate need for manpower should not yield to the possible

use of such students as doctors in 1949 or later, and they stated further that the

current Selective Service policy had the full approval of the Army and Navy.

Attempts of PAS, WMC, to have the Director of War Mobilization intervene

in the matter brought the reply that the problem was clearly the responsibility

of Selective Service. The PAS estimated at this time that there would be 1,446

civilian vacancies in the dental classes starting in 1945 (the Armed Forces

programs, discussed later in this chapter, were expected to fill 38 percent of the

available openings), and stated that if predental education were confined to

veterans, women, and physically disqualified males only a small proportion

of those vacancies would be filled.118 On 23 June 1944 Representative Louis

E. Miller of Missouri introduced a bill to commission 6,000 medical and premedical students, and 4,000 dental and predental students, but this legislation

failed to pass.119

The fears of PAS were later proved to be well founded, and as a result

of the discontinuance of predental education only 1,197 freshmen were enrolled

in dental schools in October 1945, compared with 2,496 a year earlier.120 It is

clear that if the war had continued indefinitely very few students would have

been left in the dental schools under deferment policies in effect in 1944 and 1945.

Deferment of Dental Students Through

the Granting of Reserve Commissions

While Selective Service policies actually permitted a large proportion

of all dental students to remain in school, the Office of Defense Health and

Welfare Services, PAS, ADA, and to some extent the Armed Forces, appear

not to have been satisfied that deferment was sufficiently certain under Selective

Service regulations. As late as April 1942 the ADA reported continuing

difficulty in insuring student deferment.121 Also, during much of this period

116 Selective Service as the Tide of War Turns. Washington, Government Printing Office, 1945,

pp. 79-80.

117 Selective Service restricts deferment of predental students. J. Am. Dent. A. 31 : 735, May

15, 1944.

us Procurement Service issues statement on dental students. J. Am. Dent. A. 31 : 878-880, June

15, 1944.

110 H. R. 5128, 78th Cong., introduced 23 Jun 44.

120 The supply of dental students. J. Am. Dent. A. 32 : 1454-1455, Nov-Dec 1945.

121 President's Page. J. Am. Dent. A. 29 : 653, Apr 1942.
PERSONNEL AND TRAINING 133

predental students had uncertain protection, and unless a steady flow of replacements into the entering classes could be maintained, a deferment for actual

dental students would eventually become meaningless. These considerations,

and a desire to insure the availability of young dentists on graduation, ultimately led to involvement of the Armed Forces in the field of dental education.

Even before passage of the Selective Service Act in August 1940, The

Surgeon General was given authority to transfer to the Medical Administrative

Corps (MAC) Reserve any medical, dental, or veterinary student who held

a Reserve commission in another branch and who would therefore be subject

to call to active duty.122 These MAC Reserve officers were retained in inactive

status until their professional education was completed, when they were called

on active duty in the appropriate corps of the Medical Department. The number of such students was of course small, and it seems probable that this action

was taken mainly to provide later replacements in scarce categories rather than

because the Army then felt any responsibility for the continuation of medical

education to meet postwar civilian needs. In Feburary 1941 The Surgeon

General requested additional authority to grant MAC commissions to any

junior or senior students in the medical, dental, or veterinary schools, basing

his plea on probable future needs for the Army.123 He pointed out that the

Navy had already authorized the commissioning of medical students and that

the Army would soon find itself at a disadvantage in procuring replacements

unless it acted promptly. The Adjutant General disapproved this request,

stating that exemption from the draft could be justified only when it was clear

that students would be required in key positions in industries essential to

national defense.124

In April 1941 pressure for military action to insure the deferment of professional students came from a new source outside the Armed Forces, and

this time the need for safeguarding medical education for long-term civilian

needs, as well as for the more immediate needs of the Army and Navy, was

plainly advanced as an important consideration. On the advice of the Health

and Medical Committee of the Office of Defense Health and Welfare Services

the Administrator of the Federal Security Agency reported to the Secretary

of War that he felt increasing concern over the problem of "how to insure for

our military and civilian needs the requisite number of doctors and dentists,

both now and in the future." 125 He noted that the Navy was granting Reserve

commissions to junior and senior students, but he stated that it was also necessary to safeguard the two lower classes, and he endorsed a resolution of the

Health and Medical Committee calling for first and second year students

to be given the status of "cadets" and for third and fourth year students to

122 See footnote 64, p. 122.

"

3 Ltr, Maj Gen James C. Magee to TAG, 18 Feb 41, sub : Commissioning of junior and senior

students in the Medical Department Reserve Corps. AG : 210.1.

124 1st ind, by TAG, 18 Mar 41, to ltr cited in footnote 123.

126 Ltr, Paul V. McNutt to SecWar, 28 Apr 41. AG : 210.1 Med-Res (4-28-41).
134 DENTAL SERVICE IN WORLD WAR II

be commissioned in the MAC Eeserve. He stated further that even if deferment could be arranged through Selective Service a continuing supply of medical personnel should not depend upon the understanding of 6,000 local boards,

thus giving a clue to the rather surprising decision to approach the problem

through the military rather than through Selective Service.

The Federal Security Administrator's letter influenced the Under Secretary of War to send a memorandum to General Marshall stating that he was

keenly interested in the problems of the "supply of physicians for the Medical

Eeserve" and that he hoped the program suggested by the Health and Medical

Committee could be put in action.126 It will be noted that through oversight

or intent the reference to dentists, which had been included in the original

recommendations of the Health and Medical Committee and in the Federal

Security Administrator's communication, was omitted from the letter of the

Under Secretary of War. The question of whether or not the Armed Forces

should properly assume any responsibility for medical education to meet purely

civilian needs was also avoided. The Surgeon General added his recommendation for the granting of commissions to all medical students, but he failed to

mention dental students in spite of the fact that he had requested the same

privilege for them less than 2 months before. Since The Surgeon General had

been a member of the Health and Medical Committee which had drafted the

original petition he was certainly familiar with the situation, and, presumably,

favorably inclined toward including dental students in the program, and their

omission may have been unintentional, in the thought that "medical students"

would include dental and veterinary students as well.127 The problem of preprofessional students was not considered at this time.

The Assistant Chief of Staff G-l concurred to the extent of approving the

commissioning of third and fourth year medical students, as prospective officers,

but he recommended strongly against going further to include freshmen and

sophomores. He stated that since the Selective Service Act expired in 1945

no student should be accepted by the military who would not graduate by 1943,

to allow for 1 year in internship and 1 year of service before the end of the

draft. He added that in his opinion the question of the total production of

doctors was a national one, not coming within the province of the War Department, and that if the Selective Service Act endangered medical education it

should be revised, rather than resort to the subterfuge of insuring deferment

by means of granting semimilitary status.128 The commissioning of junior

and senior medical students only was authorized on 26 May 1941.129

"«Memo, Robert P. Patterson, UnderSecVVar, for Gen George C. Marshall, 1 May 41. AG : 210.1

Med-Res (5-1-41).

127 Memo, Maj Gen James C. Magee, for ACofS G-l, 10 May 41. AG : 210.1 Med-Res.

m Memo, ACofS G-l for CofS, 14 May 41, sub: Deferment of medical students. AG: 210.1

Med-Res (5-1-41).

1MLtr, TAG to all CA and Dept Comdrs, 26 May 41, sub: Deferment of medical students. AG :

210.1 Med-Res (5-1-41).
PERSONNEL AND TRAINING 135

In January 1942 the Federal Security Administrator asked the "War

Department to reconsider its decision against commissioning first and second

year medical students, though no additional reasons were given.130 Again The

Surgeon General supported the request, and this time dental and veterinary

students were specifically included in his recommendations.131 The Adjutant

General again disapproved such action, stating that it would grant certain

students deferment for as long as 5 years,132 but his advice was rejected, and

on 11 February 1942 the War Department announced that any accepted male

matriculant in a medical school could be given an inactive commission.133

Reference to dental students and preprofessional students was again omitted,

though the provision for enrolling any "accepted matriculant" might have

covered premedical students under certain conditions.

Dentistry had been declared a critical occupancy nearly a year before134

and in April 1942 the Federal Security Administrator (acting as the Director

of the Office of Defense Health and Welfare Services) again recommended

that the privilege of accepting inactive MAC commissions be extended to

dental and veterinary students.135 He stated that the seriousness of the situation had been called to his attention by the Health and Medical Committee of

the Office of Defense Health and Welfare Services, the Procurement and Assignment Service, and officials of the professional organizations. He noted that

Selective Service boards were still refusing to defer professional students in

some instances, and emphasized the need to delay the induction not only of

actual enrollees in medical, dental, and veterinary schools, but of men preparing

for those schools as well. The requests of The Surgeon General and of other

bodies responsible for assuring a steady supply of replacements in the health

services apparently had some influence on the War Department, and the

Assistant Chief of Staff G-l recommended to the Chief of Staff that the Army

authorize the commissioning in the Reserve of dental and veterinary students

and of students holding acceptances for dental or veterinary schools.136 Approval of the Secretary of War was obtained on 14 April and the necessary

orders were issued on 17 April 1942.137 The interpretation of "students holding

acceptances for dental or veterinary schools" was not specific, and it has been

claimed that, in some cases at least, deans "accepted" enough high school gradu130 Ltr, Paul V. McNutt to SecWar, 6 Jan 42. AG : 210.1 Med-Res (1-6-42).

131 Ltr, Maj Gen James C. Magee to TAG, 15 Jan 42, sub : Granting commissions to medical students in the Medical Administrative Corps. SG : 210.1-1.

«2 1st ind, 28 Jan 42, SG : 210.1-1. TAG to ltr cited in footnote 131.

133 Ltr, TAG to all CA and Dept Comdrs (except the Philippine Dep;t), 11 Feb 42, sub : Commissions

for medical students. On file AG central flies as Tab A to ltr, Brig Gen J. H. Hilldring, G-l, to CofS,

6 Apr 42, G-l/16455-25, sub : Commission of medical and dental students. AG : 210.1.

134 See footnote 108.

135 Ltr, Paul V. McNutt to SecWar, 2 Apr 42. AG : 210.1.

138 Ltr, Brig Gen J. H. Hilldring to CofS, 6 Apr 42, sub : Commission of dental and veterinary

students. AG : 210.1 (4-6-42).

137 Ltr, TAG to all CAs and Dept Comdrs (except the Philippine Department), 17 Apr 42, sub:

Commissions for dental and veterinary students. AG : 210.1 (4-6-42).

330324 0—55 10
136 DENTAL SERVICE IN WORLD WAR II

ates just starting predental training to assure adequate entering classes 2 years

later.138 It has already been noted that Selective Service did not grant deferment to predental students until December 1942, and then only to men who had

completed the first year of training.

In anticipation of the inauguration of the Army Specialized Training

Program, the granting of new MAC commissions was discontinued in February

1943.139 A majority of the 5,383 students already holding Reserve commissions

later resigned them to accept active duty in the Enlisted Reserve under ASTP,

but a few retained their commissions until graduation. Best information now

available indicates that approximately 1,059 MAC graduates were taken on

active duty in 1943, 111 in 1944, and 16 in 1945, for a total of 1,186 officers.140

The Army Specialized Training Program

for Dental Undergraduates

(The Army Specialized Training Program, in its general aspects, has

been discussed at length in a report by Col. Francis M. Fitts, M. C.141 The

present discussion will therefore be limited mainly to those phases of the

program having special significance for dental education. Much of the material used is from Colonel Fitts' work; his documentation is not repeated.)

In December 1942 the Armed Forces announced a plan to give military

status to students in training for certain essential occupations and to continue

their education at Government expense.142 The reasons which impelled the

Army and Navy to take a direct part in medical education are not clearly

documented, but the following were probably most pertinent:

1. It has already been noted that agencies responsible for the health care

of the nation during the emergency were not assured that Selective Service

could be relied upon to permit continuous education in the health services

during the war. In spite of Selective Service advice to the local boards the

latter sometimes hesitated to consider deferment for students when they were

compelled to send other young men to combat. It was also felt that Selective

Service policies were subject to revision on short notice and that they could not

be depended upon in establishing long-term commitments.143

2. The Armed Forces wanted to have sufficient prospective professional

Info given to author by Maj Ernest Fedor, who was in the Mil Pers Div, SGO, during a large

part of the war. _ .

is» WD Memo W150-3-43, 8 Feb 43, sub : Discontinuance of appointments in the Medical Administrative Corps of accepted matriculants in medical, dental, and veterinary schools and the disposition

of those officers previously appointed as such. SG : 210.1-1.

»»Data computed by Lt Col John Brauer, DC, from statistics furnished by the Procurement

Branch, SGO; the Appointment and Induction Branch, AGO; the Classification and Assignment

Branch, AGO ; and the Resources Analysis Division, SGO.

»« Fitts, F. M. : Training in medicine, dentistry, and veterinary medicine, and in preparation

therefor, under the Army Specialized Training Program, 1 May 43 to 31 Dec 45. HD: 353 ASTP.

"2 SOS Cir 95, 18 Dec 42, sub : Establishment of the Army Specialized Training Program.

«

3

See footnote 125, p. 133.
PERSONNEL AND TRAINING 137

replacements actually under military control to assure the use of these with

certainty and without delay as soon as their training was completed.

3. It was feared that students themselves would not be content to remain

in school as civilians, even if deferment were assured. Nearly 2,000 former

dental students served with the AEF, alone, in World War I, so depleting

the schools that only 906 men graduated in 1920, compared with 3,587 in 1919.144

4. It was probably felt that if professional students were to be relieved

from the obligation to serve in hazardous assignments, the opportunity to

attain student's status should not depend upon individual ability to pay the

rather heavy costs of university training. Under ASTP the son of a laborer,

or a soldier already inducted, would in theory have the same opportunity to get

a dental education as the son of a wealthy family.

Details of the new program were released in April 1943 as follows:

1. Professional students already enrolled in the Enlisted Reserve were to

be called to active duty under ASTP. Students who held Reserve MAC commissions could resign them and be placed in the Enlisted Reserve for subsequent call to active duty, though they were not obligated to do so.

2. Acceptable dental students not in the Reserve (MAC or enlisted)

could volunteer for induction and transfer to the Enlisted Reserve under

ASTP.

3. Predental students would be selected from men already enrolled in

predental classes who volunteered for induction in the Enlisted Reserve, or

from qualified individuals already in the Army who requested transfer to

ASTP. Students not already in predental training would be accepted only

if they (a) had an Army General Classification Test score of 115 or better,

(b) passed an aptitude test for the medical professions, and (c) were approved

by an interviewing board representing both the Army and the dental schools.

Another board had to approve advancement from predental training to a

dental school. Since the ASTP was necessarily started with men already

enrolled in the schools, and since the dental phase was largely terminated after

1 year, very few new students were actually selected under the above provisions.

4. Preprofessional training for all the medical sciences was to be given in a

common course of five terms of 12 weeks each. The first two terms were devoted

to a general course prescribed for all ASTP beginners, medical and nonmedical.

The remaining three were consumed in a special preprofessional course drawn

up by ASF with the assistance of representatives of the medical, dental, and

veterinary schools. The entire 60 weeks of preprofessional training included

the following required subjects:

English 8semester hours

Physics 8semester hours

Organic chemistry 8 semester hours

Biology 8semester hours

"< Dentistry as a professional career. Chicago, American Dental Association, 1946, p. 11.
138 DENTAL SERVICE IN WORLD WAR II

5. Dental schools were to continue to give their regular wartime undergraduate courses, which had been shortened in January 1942.145 Individual

schools were to determine their own criteria for passing grades, examinations,

and the general maintenance of professional standards.

6. On graduation, students were to be commissioned in the Army Dental

Corps and called to active duty.

It was planned to utilize 35 percent of the capacity of the dental schools

for the Army, starting about 970 new students every 9 months. With an estimated 15 percent attrition, this would provide about 825 potential dental officers

every 9 months. Maximum enrollment was reached in March 1944 when 6,143

students in dental schools were enrolled in ASTP. The Navy was expected to

take an additional 20 percent of total capacity, to provide 475 dental officers

every 9 months, so that the Armed Forces, together, were to account for 55

percent of the capacity of the dental schools. In October 1943, however, the

7,775 students enrolled by the Army and Navy amounted to nearly 90 percent

of the total of 8,888 students in the dental schools.146 Since 5,883 dental students

had held Reserve commissions in February 1943, and since only 6,143 were

enrolled in ASTP at its maximum, it is clear that the majority of the dental

ASTP enrollees were men who had already been deferred as members of the

MAC Eeserve.

It was also planned to start an average of 130 preprofessional students,

earmarked for the dental ASTP, each month. It was expected that this number would provide 110 new students monthly for the dental schools.

The dental ASTP was activated in the period from May through July

1943. All dental schools in the United States, totalling 39, participated, including Meharry and Howard Universities for Negro students.

By 1944 the need for additional young manpower to push the war to a

successful, early conclusion became critical and the Army began to consider

a reduction in long-term training programs. In March 1944 it was announced

that the entire ASTP would be cut back from 145,000 men to 35,000, though

no reduction in the medical or dental programs was anticipated at that time.

A few days later, however, the director of the Military Personnel Division

advised The Surgeon General that it seemed doubtful that men then in preprofessional training would ever be used by the Army in view of changes in

the general war situation.147 He reflected only current confusion on the propriety of the Armed Forces concerning themselves with medical education for

civilian needs when he noted that the Army should not be placed in the position of agreeing to an interruption of medical education, even when gradu-

"= In January 1942 the Council on Dental Education, ADA, had recommended that the dental

course during the war be continuous (no summer vacation) and that it be cut to three years instead

of four. This recommendation was accepted by all schools. See Acceleration of the dental school

program. J. Am. Dent. A. 29 : 287-288, Feb. 1942.

"• 7,775 out of 8,888 in dental schools are in armed services. J. Am. Dent. A. 31: 164, 15 Jan 44.

"'Memo, Lt Col Durward G. Hall for SG, 28 Mar 44, sub: Medical section, Army Specialized

Training Program. SG : 353.9-1.
PERSONNEL AND TRAINING 139

ates would not be available until after the emergency, but that the responsibility properly lay with Selective Service, and that in his opinion the latter

would not act as long as the military were in the field. He recommended that

further procurement for entering classes be terminated. There is no indication

that this advice had any direct influence on the subsequent curtailment of the

dental ASTP, but it is of interest as revealing the trend of thought among

officers charged with personnel responsibilities in the Office of The Surgeon

General.

On 18 April 1944 ASF announced that the Army's share of the classes

entering dental schools after 1 January 1945 would be 18 percent instead of

35 percent, and that no commitments would be made covering classes to start in

1946.148 At this time the Dental Corps was approaching its maximum authorized strength (see chapters III and IX), and efforts of The Surgeon

General to have a significant number of older dental officers replaced with

younger men were meeting with little success; as a result it was impossible

to commission the ASTP graduates of June and early July 1944, and they

had to be unconditionally released by the Army,149 causing much adverse comment from dental officers and civilians. On 2 June 1944 the director of the

Strategic and Logistic Planning Unit advised The Surgeon General that a

demand for continuation of the dental ASTP could no longer be supported

on the basis of military requirements,150 and in drawing up recommendations

for future ASTP training in the medical sciences The Surgeon General recommended, on 9 June 1944, that the dental and veterinary programs be dropped.

On the protest of the Director of the Dental Division, however, this request

was withdrawn on 27 June and resubmitted to provide for a continuation of

dental training. In reply, The Surgeon General was advised on 1 August 1944

that the War Department General Staff had definitely decided to drop the

dental ASTP.151 This statement came as an anticlimax, however, since the

termination of the dental ASTP had already been announced by the War Department on 18 July 1944.152 Under the terms of this latter directive all senior

students, numbering about 1,175 men, were to be allowed to complete their

courses, when they would be commissioned in the Dental Corps. Dental students not in their final year (about 4,810 men), and predental students who

would complete their preliminary training at the end of the current term and

who held acceptances for dental courses beginning prior to 31 December 1944,

148 Memo, Brig Gen W. L. Weible for SO, 18 Apr 44, sub : War Department policy governing

training in medicine and dentistry under ASTP. SG : 353.9-1.

"» Ltr, Col J. R. Hudnall to Comdt, 3930 Service Unit, ASTU, University of Southern California,

Los Angeles, Calif., 1 Jul 44, sub : Disposition of senior dental ASTP trainees on date of graduation.

SG : 000.8 (University of S. Calif.) W.

Memo, Lt Col Durward G. Hall for Deputy SG, 2 Jun 44, sub : Demand schedule for ASTP

graduates. SG : 353.9-1.

1« 3d Ind, Brig Gen Rüssel B. Reynolds, 1 Aug 44, en Ltr, Col J. R. Hudnall to CG ASF, 9 Jun 44,

sub : Requirements for ASTP graduates for last nine months of 1944 and the year 1945. SG : 353.9-1.

162 Ltr, Maj Gen M. G. White, ACofS G-l, to CG, ASF, 18 Jul 44, sub : ASTP dental program.

SG: 353.9 (Med).
140 DENTAL SERVICE IN WORLD WAR II

were to be discharged from the Army at the end of the term, to continue their

education at their own expense. Students who could not meet these requirements (about 722' men), or who could not pay for their own schooling, were to

be transferred to the Medical Department as enlisted men. The dental ASTP

was thus limited to senior students in July 1944 and it came to an end with the

classes graduating in April 1945.

Cost of the Dental ASTP. It is difficult even to estimate the cost of the

dental ASTP since such unknown factors as the expense of providing medical

care for trainees and the potential cost of veterans' benefits following the war

were involved. Some of the more important items, calculated to 12 October

1945, have been reported as follows:153

Academic cost per student per month (tuitition, books, instruments) $64.90

Housing (at institutions) 9.04

Housing (on commutation) 37.50

Pood (at institutions) 31.50

Food (on commutation) 54.00

The monthly cost for academic expenses, food, and housing thus varied from

$105.44 for students housed and fed under contract, to $156.40 for students

granted commutation for housing and food obtained on their own responsibility. To this amount must be added at least $50 per month for salary, plus

an unknown amount for overhead, including the salaries of military administrators, hospitalization, travel, et cetera. Money received from the resale of

books and equipment after the termination of the program reduced the above

cost for academic expenses by about $8.00 per month.

Results of the Dental ASTP. The following tabulation summarizes the

results of the Dental ASTP:

Number of dental schools participating 39

Number of months in operation 26

Total dental students enrolled 7, 734

Disposition of 7,734 enrollees :

Graduated 2,458

Discharged to continue at own expense at end of program 4, 651

Failed 472

Dropped for other reasons 101

Transferred to Medical Department as enlisted men 52

Disposition of 2,458 graduates :

Commissioned in the Dental Corps 1, 914

Discharged for lack of vacancies, June and July 1944 113

Commissioned by Veterans Administration, mainly in June and

July 1944 36

Commissioned by Navy, same period :__ 269

Disqualified for physical or other reasons 126

Predental students enrolled 1,407

Completed predental training 499

163 Statistics relating to the dental ASTP program. Published by the Training Contracts Section,

Production and Purchases Div, ASF, undated. HD : 314.
PERSONNEL AND TRAINING 141

Discussion, Dental A8TP. The Dental ASTP was bitterly criticized

almost from its inception until long after it had gone out of existence, indicating

the need for a careful evaluation of the objectives and policies involved in order

to avoid similar difficulties in any future emergency.

Probably the most fundamental criticism was based on claims that there

was actually no need for the military to venture into the unfamiliar field of

undergraduate professional education. The profession, the schools, and the

public were of course interested in maintaining an adequate flow of dental

graduates and in keeping the dental schools operating in a healthy condition.

It has already been pointed out that various professional and governmental

agencies, which apparently did not have full confidence in Selective Service's

intentions, had repeatedly requested the Armed Forces to give students inactive

military status to insure their deferment. But the professional agencies, at

least, vigorously opposed the more detailed involvement of the Army and Navy

in the administration of dental education, even though the actual instruction

was left to the established schools. As early as May 1943 the position of the

ADA was stated as follows:154

recalling vividly the awkward blunder of the administration of the Student's

Army Training Corps in World War I, which, but for the providential Armistice in

November 1918, would probably have led to the collapse of higher and professional

education, we have hoped profoundly that dental education might be spared military

regimentation during this war. With every wish to see competent dentists provided

promptly and unhesitatingly for the Army and the Navy, as they happily have been,

and, we believe, will continue to be, we are concerned about the working out of a

system of dental education "by contract" with the Army and Navy. We gravely

question whether the common end to be gained, about which there is no debate,

may not be accomplished more economically, more expeditiously, with sounder educational procedure, with greater assurance of a steady supply of new entrants to dental

practice to meet civilians as well as war service needs with greater safety for the

future of the profession, by the conduct of the dental schools free from the inevitable

effects of Army and Navy regimentation. . . .

After all this military machine does its work, it will transpire, we predict, that

there was really no occasion or necessity for doing anything. What more do the

Army and Navy want than a steady flow of well-trained dentists to meet their replacement needs? The dental schools could have gone on and would have gone on

cheerfully without any overlordship or regimentation, and, indeed, without any

financial aid. ... All the Government needed to do was to establish a sensible

working scheme for the deferment of enough bona fide high school and liberal arts

college students to sustain the present enrollment in dental schools. . . .

In justification of the Armed Forces' decision to place dental students on

active duty, it should be noted that the opinion that professional trainees would

be content to remain in school if they were assured of deferment was not

universally accepted. Even the Secretary-Treasurer of the American Association of Dental Schools reported that "the average student of the desirable type

took a rather dim view of deferment while other young men of his age were in

i« Dental education in wartime. J. Am. Dent. A. 30 : 741-749,1 May 43.
142 DENTAL SERVICE IN WORLD WAR II

uniform," and he stated that "assignment [to the Armed Forces], as a principle,

appeared to be the most desirable, although uneconomic procedure."155 The

feeling that if young men were to be given deferment from dangerous duty to

remain in school the Armed Forces should select those to be given that opportunity, and that those selected should be paid so that such preferred treatment

would not be based on economic status, has already been mentioned. By the

time the dental ASTP was inaugurated, however, it was already reasonably

clear that no general voluntary exodus from the professional schools need be

anticipated in World War II, and that deferment would in itself be sufficient

stimulus to keep a sufficient number of dental students in training. Enrollment in the dental schools had, in fact, actually increased from 7,184 in 1937

to 9,014 in 1943, when it was higher than at any time since 1928.156 The contention that any qualified individual should have equal opportunity to obtain

deferment for professional education, regardless of ability to pay, was a

plausible theory, but in practice the ASTP had to be set up with students who

had, for the most part, already been pursuing their courses for from 1 to 5

years, and who were presumably already assured that they would be able to

pay the necessary costs. Thus it was found, when the dental ASTP was terminated in 1944 and students were forced to continue at their own expense, that

only a little over 1 percent had to drop out. Whether the professional student

was entitled not only to deferment in time of war, but to the salve to his feelings

which was provided by the fact that he was placed in uniform, is at least

open to question.

The belief that the personnel needs of the Dental Services of the Armed

Forces could not be met unless dental students were placed under military

control has also been challenged. When ASTP was first being considered, in

the fall of 1942, the Army Dental Corps was faced with a procurement objective of over 7,000 officers for 1943, and there is every indication that some

difficulty in getting this number of dentists was anticipated. (See chapter

III.) Selective Service had shown its inability to draft dentists in significant

numbers, and it was apparently felt that dental students should be required

to make themselves available for immediate military service on graduation in

return for the privilege of deferment. The Director of the Dental Division

stated in August 1944 that:

The Dental Corps at one time had an anticipated procurement objective of at least

25% more than the maximum level reached. . . .

It has been stated that the Army could have attained all the dental officers desired

without the ASTP, and that the dental schools could have produced just as many

officers for the Army. This statement in all probability is true, but the fact is that

the procurement objective for dentists was never reached in many of the states.

There was no mechanism whereby dentists could be drafted except through the

normal channels of Selective Service. That many dentists refused commissions in

1=5 Personal Ltr, Dr. John E. Buhler to Col William Wilson, 11 May 48.

"»• Horner, H. H. : Dental education and dental personnel. J. Am. Dent. A. 33 : 872-888, 1 Jul 46.
PERSONNEL AND TRAINING 143

the Army is a fact that nearly every State Dental Procurement and Assignment

chairman can testify. Many dentists . . . preferred to have the other fellow go.

These facts, and those associated with the potential military needs, caused the War

Department to include dentistry in the ASTP.

After the war the Director of the Dental Division noted that:

. . . when the ASTP was initiated said program was justified for the reason that

it was impossible to predict the length of the war and available dentists in civilian

life were limited. It is believed, however, that the Army Dental Corps needs could

have been satisfied without the AST Program.15'

The ASTP predental training was criticized by dental educators who felt

that the five-term course was inadequate. At the invitation of The Surgeon

General representatives of the professional schools met in January 1943 to

advise on the premedical, predental, and preveterinary courses. This committee, which included three dental educators, recommended a common program

for all branches of medical science and they advised that six semesters of 12

weeks each be allowed for preprofessional schooling. It recommended further

that the course include the following minimum requirements:158

English 6semester hours

Physics 6 semester hours

Biology 6 semester hours

General chemistry 8 semester hours

Organic chemistry 4 semester hours

An additional 30 hours were to be selected from optional technical subjects,

depending upon the facilities of the school and the desires of the student. The

curriculum finally approved by ASF has been described in paragraph 4,

page 137.

The charge that dental educators had not been consulted is certainly open

to question, though one dental representative on the committee stated later that

they had accepted the final plan in an effortto make the best of a program which

they had personally thought ill-advised, but which had been definitely decided

upon by the War Department.159

The effect of the ASTP on the morale of other military personnel was

unfavorable, but difficult to evaluate in respect to degree. The young men who

had been taken from a school of business administration and sent to New

Guinea could not always understand why the able-bodied boy next door was

continuing his dental education as before, except that now the Government

took care of his expenses and paid him a salary. The paratrooper's pride in

his skill as a fighting man was apt to be dampened when he heard that college

students at home were wearing uniforms which the general public could not

distinguish from the one he was currently wearing in a foxhole on the wrong

side of the Rhine. This type of "discrimination" was regrettable but unavoid15' See footnote 9, p. 107.

168 Ltr, SG to Dir ASTP, 2 Jan 43, sub : Premedical and medical education. SG : 353.9-1.

> Army specialized training program. J. Am. Dent. A. 31 : 1149-1154, 15 Aug 45.
144 DENTAL SERVICE IN WORLD WAR II

able if there was to be' no break in the training of replacements for vital

occupations, but the opinion was widely held and expressed that the Army had

done enough when it guaranteed deferment for professional students, without

subsidizing them and giving them the status of soldiers.

Probably the most bitter criticism of ASTP came from dental officers

of the Armed Forces, especially when it was announced in 1944 that recent

graduates would be released to civil life. Dental officers on military duty

were not always in full possession of all the facts concerning the ASTP, and

the fairly common belief that dental students had been educated at Government expense and then released to enjoy the lucrative practice at home is

understandable, if not entirely justified. Actually, no dental student received

all, or even a major part, of his schooling under ASTP. Juniors entering

the program in 1943 received up to 2 years of education at Government expense;

others received a maximum of about 1 year since only seniors were continued

in the course after July 1944. Also, in spite of the Army decision to release

graduates in June and July 1944 only a small proportion entered civil practice.

The lack of vacancies at that time was temporary, and all qualified men graduating from July 1944 until ASTP ended in April 1945 were given commissions

in the Army Dental Corps. All but 113 of the physically qualified graduates

of the dental ASTP eventually entered the Army, Navy, Veterans Administration, or the Public Health Service.160 (For a discussion of the reasons why

ASTP graduates were not commissioned in the summer of 1944 see chapter III.)

Even a considerable number of the critics of ASTP held that once it had

been established it should have been kept in operation until the end of the

war, both to assure continued replacements for civilian practice and to provide

dental officers when it became necessary to demobilize veteran dentists after

the end of hostilities. Colonel Fitts states in his report that:

It is extremely interesting to note that the curtailment and termination of both

the dental and veterinary training programs have proved to have been premature

and ill-advised. The lack of replacements for dental officers has required the retention

of dentists in the active military service for periods in excess of those required for

emergency medical officers, with resulting criticism and dissatisfaction. The dental

ASTP trainees who were discharged in order to continue their studies as civilians

have upon graduation been under no obligation or compulsion to enter the military

service either as enlisted men or officers. Efforts at the recruitment of volunteers

as replacements among this group have proved completely futile and on 24 May 1946

the War Department placed a special call on Selective Service for the draft of dentists.

Though the Director of the Dental Division and The Surgeon General had

advised against the termination of the dental ASTP, the War Department

appeared to feel that it could not justify the program when the Dental Service

was refusing to accept graduates for lack of vacancies. At the time the dental

ASTP was terminated the demand for combat troops was so critical that

180 Memo, Brig Gen J. J. O'Hare, Chief, Manpower Control Group, to Gen Willard S. Paul, ACofS

G-l, 8 May 46, sub : Dental ASTP program. SG : 353 (Student training).
PERSONNEL AND TRAINING 145

partially trained pilots were being transferred to the infantry, and medical

units overseas were being stripped of able-bodied enlisted men, who were

replaced with untrained, limited-service personnel. It may or may not be

held that the action taken was unjustified, but it cannot be argued that the

reasons which motivated the War Department were trivial. (See also the

discussions of this problem in chaptersIII and IX.)

The Deferment of Instructors in Dental Schools

The question of maintaining the faculties of the dental schools during

the war did not at first receive the attention given the maintenance of their

student bodies. Some increase in the load carried by individual instructors

was possible, and as a group the teachers were less likely to be subject to

induction under Selective Service because of age. The problem eventually

assumed important proportions, however, and its solution involved the Armed

Forces, Selective Service, PAS, and various other organizations and agencies.

Instructors were not mentioned in the first bills introduced in Congress

to provide for the deferment of dental students. A modification of the earlier

Murray bills, introduced in the Senate in February 1941, directed the exemption

of professional instructors, but this legislation, and later similar acts, met the

same fate as the various bills to defer students.161 Selective Service also omitted consideration of instructors in its early directives concerning occupational

deferment, but on 20 June 1941 all State Directors were advised that serious

consideration should be given to the exemption of individuals found necessary

for the instruction of students in critical occupations.162

Early in 1943, PAS became interested in this problem and conducted a

survey to determine the actual situation.163 Thirty-eight dental schools were

found to have 2,000 instructors, of whom 1,200 were declared to be essential

by the schools themselves. Fifty percent of the instructors were under 45

years of age, and 40 percent were under 40 years of age, but no attempt was

made to obtain more detailed information on eligibility for induction under

Selective Service. The medical schools were found to vary greatly in the

proportion of instructors declared essential, from a minimum of 10 percent to

a maximum of 98 percent; similar figures were not given for the dental schools,

but comparable variation was reported to exist. PAS recommended that 12

instructors be allowed for the first 100 students in professional schools, and

that 9 instructors be authorized for each additional 100 students, but it was

found that few schools approached the calculated ideal. Individual institutions varied from a minimum of only 40 percent of the recommended total of

instructors to a maximum of 206 percent. PAS appealed to the schools to

adhere to the proposed ratio, but the results of this effort, if any, are unknown.

181 See footnote 100, p. 129.

182 See footnote 107, p. 130.

193 Minutes of Committee on Dentistry, PAS, 13 Feb 43. Natl Archives, PAS flies.
146 DENTAL SERVICE IN WORLD WAR II

The professional press carried numerous discussions of the shortage of

dental instructors, but factual data on this subject, beyond that reported by

PAS, have not been revealed. After the war the Secretary-Treasurer of the

American Association of Dental Schools advised that in any future emergency

it was essential that professional schools be assured an adequate complement of

trained teacher personnel, either by deferment or by assignment from the military forces after being taken on active duty.164

Summary, Dental Undergraduate Education, World War II

In spite of outspoken criticism of many aspects of the handling of professional students during World War II it is clear that the primary objective, to

maintain the dental schools and to provide a continuing flow of graduates, was

attained. Shortly after automatic deferment was ended in July 1941, over

80 percent of all dental enrollees were already being deferred by their local

boards on an occupational basis. More vigorous action by Selective Service in

late 1941 and in 1942, and the granting of inactive military status by the Armed

Forces, not only maintained enrollment, but increased it by 1943 to the largest

figure since 1928. Average registration in the dental schools in the 5 war

years, from 1941 through 1945, was 8,416 students, compared with an average

of only 7,354 students in the 9 years from 1932 through 1940.165

It would seem that World War II policies in respect to the deferment

of professional students cannot be criticized for impeding dental education;

it is not equally certain that they should not be criticized for actually increasing the number of students registered in professional schools in wartime. The

need for a long-term augmentation of training in the medical sciences cannot

be denied, but the propriety of a major increase in enrollment in dental schools

in a time of national emergency, when the desire for deferment from dangerous

military service was presumably a strong motive for seeking a professional

education, is at least open to question. Students who were already enrolled

in the dental schools, or who had begun their general university preparation

with the specific purpose of entering dental training, were of course above suspicion in this respect, but since average enrollment during the war exceeded the

prewar average by more than a thousand men it is difficult to escape the conclusion that a considerable number of men of military age took up the study

of dentistry for reasons directly or indirectly connected with the war. To the

extent that these men were motivated by a desire to escape military duty, rather

than by a strong desire to enter the profession of dentistry, their deferment

could hardly be a cause for satisfaction, either to the profession or to the public.

It would seem that agencies responsible for the exemption of professional

students should, by voluntary agreement if possible, limit such exemption to

a number consistent with average normal enrollment.

i« See footnote 155, p. 142.

1B Enrollment data from 1932 through 1945 obtained by author from the Washington office of the

ADA, 26 May 48.
PERSONNEL AND TRAINING 147

It is true that the end of ASTP in 1944, and the simultaneous termination

of Selective Service deferment for predental students, would have resulted

in a serious situation if the war had not come to a close in a short time. In

October 1945 only 1,197 freshmen dental students were enrolled, compared with

2,496 the year before,166 and it was estimated that as a result there would be

only about 1,000 graduates in 1948.167 It is highly probable that both the

actions which led to this situation were based on a reasonable belief that

hostilities would not be prolonged after 1944, but the ensuing rapid reduction

in freshmen enrollment emphasized the need for assuring continuous predental

education if the dental schools are to continue their operations.

The ideal mechanism for providing deferment for students in essential

occupations was not found during World War II. Attempts to attain that

end through legislation failed because they conflicted with the basic concept,

accepted by Congress, that no group should be granted blanket preferred consideration under the Selective Service law. Any exception to that policy would

probably result in strong political pressure to have the privilege extended to

an ever-widening population. Even if blanket deferment of dental students

were authorized, the administration of such a policy would entail serious

difficulties; if no restrictions were prescribed the schools would soon be flooded

with applicants who were interested mainly in exemption from military duty,

and if the number to be deferred were limited, the question of determining

which men should be accepted would involve knotty political and administrative

problems.

The Selective Service System was of course charged with formal responsibility for determining which individuals should be inducted and which should

be allowed to continue in training for essential occupations, and it actually

authorized most deferments of dental students until the Armed Forces started

granting inactive Eeserve commissions in late 1941 and early 1942. Selective

Service was again left to carry almost the entire burden of exempting dental

students after the Armed Forces abandoned their dental undergraduate programs in 1944, and during all this period a considerable number of professional

students who were not eligible for, or who did not desire, military status continued their education under Selective Service policies. It has been pointed

out, however, that in spite of this record many dental educators, members of

the profession, and even governmental agencies responsible for national health,

had serious misgivings concerning Selective Service's willingness and ability

to follow a consistent course which would insure the regular operation of

the schools. Selective Service was committed to a policy of placing heavy

responsibility on the local boards, on the theory that they were most familiar

with circumstances which affected individual priority for induction, and critics

appear to have felt that the local boards lacked the technical background for

166 See footnote 120, p. 132.

1,7 See footnote 156, p. 142.
148 DENTAL SERVICE IN WORLD WAR II

selecting dental students and that they could not be relied upon to follow the

general policies recommended by national agencies which were familiar with

larger aspects of the problem of continuing training in the health services.

This fear does not seem to have been supported by the facts since enrollment

in the dental schools increased steadily from 1940 through 1943, though it was

reported that individual boards refused to defer professional students.

The suitability of Selective Service as the agency to defer professional students may be questioned on more fundamental grounds. The entry of the military into the educational field minimized Selective Service's problem by the

time it became necessary to choose large numbers of new students, and it will

be seen later that Selective Service actually delegated much of its nominal

authority to the dental schools. If it had retained full responsibility in this

matter during the entire war it would ultimately have been faced with the

necessity for finding acceptable answers to such problems as the following:

1. How many students should be granted deferment each year to take up

the study of dentistry ?

2. How should students be allocated geographically and according to

schools? Should state quotas be determined? Kural and urban? Racial?

Should wartime quotas attempt to correct longstanding peacetime imbalances

in the distribution of dentists ? How assure that state universities would accept

a reasonable proportion of students from adjoining states having no dental

schools ?

3. How coordinate the actions of local boards which had no way of comparing the qualifications of their applicants with those appearing before other

boards ?

4. How select approximately 2,000 students each year from some 10,000

applicants so as to insure deferment for those who were most likely to succeed

in school and in the practice of the profession ? Could this selection be left

to the schools without risking charges of favoritism ? Should Selective Service

set up agencies for investigating scholastic records, giving aptitude tests, and

otherwise determining the relative eligibility of thousands of would-be dental

students ?

5. Should ability to pay for a dental education be a deciding factor in the

selection of students for deferment in time of war ?

6. How eliminate applicants who were interested in deferment rather than

in the practice of dentistry ?

A similar situation arose very early in the war when it became apparent

that Selective Service alone could not handle the problem of procuring

physicians, dentists, and veterinarians, on the basis of individual liability

for military service, without endangering the health services of the nation.

In this instance the Procurement and Assignment Service of the War

Manpower Commission was established to render expert advice, though coopera-
PERSONNEL AND TRAINING 149

tion between the two agencies sometimes left much to be desired. It is possible

that with the assistance of some such body of professional experts, either in or

out of its own organization, Selective Service could have handled the question

of deferring students with reasonable satisfaction, but it seems probable that

a purely lay body would have been on unfamiliar ground had it attempted to

administer such a highly technical matter unaided.

It is noted above that during the period when it was nominally responsible

for the deferment of dental students Selective Service actually delegated most of

its responsibility to the schools. Students already enrolled were generally

continued in their studies without question by the Selective Service boards, and

the deferment of new applicants was normally based on acceptance for admission to a dental school. For all practical purposes, therefore, the deans of the

professional schools had the final decision in determining which applicants

would be accepted to continue their education and which would be rejected

and inducted into the Armed Forces. It is clear, from published criticisms

of the Army and Navy programs, that the dental schools preferred to select

their own students, and that they wanted nothing from any governmental

agency but deferment of the men chosen.168 The Armed Forces entered the

situation before the results of this policy could be fully determined in World

War II, and there is no evidence that the deans of the dental schools did not

choose applicants as impartially as possible, on the basis of their desirability

for the profession as interpreted by the deans themselves. It is possible, however, that with the best intentions in the world both the schools and Selective

Service would ultimately have come in for serious criticism if the matter had

not been largely taken from their hands by the inauguration of the Army

ASTP and the Navy V-12 programs.

In the first place, it is doubtful if dental educators, as individuals, were any

better fitted than Selective Service to answer such questions as the following:

1. How many students should be admitted? During the war the capacity

of the school was apparently the deciding factor in most cases, and it appears

that the schools and the profession escaped criticism for the resulting great

increase in enrollment only by sheer good luck.

2. Should students be selected purely on the basis of individual qualifications, or should some effort be made to apportion vacancies on a geographical

basis? If the latter, how?

3. How could a dental school supported by state funds resist strong political

pressure to limit deferment to citizens of that state, so as to provide for students

who normally came from adjoining states with no dental schools of their own ?

If vacancies were to be reserved for out-of-state students, how should they be

apportioned among the many schools which might be called upon to accept such

students ? Who would enforce such apportionment ?

>« See footnote 154. p. 141.
150 DENTAL SERVICE IN WORLD WAR II

4. If questions of the fair allotment of vacancies could be solved by voluntary cooperation between schools, how could accepted policies be implemented

through Selective Service, which alone could grant actual deferment?

5. How select a few thousand new students from the many thousands of

applicants each year? Educators were presumably best fitted to determine

the scholastic qualifications of applicants, but even the opinions of experts in

this field are notoriously fallible. During World War II the problem was

further complicated by the fact that in order to insure his deferment until he

could complete predental requirements, a dean often had to "accept" a dental

student soon after graduation from high school, long before his capacity to

absorb highly technical university training had been established. The increasing reliability of aptitude tests also suggests that in the near future

trained personnel administrators may be able to select prospective dental

students with greater accuracy than educators relying upon their own impressions and upon scholastic records, but neither personal impressions nor

aptitude tests will eliminate the opportunist who is interested in draft deferment rather than in the practice of dentistry.

Such problems can be solved only by an agency which has full information on

national as well as local needs, which has close liaison with the Armed Forces,

with Selective Service, with other interested governmental activities, and with

the professional organizations; and which has sufficient official authority to

insure adequate consideration for its recommendations.

Potentially at least, the greatest objection to leaving the deferment of

students to dental educators is probably the degree of personal responsibility

involved. It has already been pointed out that wartime enrollment in the

dental schools exceeded normal peacetime registration by more than a thousand

men, and that Selective Service boards openly charged that the universities

were "havens for slackers."169 So far as is known the corollary charge, that

the schools were using the national emergency to swell their own income, was

never made, but the possibility that it would be was constantly present. It

seems highly probable that most deans were influenced only by a sincere desire

to provide needed personnel for the profession, but the administration of any

policy having to do with exempting individuals from dangerous duties in wartime inevitably and properly receives close scrutiny from Congress, the public,

and the press, and the opportunity for misunderstanding is enormous. The

objections to allowing any private individual or organization to select men to

receive such a fundamental privilege as exemption from military service are

obvious. It is probable that if the deans had carried this heavy responsibility

during the entire war they would ultimately have become targets for such

vigorous criticism, and such political and personal pressure, that they would

have welcomed the intervention of some official or semiofficial agency roughly

similar to the Procurement and Assignment Service.

1M See footnote 96, p. 126.
PERSONNEL AND TRAINING 151

The military were probably least qualified of all agencies to select new

professional students, and it is difficult to find theoretical or practical justification for the Army and Navy becoming involved in such extraneous matters in a national emergency. The Armed Forces initiated their World War

II training programs with men already enrolled in dental schools or in predental preparation, and had the assistance of dental educators in selecting new

applicants during the short time they were directly concerned with dental

undergraduate instruction, but this field was so remote from military activities

that it would seem more appropriate to leave it to other agencies. Much can

also be said for the early contention of the War Department that the military

should not involve itself with any phase of professional education beyond the

minimum steps necessary to insure sufficient trained replacements, and that

questions of deferment of professional students to meet the needs of the

civilian population should properly be the responsibility of Congress, Selective

Service, the Federal Security Agency, the War Manpower Commission, and

other nonmilitary organizations. The fact that at least some of these agencies

considered it necessary to request the Armed Forces to assume such an unfamiliar role inWorld War II emphasizes the need for a clear and enforceable

policy on student deferment at the start of mobilization.

The statement of the Director of the Dental Division after the war, that

Army requirements for dental officers could have been met without recourse

to the ASTP, seems well substantiated.

AUXILIARY DENTAL PERSONNEL

Period Before World War II

Soon after contract dentists were first authorized it was provided that each

would have an enlisted assistant detailed from members of the Hospital Corps

and that these assistants would be under full control of dentists during duty

hours.170 As early as 1904, Dr. Marshall reported to The Surgeon General

that it was difficult to obtain enlisted assistants, and that competent men

became dissatisfied with the long hours, confining work, and lack of opportunity for advancement incident to assignment to the Dental Service.171

In World War I, about 5,000 enlisted assistants were on duty with 4,620

dental officers. These men were detailed from Medical Department enlisted

personnel and were largely trained by the officers with whom they worked.

In the period between World Wars I and II, dental auxiliary personnel

continued to be obtained from the Medical Department though provision was

made in Army regulations for special detail of enlisted men to the Dental

Service.172 Men so detailed, on the authority of The Surgeon General, were

1,0 Manual for the Medical Department, 1906. Washington, Government Printing Office, 1906,

p. 40.

"»Ltr, Dr. John S. Marshall to SG, 16 Feb. 04. Natl Archives: 70760-27.

"

2 AR 40-15, 28 Dec 42.

330324 O—55 11
!52 DENTAL SERVICE IN WORLD WAR II

to be more directly under the control of dental officers for training and duty

than would those merely assigned, and it was believed that this provision would

ensure a more stable source of auxiliary dental personnel. In practice few

men were ever so assigned and the merits of the plan were never determined.

It was abandoned completely in May 1943.173

Before World War II, it was generally believed by enlisted men of the

Medical Department that duty with the Dental Service meant long hours and

loss of opportunity for promotion. Dental officers spent months training

laboratory technicians and chair assistants, knowing all the while that the

best grade they could offer in their relatively small clinics would be that of

private first class or corporal, and that as soon as these men had sufficient service

to be considered for promotion they would have to transfer to the surgical

service or medical supply. The alternative was to accept those misfits who

had no ambition or hope for advancement. Seldom could the Dental Service

offer grades comparable to those available in other, larger departments. Further, when the enlisted man of the Dental Service was examined for promotion

he was questioned on general medical subjects in which men assigned in other

services had the obvious advantage. As a result, service in the dental clinic

came to be regarded as a dead end on the road to promotion. There was very

little change in this situation until the start of World War II.

Auxiliary Personnel, World War II

Mobilization for World War II brought considerable improvement in the

adequacy and status of auxiliary personnel provided the Dental Service. In

June 1941, only 1,488 enlisted men and a limited number of civilians were on

duty with dental installations.174 In September 1943, 13,851 enlisted men and

2,441 civilians were so engaged,175 and by January 1944 the number had increased to 15,585 enlisted men and 2,410 civilians.1 The percentages of men in

the various grades and a comparison with grades held by enlisted men of the

Medical Department as a whole were as follows:

Dental Service Medical Dept.

Dental Service (Continental {Continental

Grade' (Total Army) US) US)

Percent Percent Percent

Master sergeant 0.06 0.09 0.50

Technical sergeant 0.48 0.61 1.50

Staff sergeant and technician 3/c 4. 36 3. 84 5. 00

Sergeant and technician 4/c 13.60 12.72 11.70

Corporal and technician 5/c 44.01 39.19 17.80

Private first class 20.35 23.56 23.10

Private 17. 11 19.96 40.90

•308 Wacs in unknown grades are not included in above percentages tor the Dental Service.

«

3AR 40-15, C 1, 10 May 43.

History of the Army Dental Corps, Personnel, 1940-43. HD : 314.7-2.

"

B

Ibid.

"«Annual Rpt, Dental Div SGO, 1945. HD.
PERSONNEL AND TRAINING I

53

It is apparent that the enlisted man of the Dental Service had a poor chance

of reaching the top three grades, but he had a better chance than the enlisted

man of the Medical Service to reach the grades of sergeant and corporal.

By June 1944, enlisted personnel were being replaced somewhat by civilians

and the number of enlisted men on duty had dropped to 14,859 while that of

civilians had increased to 3,446. These figures remained substantially unchanged until the start of demobilization.177

When initially assigned to the Dental Service all enlisted assistants had

completed from 8 to 17 weeks of basic military training; many had no other

experience in the duties they would have to perform.

Dental Laboratory Technicians. One of the first problems to be solved

by the Dental Service in World War II was a severe shortage of dental laboratory technicians. When the dental requirements for induction were considerably relaxed in October 1942, the disqualification rate for dental reasons sharply

decreased and by the end of 1942 itreached the level of 0.1 percent. It remained

at about that level for the remainder of World War II.178 To meet the needs of

the hundreds of thousands of men who would previously have been considered unfit for military duty, the Army was eventually to construct over two and

a half million dentures, requiring a mobilization of laboratory facilities on a

scale not foreseen in early planning.

To meet this need for increased laboratory facilities, the Army could count

on inducting only a fraction of the required personnel. A survey by the Dental

Laboratory Institute of America and the American Dental Association showed

that in 1942 there were only a little over 12,000 trained dental technicians

in the entire United States.179 Many of these were ineligible for induction because of age or dependency, and when it is noted that about one-third of all men

actually called by Selective Service during World War II were rejected for

physical and mental reasons, it is apparent that but a few laboratory men could

be taken from the civilian reservoir. It should be noted that civilian demand

for dental prosthetic appliances also increased greatly during the war because

of the rapid rise in general income levels. A sample group of laboratories questioned early in 1942 reported that they had lost about 18 percent of their

technicians.180 If this proportion held throughout the country the Armed

Forces inducted about 2,200 laboratory workers from this source.

To make the situation worse, many of the dental technicians taken into the

Armed Forces during the first part of the war were lost to the Dental Service.181

The test group of laboratories previously mentioned reported that only 44

"'Unpublished data from the flies of the Dental Division. Abstracted by Lt Col John C.

Brauer, DC, Dent Dlv SGO.

178 Unpublished data from the Medical Statistics Dlv, SGO.

«»Complete survey of dental laboratory technicians to be undertaken by committee. J. Am.

Dent. A. 29 : 2060, 1 Nov 42.

«»Ibid. m

Proceedings of The Surgeon General's Conference with Corps Area and Army Dental Surgeons,

8-9 Jul 42, p. 11. HD: 337.
154 DENTAL SERVICE IN WORLD WAR II

percent of their inducted laboratory men were sent to duty with the Dental

Corps. Some were assigned from the reception centers to nonmedical units,

probably on the basis of mechanical ability; others were assigned as chair assistants because Army classification procedure at first failed to distinguish clearly

between laboratory and assistant functions.182 The latter mistake was readily

correctible, except when technicians taken from Zone of Interior laboratories

were assigned as chair assistants to units going overseas, in which case they

were often irrevocably lost to the prosthetic service.

On 23 November 1942, on the advice of the Director of the Dental Division,

the chief of the Personnel Service, SGO, asked Army Service Forces to take

steps to insure that dental laboratory technicians would be assigned to the

Medical Department, and requested further that the forces in the United States

be combed for technicians who had already been assigned to other branches.183

At about the same time the ADA and the Dental Laboratory Institute of

America cooperated to make the survey of laboratory manpower which has

already been mentioned and to furnish the Dental Division, SGO, with the

names of inducted technicians so that a check could be made of their current

assignments. In January 1943 the Dental Division also requested that the

practice of assigning laboratory men to chair assistants' duties be stopped.184

In February 1943 it was reported that The Adjutant General was taking

the following steps:1S5

1. Directing an Army-wide report on dental technicians performing other

duties.

2. Kequesting from the Surgeon General's Office a list of vacancies for

dental technicians.

3. Notifying reception centers to send all inductees with laboratory experience to the nearest Medical Department replacement training center for assignment.

While few dental technicians were assigned outside the Medical Department after the spring of 1943, another critical situation soon arose when ASF

directed that personnel fitted for general overseas assignment would not be

retained in service commands in the United States. Some laboratory men were

of course required overseas, but in April 1943 the Director of the Dental Division complained that Zone of Interior installations were being stripped of

dental mechanics who were subsequently being assigned to tactical units as dental

chair assistants.186 He strongly recommended to ASF that dental laboratory

men be assigned only to those organizations having prosthetic facilities. Two

i

83 AE 615-26, 15 Sep 42.

188 Ltr, Chief, Pers Serv, SGO, to Dir, Mil Pers, ASF, 23 Nor 42, sub : Dental technicians. SG:

221 (Technologists).

»«Memo, Dental Div. SGO for Pers Serv, SGO, 28 Jan 43. SG: 221 (Technologists).

m Memo, Dir Tng Div, SGO, for Pers Serv, SGO, 26 Feb 43, sub: Dental laboratory technicians

(067). SG: 221 (Technologists).

188 Ltr, Chief, Pers Serv, SGO, to Dir, Mil Pers, ASF, 7 Apr 43, sub: Dental laboratory technicians

(Dental Mechanics). SG : 221 (Technologists).
PERSONNEL AND TRAINING 155

days later The Adjutant General authorized The Surgeon General to make

his own arrangements to that end with the individual service commands concerned. On 14 April 1943 The Adjutant General notified The Surgeon General

that a separate personnel category (SSN 067) had been reserved for dental

technicians, to distinguish them from dental chair assistants (SSN 855), paving

the way for a clear definition of the two types of duty in drawing up tables of

organization.187 The new classifications were published in a memorandum

from The Adjutant General's Office (AGO), dated 13 May 1943.188

These measures did much to prevent the waste of laboratory men in routine

jobs. In January 1944, however, the whole matter was again thrown into

confusion when ASF placed laboratory men in the "scarce" category and

directed that they would not be assigned to any overseas organization.189 lfl0

This action was apparently designed to prevent the misuse of such personnel,

but it overlooked the fact that a limited number of technicians were needed in

theaters of operations, and the Director of the Dental Division immediately

recommended modification of the order. A letter was subsequently prepared

for the Commanding General, ASF, listing the specific units in which the

assignment of laboratory men was essential,191 and the misunderstanding was

corrected in a War Department circular of 4 April 1944.192 A supplementary

order of 29 May 1944 directed that dental technicians would be used only in

the duties for which they had been trained.193

Steps to improve the utilization of laboratory personnel proved generally

effective, but they did not prevent a minor loss of technicians to other duties.

Hospitals sometimes reclassified dental technicians as chair assistants to avoid

an excess of this category over the numbers permitted by tables of organization, but in such cases the individual usually continued to perform his old

duties as long as he remained with the unit. If he were transferred, however, he was likely to be assigned on the basis of his specification serial number.

In other cases the authorization for laboratory technicians was revoked for

certain units, and the men holding laboratory ratings were sometimes reclassified under such circumstances to prevent their loss to the organization. Keeping dental technicians assigned to their proper duties was a continuing problem

for the Dental Service throughout the war.194

A defect of the broad classification of "dental technicians" was that it

failed to specify individual special skills or degrees of experience. Both Army

and civilian laboratories normally function on a "production line" basis, with

187Memo, TAG for SG, 14 Apr 43, sub: Dental laboratory technicians. SG: 221 (Technologists).

188 AGO Memo W 615-45-43, 13 May 43, sub : Eevislon of specification serial numbers—AR 615-26.

SG : 221 (Technologists).

189 ASF Cir 26, 24 Jan 44.

190 ASF Cir 50, 16 Feb 44.

191 Ltr, Chief, Oprs Serv, SGO, to CG, ASF, 3 Mar 44, sub: Dental laboratory technicians (067).

SG: 300.5-5.

192 WD Cir 130, 4 Apr 44.

193 WD Memo W 615-44, 29 May 44, sub : Critically needed specialists.

194 History of the Army Dental Corps, 1 Apr 44-1 May 1944. HD : 024.10-3.
156 DENTAL SERVICE IN WORLD WAR II

each man carrying out a limited operation. The technician who is qualified to

perform all duties in a laboratory with equal competence is therefore rare.

Under the Army classification a hospital which needed a man to set up teeth

was likely to receive a replacement whose specialty was polishing dentures.

Even in peacetime the number of trained technicians entering the Army

from civilian life had been negligible, and the Medical Department had

conducted training for this category of personnel since the founding of the

Army Dental School in 1922. An average of 18 men had graduated from the

4-month course each year in the period 1935-1938.195 The training emphasized

laboratory work, but it also included some instruction in administration, x-ray

technique, and chair assisting. The course was expected to be increased to a

full year beginning with the class of September 1939, but the outbreak of war

caused this class to be graduated in July 1940, and thereafter the period of

instruction was reduced to 3 months.

The wartime 3-month course for laboratory technicians was really a combined course for laboratory men and chair assistants, though most time was

spent on laboratory procedures. Itincluded instruction in dental anatomy and

tooth carving, dental materials and metallurgy, dental records, dental roentgenology, dental hygiene, inlays and crowns, chair assisting, impressions,

clasps, full and partial dentures, and actual work in the laboratory. It also

included instruction in the care and maintenance of equipment.196 Applicants

were required to have the equivalent of a high school education and must have

completed basic military training. The course given at Fitzsimons General

Hospital in 1942 was as follows:

Organization 2 hours

Basic dental instruction 40 hours

Dental assisting 47 hours

Chair assisting 9 hours

Army dental records 6 hours

X-ray . 25 hours

Fractures 5 hours

Mailing dental materials . 2 hours

Prosthetics:

Upper partial dentures 42 hours

Lower partial dentures 78 hours

Full dentures 128 hours

Acrylic splints 35 hours

Total 283 hours

Crown, bridge, and inlay:

Metallurgy 12 hours

Posterior bridge 92 hours

Anterior bridge 28 hours

Total 132 hours

195 Annual Reports . . . Surgeon General, 1935-38.

'<" ASF Manual M3, 25 Apr 44. HD.
PERSONNEL AND TRAINING 157

The first month was devoted to didactic instruction and the last 2 months to

actual work in a laboratory under supervision. It was recognized that competent dental technicians could not be trained in 3 months and the course was

expected to establish a basis for the individual's further progress at his home

station. The rating of SSN 067 was conferred at the schools only on the best

qualified graduates (40 percent at Fitzsimons General Hospital, 1943). More

often it was given later, on recommendation of the unit dental surgeon after

the student had improved his knowledge by "on-the-job" training. Those who

showed little aptitude for laboratory work remained SSN 855's (chair

assistants).

The dental technician training program soon outgrew the Army Dental

School and courses were given in six general hospitals in 1940. Nine schools

were in operation during fiscal 1943 and over 5,000 students were enrolled

during that year. Maximum authorized capacity was 600 men a month. Many

of the schools operated double shifts during 1943 to accommodate the augmented

classes without additional equipment. The program fell off sharply in the

latter part of 1944 and only a handful of students remained after March 1945.

Eesults of the training program for dental technicians are listed in the

following tabulation:197

Enlisted men Wacs Enlisted men Wacs

Fiscal year enrolled enrolled* graduated graduated'

1940 13 0 13 0

1941 295 0 121 0

1942 1,012 0 843 0

1943 5,438 0 3,691 0

1944 3,361 103 3,791 69

1945~ 1,007 396 1,550 346

Totals 11,126 499 10,009 415

»In the entire program, from July 1939 through January 1946, 511 Wacs enrolled m the dental technicians schools

of whom 473 graduated.

The percentage of failures from July 1939 through January 1946 were as

follows:198

Type Enlisted men Wacs Allstudents

Percent Percent Percent

Scholastic 4.7 2.2 4.6

Other 4.8 5.3 4.8

Totals 9-5 7.5 9.4

m

See footnote 79, p. 126.

198 The percentages of failures quoted here were calculated from figures of the Training Division,

SGO, which show 541 scholastic failures and 573 other failures out of a total enrollment of 11,847.

Of the entire enrollment, 10,713 men were graduated through April 1946 (men enrolled in January

did not graduate until April). Since 20 enrollees of the total number are not accounted for In

the numbers reported for failures and graduates, it may be that these students did not complete

the course during the February-April 1946 period. However, if these 20 were to be considered as

failures, the total percent would only be changed from 9.4 to 9.6.
158 DENTAL SERVICE IN WORLD WAR II

Since graduates of the technicians' schools were seldom given specialist's

ratings until they had served for some time at their own stations it is not known

exactly how many became laboratory workers and how many remained chair

assistants. In July 1945, 2,494 men, or 17.6 percent of the 14,191 enlisted men

with the Dental Service, were rated SSN 067.m

The Director of the Dental Division stated in 1945 that the 3-month course

had been too short for dental laboratory workers, though he felt that it was

adequate for chair assistants. He recommended a minimum course of 6 months

for technicians, to be extended to one year if possible.200

Use was made of civilian laboratory technicians to replace enlisted men

where possible but civilians were never employed in this work to the extent

that they were as assistants and hygienists, probably due to difficulties of procurement. By August 1943, 144 civilian laboratory men were on duty with

the Army, butthis number declined through 1944.

Prosthetic Supply Clerks. Beginning on 20 March 1944, six enlisted men

of the Dental Service were given 4 weeks of training at Binghamton Medical

Depot to prepare them for duty as prosthetic supply clerks. The scarcity of

personnel capable of handling the many sizes, shapes, and shades of porcelain

teeth stocked in laboratories and depots made this small but important course

necessary.201

Dental Assistants. With mobilization it became necessary to staff large

numbers of clinics with assistants in a very short time and more emphasis was

placed on training for this category. In the paragraph on dental technicians

it is explained that the dental technicians' course was a combined project, including instruction in both laboratory procedures and the duties of a chair

assistant. Those men who did not show mechanical aptitude for laboratory

work eventually went to duty as chair assistants (SSN 855). It is not known

exactly how many graduates of Army schools became dental assistants because

the final rating as technician or assistant was often made at the home station.

In July 1945, 11,697 men, or 82.4 percent of a total of 14,191, were rated as

SSN 855.202 Since only 11,625 enlisted personnel attended the Army schools

through fiscal 1945, and since the enlisted auxiliary personnel of the Dental

Service numbered over 15,000 men at its maximum, we can assume that not

more than two-thirds of the chair assistants had formal school training. The

equivalent of a high school education and completion of basic military training

were prerequisites for training as a dental assistant.

In January 1943, the Director of the Dental Division recommended approval of a request from Camp Pickett for 100 "WAC personnel for duty as

1M Information from the Strength Accounting Branch, AGO, given the author on 11 Dec 46.

200 See footnote 9, p. 107.

201 A report of the schooling of enlisted personnel, Medical Department, 1 Jul 39 to 30 Jun 44.

In the history of training in the Army Service Forces for the period 1 Jul 39-30 Jun 44, vol IV, p. 109.

HD: 314.7-2.

202 See footnote 199, p. 158.
PERSONNEL AND TRAINING 159

dental assistants, and at the same time recommended that women be used to

replace male assistants in all large clinics.203 The Surgeon General approved

this request and forwarded it to the Director of the Women's Army Corps for

action. In June 1943, The Surgeon General estimated, on information from

the Dental Division, that 1,519 Wacs could be used in Army dental installations.204 Training courses for Wac dental technicians were established at

Army-Navy, Brooke, Fitzsimons, Wakeman, and William Beaumont General

Hospitals and at Fort Huachuca, and a total of 473 female dental technicians,

including 9 Negro Wacs, were trained from September 1943 to January 1946,

most of these (335) at Wakeman General Hospital.205 Three hundred and

eight Wac assistants were on duty in January 1944. By June the number had

increased to 462.206 It is not known how many ultimately went to duty with

the Dental Service but the figure was certainly far short of the 1,519 which

it had been estimated could be used.207

The fact that wider utilization was not made of Wac dental assistants

was due mainly to inability to obtain them. There were, however, certain disadvantages in using women for such work. Eequirements for quarters were

more difficult to meet, their sickness rate was higher, and they could not be

assigned to some types of tactical units. Another objection to Wac assistants

was that male clinic personnel had to assume additional work in connection

with heavy clinic maintenance. In many places the Wacs scrubbed floors and

worked on an almost equal basis with the men, butthere was a feeling among the

males that they were given additional work when a considerable number of

women assistants were assigned to a clinic. On the other hand, the Wac

assistants were not subject to the strict limitations on hours and type of work

which applied to salaried civilian women assistants.

Forsome years civilian dental assistants had been used in a few large clinics.

As enlisted assistants became harder to replace an effort was made to obtain a

substantial number of civilians for this duty in fixed installations in the United

States. In July 1942 The Surgeon General specified conditions under which

female civilian assistants could be hired.208 Civilian dental assistants were

to be given the Civil Service grade of SP-3, paying $1,440 yearly. They were

required to have a minimum of 6 years grade school education and at least 1

year of experience as a dental assistant. They provided their own uniforms.

Civilian dental assistants were to conform to the rules of conduct prescribed

for Army nurses. In January 1943 the additional grade of "Junior Dental

*» Memo, Dir Dental DIv, SGO, for General McAfee, 5 Jan 43, no sub. SG : 322.5 (Camp Plekett).

204 Ltr, SG to CG, ASF, 2 Jun 43, sub : Technical training of WAAC personnel. SG : 322.5-1.

2<B See footnote 79, p. 126.

206 Ltr, Capt Emily Gorman to Mr. Frank Rand, 11 Oct 44, no sub. SG : 221 (Technicians).

207 It is extremely difficult to get information on the personnel on duty with the Dental Service

during the war since all enlisted men and women were assigned only to the Medical Department;

they were placed on specific duties by local surgeons and might be shifted on short notice. Strength

returns from installations did not specify the services to which personnel were assigned.

208 SG Ltr 75, 27 Jul 42.
160 DENTAL SERVICE IN WORLD WAR II

Assistant," SP-2, paying $1,320 yearly, was established.200 The position of

Junior Dental Assistant was to be filled by persons with limited experience and

was considered temporary until additional training had been completed in the

dental clinic. By June 1944, 2,909 civilian dental assistants were on duty in

the United States and 15 had been hired overseas. (None were sent overseas

from the United States during the actual combat period.) Later figures are

not available, but it is probable that the strength given for June 1944 represents

about the maximum number on duty during the war as the percentage of the

Army on duty overseas increased rapidly after this time and civilian assistants

were not sent abroad.

The use of civilian assistants released a large number of men for other

duties. In general, they were superior to enlisted men in the handling of patients and in the care of instruments and small equipment. On the other hand,

they worked limited hours and were not available for emergencies. They could

not be called upon to clean floors and do major maintenance work in the clinic,

and the rate of absence was generally thought to be higher than for enlisted

men, though there are no statistical data bearing on this matter. The use of

both enlisted and civilian personnel in the same clinic sometimes resulted in

friction as the women received twice as much pay for shorter hours. Also,

unless janitor service was provided, the enlisted man was required, after the

close of the day's operations, to clean not only his own operating room but also

that of the civilian assistant. In general, the service rendered by civilian

assistants justified their use, but best results were obtained when civilian and

enlisted personnel in clinics were mixed as little as possible.

Dental Hygienists. Before the war civilian dental hygienists were on

duty in only a few of the larger clinics. Training in this work was given

enlisted men in the Army Dental School course and oral prophylactic treatments were generally given by enlisted men or by dental officers. With mobilization it was decided to make wider use of civilian hygienists and the conditions of employment were prescribed in July 1942.210 The position of dental

hygienist was rated as SP-4, and paid $1,620 yearly. The applicant was required to (1) be a graduate of a course of at least 2 years at a recognized school

of oral hygiene, (2) have a license from a state or territory, and (3) have

practiced 2 years in a clinic or office of a private dentist. In July 1943 this

last requirement was waived.211 The position of senior dental hygienist, SP-5,

was authorized in clinics where five or more hygienists were on duty, or under

certain other circumstances involving increased responsibility. The pay of

a senior hygienist was $1,800 yearly. In January 1944, over 500 hygienists

were on duty, a figure which was approximately the maximum during the

war.212 Soon after the declaration of war four civilian dental hygienists were

2TO SG Ltr 1, 1 Jan 43.

21° See footnote 206, p. 159.

211 SG Ltr 117, 1 Jnl 43.

212 See footnote 177, p. 153.
PERSONNEL AND TRAINING 161

sent overseas with their organizations and they were allowed to remain until

returned to the United States under routine, established policies. No additional female hygienists were permitted to leave the Zone of Interior, however,

and their places were taken by enlisted men prior to embarkation.

The status of dental hygienists during the war was the cause of considerable dissatisfaction on the part of hygienists' organizations. Difficulty was

first encountered when dental assistants were occasionally promoted to the

grade of hygienist, SP^. Such promotion was never authorized, but occurred

with sufficient frequency to make necessary a specific prohibition against the

practice in July 1943.213 The Dental Division agreed with hygienists' organizations that, except for military personnel trained by the Army itself, the

scaling and polishing of teeth should be limited to persons who had completed

the prescribed course of instruction in authorized schools. With the inauguration of the Women's Army Corps, requests were made for the incorporation

of dental hygienists as officers in that organization. This request was opposed

by both the Medical Department and the Dental Division because of rigid

regulations affecting the utilization of WAC personnel. These regulations

provided that Wacs could not replace civilian employees and would replace

male officers in the ratio of one Wac for one male officer. It was therefore

feared that commissioning of hygienists in the WAC would entail the loss of

an equal number of dental officers.214

Late in 1942 the Medical Department sponsored a bill (H. E. 3790, S. 839)

to provide commissions for female dietitians and physiotherapists. This step

was made necessary by difficulties encountered when organizations employing

these essential civilians were shipped overseas. The Dental Division called

attention to the fact that hygienists would probably remain a permanent part

of the Army Dental Service and recommended that they also be included in

the pending bill, but this recommendation was returned with the pencilled

notation "not now," signed by the executive officer of the Surgeon General's

Office. Organizations representing the hygienists made a vigorous presentation of their cause in congressional committee hearings, however, and finally

succeeded in having a clause incorporated authorizing the President to provide commissions for other "technical and professional female personnel in

categories required for service outside the continental United States." 215 But

since the bill did not specifically mention hygienists the Medical Department

later held that their services were not required outside the United States and

that it was not necessary to invoke the provisions of the bill in their interest.216

In July 1944, the Director of the Dental Division called attention to difficulties in obtaining dental hygienists and assistants and noted that the Army

213 See footnote 211, p. 160.

214 Ltr, Maj Gen Norman T. Kirk to Hon Harve Tibbott, 2 Sep 43. SG: 231 (Dental Hygienists).

m

56 Stat 1072.

216 Ind, Brig Gen Larry B. McAfee to IAS to SG from TAG, 6 Apr 43, sub : Dental hygienists not

included in Public Law 828, 77th Congress. SG : 231 (Dental Hygienists).
162 DENTAL SERVICE IN WORLD WAR II

had no installations with five hygienists where the grade of SP-5 could be

authorized.217 He recommended creation of the position of "Senior Dental

Assistant," SP-4, and a corresponding increase of rating for hygienists to

SP-5 and SP-6, the latter to pay $2,000 yearly. At the end of the war no

action had been taken on this recommendation. In September 1944 the Director of the Dental Division again recommended the establishment of a Hygienist's

Corps, on the basis of 0.3 officers per 1,000 strength of the Army. He recommended that hygienists be limited to the grade of captain, unless dietitians

and physiotherapists were to be granted higher grades, in which case it was

recommended that hygienists be placed on an equal status. In 1945 he again

recommended the commissioning of hygienists, but advised that only graduates holding a bachelor of science degree in oral hygiene be accepted.218 No

action had been taken in this direction at the end of the war. (In 1943 the

Navy offered commissions in the WAVES to hygienists who were graduates

of courses of at least 2 years. Hygienists with less than this minimum training

were accepted as pharmacist's mates.)219

Informal' Training, Auxiliary Personnel. One of the most important

aspects of the training of auxiliary personnel was the daily informal instruction which such personnel received while performing their duties in dental

installations. New men were placed on duty in operating clinics, learned

their work under the supervision of dental officers, and in turn helped teach

other men or were incorporated into cadres to form the nucleus of new organizations. This training was continuous during the war and accounted for the

only instruction (other than basic training) that at least one-third of all

dental enlisted men received.

Course on Gare of Equipment. Early in 1942, a course of instruction in

the care and minor repair of dental equipment was initiated by a large dental

manufacturer. The course lasted 2 weeks and representatives of other manufacturers were invited to lecture on their particular products so that a wide

coverage of the field was obtained. Approximately 180 enlisted assistants

received thistraining.220

Summary, Auxiliary Personnel

Over 18,000 auxiliary personnel were used in the operation of the Dental

Service by 15,000 dental officers. In wartime, dental officers should not waste

their efforts in work which can be done by less specialized personnel, and considerably more than the above number of auxiliary assistants could have been

used efficiently if they had been available. It has been estimated that the

"Memo, Maj Gen R. H. Mills for Pers Serv, SGO, 24 Jul 44. SG: 231 (Dental Hygienists).

(This communication accompanies a memo to Col George Kennebeck from Brig Gen Rex McDowell

(no subject), 16 Mar 45, same file.)

»» See footnote 9, p. 107.

»• Capt Robert S. Davis discusses problems of Navy Dental Corps. J. Am. Dent. A, 31: 587-589,

15 Apr 44.

2

» Report of the Dental Division, SGO, for fiscal 1942. HD : 319.1-2.
PERSONNEL AND TRAINING 163

services of a full-time dental assistant will increase the output of a dentist from

30 percent (U. S. Public Health Service) to 63 percent (U. S. Navy), but the

wartime ratio of 1.2 auxiliary personnel per dental officer did not permit

assignment of a full-time dental assistant to each officer after provision had been

made for hygienists, x-ray technicians, clerical workers, and laboratory

technicians.221

Shortage of manpower in time of war makes necessary the wide use of

female auxiliary personnel, including civilians.

In a mobilization, competent laboratory technicians will not be available

in sufficient numbers from among inducted men, and a program for their training must be anticipated. Every precaution must be taken to insure that

inducted laboratory technicians are assigned to appropriate duties in the Army.

A course of 3-months duration is not adequate for the training of laboratory

technicians, but will provide a sufficient basis for further "on-the-job" training

in a dental laboratory.

It is evident that there was considerable waste effort involved in giving

laboratory training to nearly 10,000 enlisted personnel when over 80 percent

ultimately served as chair assistants. The whole period of training was not

entirely wasted for this group, however, since the course included some work

important to dental assistants as well as to the laboratory technician. There

is also some need, especially in time of peace, for assistants who can "double in

brass" to carry out minor laboratory procedures at smaller stations having no

assigned technicians. But in the opinion of senior dental officers the training

for chair assistants in a time of emergency could profitably be cut to 1 or 2

months and separated from that given prosthetic workers. During World

War II it was necessary to send a large number of men to the technician's1 schools to obtain the few who could acquire the needed special skills, but aptitude tests developed during the latter part of that war should make it possible in

the future to select candidates for laboratory training with a much higher

degree of accuracy. When it can be predicted with fair certainty that students

chosen for technician training will be able to complete the course successfully it

will probably be more economical of time and effort to shorten the period of

training for assistants and to eliminate from the already overcrowded labortory course all instruction intended for them.

It was the general opinion of dental officers that the Dental Service exercised inadequate control of its enlisted auxiliary personnel. The most serious

difficulties were:

1. Clinic personnel were under the direct command of the medical detachment commander, acting for the surgeon. They could be, and were, taken from

their duties in the clinic for training or other nondental work. When such

withdrawals were moderate in number and made on adequate notice, they were

annoying but unavoidable. When they were made in large numbers on short

221 Army-Navy Register, 21 Sep 46, p. 11.
164 DENTAL SERVICE IN WORLD WAR II

notice they were disastrous in a service which had to schedule its work weeks

ahead.

2. The fact that auxiliary personnel were not permanently assigned to the

Dental Service was directly responsible for some inefficiency in operation.

Months of training were required to qualify a competent dental assistant, and

when a skilled man was transferred to other duties because he felt that life was

easier in the surgery, or to increase his chance for promotion, both the Dental

Service and the Army suffered.222

3. The fact that promotion of enlisted assistants was in the hands of

medical officers was widely believed to have resulted to the disadvantage of

dental auxiliary personnel. This belief is not wholly confirmed by comparison

of the grades held by dental and medical enlisted men in the United States.

Medical officers did have the authority to promote or demote dental personnel

without consultation with the dental officers in charge of clinics, however, and

though this action was rarely taken, the results, when it did happen, were

inevitably detrimental to efficiency and morale.

The following changes were among those most commonly recommended

by dental officers:

1. Permanent assignment of enlisted personnel to the Dental Service, with

transfer only for significant reasons which would normally justify transfer

between other corps of the Army.

2. Adequate provision for promotion of outstanding enlisted men within

the Dental Service so that competent men could plan a career in that service

without jeopardizing their chances of arriving at the higher grades.

3. Correction of the system whereby dental personnel were examined for

promotion in purely medical subjects, in competition with men who had been

engaged in medical activities in their daily work.223

222 See footnote 9, p. 107.

223 Ibid.
CHAPTER V

Dental Equipment and Supply

EARLY SHORTAGES OF DENTAL SUPPLIES

The critical shortage of dental equipment and supplies was probably the

most serious difficulty faced by the Dental Service during the first 2 years of

mobilization. There is ample evidence of the extent of this shortage. The

Committee to Study the Medical Department of the Army reported, about

November 1942, that "there are serious deficiencies in certain critical items of

equipment and supplies. Dental officers . . . have been handicapped by an

appalling lack of certain materials and equipment." A survey of 199 Air

Force stations in December 1942 revealed that only 26 were without serious

shortages which ranged from instruments to chairs, units, x-ray machines, and

field chests,2and the following reports were typical of many received in the

Dental Division during the early part of the war:

The July (1941) Report of Dental Service from Camp Davis, N. C, reveals the fact

that for some time construction of both DC-1 and DO-2 dental clinics has been completed, and that only four handpieces, all of which were borrowed from other stations,

were available. This means that at this station, where twenty dental officers are on duty

with the station complement, the services of only four can be utilized in a professional

capacity at one time. This situation has existed at Camp Davis for many months. . . .

3

The dental clinic No. 1 at Camp Livingston, La., has not been activated due to the

lack of cabinets, sterilizers, handpieces, and lights. Requisition was made for these

items in December 1940. (This report was made in October 1941.)

Overseas, where the shortages were further aggravated by delays and

losses in shipping and by difficulties of storage and distribution, the situation

was for a while even worse.* The dental surgeon of the European Theater of

Operations (ETO) reported in November 1942 that 30 percent of the dental

officers in England had no equipment.5In December 1942, 39 dental officers

in the Middle East theater had a total of 6 field sets, 2 units and chairs, 1 incomplete laboratory, and a few miscellaneous items purchased locally.6

In

1A general discussion of the organization and operation of the medical supply service has been

written under the title, "The Procurement and Distribution of Medical Supplies in the Zone of the

Interior during World War II," by Capt Richard E. Yates. This chapter deals only with aspects

of the supply problem which were of particular concern to the Dental Service. HD.

2 Memo, Col George R. Kennebeck for Brig Gen David N. W. Grant, 11 Jan 43. SG : 444.4-1.

3 Memo, Brig Gen Leigh C. Fairbank for Finance and Supply Div, SGO, 29 Aug 41. SG: 444.4-1

(Camp Davis)C. (At the time of this report there were about 15,000 men at Camp Davis.)

4 Medical supplies for Europe waited in the channel for as long as four months while high priority

munitions were being unloaded. See History of the Dental Division, Headquarters, ETOUSA,

1 Sep-31 Dec 44. HD: 319.1-2 (ETO).

5 Personal ltr, Col William D. White to Brig Gen Robert H. Mills, 2 Nov 42. HD : 730.

• Personal knowledge of the author who was dental surgeon of the Middle East theater in

December 1942.
166 DENTAL SERVICE IN WORLD WAR II

December 1942 the North African theater was short 37 percent of its authorized

MD Chests No. 60.r 8In January 1943 the Director of the Dental Division,

SGO, stated: "We have no chests 60 at all, it seems, to issue to troops in this

country."9

Serious deficiencies of supplies and equipment involved shortages of the

following important items:

Burs. The War Production Board (WPB) reported in 1943 that stocks

of dental burs in the hands of civilian dealers averaged only 33 percent of prewar levels, and that 88 percent of all dentists complained of difficulty in obtaining this essential item.10 Total output in 1943 was estimated at 48 million,

while total requirements were placed at over 93 million, of which 52 million

were requested by the Armed Forces.11 In spite of the fact that the Army

was given only 15 million in 1943 instead of the 35 million requested, final

allocations to the Armed Forces still totalled more than half of all production

for the year.12 As late as November 1944 WPB considered construction of a

new bur factory at Government expense, though the project was dropped when

it became apparent that low output was due more to the lack of materials and

labor than to inadequate capacity.13

Hewvy clinical equipment. Production of units, chairs, x-ray machines,

and other large clinical items had naturally been small in peacetime since

they could be classed as capital goods which required replacement only after

many years of use. In 1940, civilian dentists purchased only about 2,000 units

and 2,500 chairs.14 In 1943, however, the Army alone required about 5,500 units

and 5,000 chairs.15 The production of individual companies manufacturing

these items was increased from 50 to 300 percent16but capacity was severely

strained. In April 1943, delivery of 1,697 units, of 8,359 contracted, caused

certain manufacturers to be classed as "delinquent."17

Dental field chests. During the early part of the war many units were

sent overseas without field dental equipment, or with chests which were incomY Ltr, Col Egbert W. V. Cowan to Chief Surg, NATOUSA, 13 Mar 43, sub : Dental needs In the

Theater of Operations. On file as incl to pers ltr, Col William D. White to Brig Gen R. H. Mills,

7 Apr 43. HD : 730.

8

Personal ltr, Brig Gen R. H. Mills to Col William D. White, 18 Jan 43. HD : 730.

» See this chapter, p. 180 for contents of M. D. Chest No. 60.

10 Special problems discussed at War Service Committee meeting. J. Am. Dent. A. 31: 445-450,

15 Mar 44.

11 Memo, Col Clifford V. Morgan, Chief of Materials Br, Production Div, SOS, for SG, 6 Jan 43,

sub: Dental burs—production and requirements. SG : 444.4—1.

» Memo, Col F. R. Fenton, Resources and Production Div, SOS, for SG, 24 Feb 43, sub : Dental

burs—proposed allotment. SG : 444.4-1.

M

Ltr, Senator Harold Burton to Mr. Highland G. Batcheller, Vice Chairman of Operations, WPB,

10 Nov 44. SG : 444.4-1.

14 Info, Medical and Health Supplies Section, Consumer Programs Branch, WPB, for Col C. F.

Shook, 18 Sep 42. The original of this letter cannot be located. The source of the figures given was

said to be the American Dental Trade Association.

M Ltr, Maj J. E. Rice to Chief, Reqmts Br, Resources and Production Div, Hq, ASF, 5 Apr 43,

sub : Allocation of dental operating units and chairs. SG : 444.4-1.

16 Annual Report of the Army Medical Procurement Office, fiscal 1944. HD: 319.1-2.

17 Incl to memo, Lt Col C. G. Gruber for Chief, Health Supplies Section, Production Div, ASF,

10 Jun 43, sub : Report on dental supplies. SG : 444.4-1.
DENTAL EQUIPMENT AND SUPPLY 167

plete in essential items.18 This particular deficiency was one of the most critical

encountered since it was extremely difficult to make any informal arrangement

for obtaining dental care in the areas first occupied by American troops.

Handfieces. The production of handpieces, especially of the contra-angle

type, was such a specialized operation that expansion of facilities was slow

and for many months output lagged behind wartime needs. In many otherwise

fully equipped clinics the dental officers could perform only the operations

possible with the simpler straight handpiece. At times, in early 1943, dental

officers scattered over thousands of miles of desert in the Middle East theater

had only a single contra-angle handpiece per dentist, and there was not one

replacement in the theater.

These shortages resulted from a number of factors among which the following were most important:

1. The Armed Forces took nearly one-third of the Nation's active dentists.

In addition to providing these men with complete outfits, adequate reserve

stocks had to be assembled for future operations as the loss of dental supplies

was inevitably high under combat conditions. (The dental surgeon of the ETO

reported that 40 complete field outfits were lost while in shipment to his

area.)19

2. The Supply Division, SGO, suffered from a lack of officers trained

in dental supply. The director of that division stated in September 1942 that

"The dental supply program has been materially retarded due to shortage of

personnel capable of negotiating contracts for the Medical Department."20

The Director of the Dental Division, SGO, noted that difficulties encountered

had been "in part due to the inexperience of supply personnel in evaluating

dental needs and requirements." 21

3. Requirements for lend-lease aggravated shortages in some of the most

critical items. Late in 1942 when units were being shipped withouttheir dental

field chests, the British Army was supplied with 200 of these scarce items under

previous commitments.22

4. In peace, the United States had depended to a considerable extent on

imports of dental items from European countries. For instance, American

industry had produced only from 6023to 70 percent of the 33 million burs used

each year prior to World War II. With the outbreak of hostilities these

imports were immediately cut off not only to the United States, but to its allies

and to South and Central America.

18 Personal ltr, Col William D. White to Maj Gen Robert H. Mills, 22 Oct 43. HD: 730.

<"> See footnote 4, p. 165.

20 3d ind, Assistant Chief of the Supply Div, SGO, 19 Sep 42, on Ltr, Lt Col James P. Holliers.

SG: 444.4-1.

«Final Report for ASF, Logistics in World War II. HD: 319.1-2 (Dental Division).

M

Personal Ltr, Brig Gen R. H. Mills to Col William D. White, 28 Nov 42. HD : 730 (ETO).

s3 President J. Ben Robinson discusses personnel and supply problems arising out of the war.

J. Am. Dent. A. 30 : 163-166, 13 Jan 43.

330324 O—55 12
168 DENTAL SERVICE IN WORLD WAR II

5. High wartime wages swelled the demand of the civilian population for

dental care which it had not received in the years of depression preceding World

War II.

6. The threat of future shortages probably resulted in some hoarding of

dental supplies. At a conference of dental manufacturers in September 1942

the representative of one firm noted that his company alone was under contract

to provide 261,000 instruments for the Army, and he expressed doubt that such

a number was actually required.24 The Director of the Dental Division immediately pointed out the elimination of many dental items from the supply lists

of the Army, and claimed, in turn, that the Navy had ordered as many burs as

the Army though it had only one-fourth as many dentists.25

In December 1942 a representative of the Supply Division, SGO, claimed

that large quantities of surplus burs were in the hands of the schools, supply

houses, and the profession, and asked the Association of Dental Manufacturers

of America to attempt to collect these for military use. The Association issued

a bulletin to its dealers asking that customers be impressed with the need for

turning in excess stocks as an alternative to a complete "freeze" on sales to

civilians, but this action produced more criticism than burs. The president of

the ADA protested vigorously, both at the supposed threat of a "freeze" on

civilian sales, and at the implication that civilian dentists were guilty of what

was delicately called "anticipatory buying."2eThe Supply Division, SGO,

replied that it had never intended to hint that hoarding had occurred, and that

its action had really been expected to impress the manufacturers with the need

for intensive efforts to increase production.27 In any event, the attempt to

collect burs from civilian sources produced only about 2,100 packages, and the

effort was soon dropped.28

It is difficult to deny, however, that hoarding of scarce supplies was practiced both by civilian and military users. The chairman of the Medical Supplies

Commission, Army and Navy Munitions Board, reported that civilian purchases

of burs in 1941 had been 70 percent higher than in any previous year, in spite

of the number of dentists and patients in the Armed Forces.29 In 1943 total

requirements for burs were placed at nearly 94 million, compared with an

average prewar demand for about 33 million burs. The Army, alone, asked

for over 35 million burs in that year, or more than the normal total peacetime

requirement, and combined requests of the Armed Forces totalled 52 million

burs.30 The clashes reported above, between the Army, Navy, civilian practi21 Memo, Col C. F. Shook for Col F. C. Tyng, 3 Sep 42. HD: 444.4-1 (Dental).

25 2d ind, Dir. Dental Div, to Memo cited in footnote 24, 16 Sep 42. HD: 444.4-1 (Dental).

" (1) Ltr, Dr. J. Ben Robinson to Col F. C. Tyng, 29 Dec 42. SG : 444.4-1. (2) See footnote

23, p. 167.

27 Ltr, Col F. C. Tyng to Dr. J. Ben Robinson, 10 Jan 43. SG : 444.4-1.

28 Ltr, Dental Manufacturers of America to Col F. C Tyng, 29 Jan 43. SG : 444.4-1.

29 Ltr, Lt Col C. F. Shook to Hon Leslie C. Arends, 23 Jan 42. SG : 444.4-1.

30 Info memo, Safety and Technical Equipment Division, Health Supplies Committee, WPB, 5 Jan

43. SG: 444.4-1.
DENTAL EQUIPMENT AND SUPPLY 169

tioners, and the manufacturers, are significant mainly because they show that

users tend to overestimate their needs when supplies are uncertain, and because

they indicate the need for disinterested control of distribution when production

isinadequate to meet all demands.

In the final analysis, wartime shortage of dental supplies was due primarily to increased demand rather than to defects in production. In spite of

the difficulties noted in obtaining labor and materials, the output of dental items

soon exceeded peacetime rates. The manufacture of burs, for instance, tripled

between 1937 and 1944.31 A representative of The Surgeon General stated that

wartime production of dental supplies reached 3% times normal peacetime

levels.32 It is apparent that in time of war the production of dental supplies

for civilian needs can be reduced very little if at all, and that any reduction in

the output for civilians will be more than balanced by the increased demands

of the Armed Forces.

ACTION TAKEN TO IMPROVE THE DENTAL SUPPLY SITUATION

Improvement in the dental supply situation depended mainly on an increase in civilian production, and this phase of the problem was largely out of

the hands of the Dental Division. The latter did cooperate, however, in a

number of steps to assure the most effective use of the available stocks and raw

materials, of which the following were the mostimportant:

Simplification of Dental Items

Early in the war the Armed Forces, governmental agencies, manufacturers,

and the civilian profession cooperated to reduce the number of types, and to

simplify the design, of many items produced for dental use. As early as February 1942 the Dental Division had voluntarily suggested that for the duration

of the war 81 items, including 33 sizes of burs, be dropped from Army supply

tables. A total of 134 items were eventually recommended to be dropped, and

most were actually removed from the tables. The requisition of nonstandard

items was also discouraged.33

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

31 See footnote 10, p. 166.

32 Testimony, Maj Gen George F. Lull before the Senate Subcommittee on Wartime Health and

Education. In Hearings before a Subcommittee of the Committee on Education and Labor, United

States Senate, Seventy-eighth Congress. Washington, Government Printing Office, 1944, pt 5, p. 1672.

33 SG Ltr 2, 8 Jan 42.

«WPB General Limitation Order 139, Schedule 1, pt 1254. In Federal Register, 26 Jun 42.

3> Memo, Col C. F. Shook for Col F. C. Tyng, 26 Nov 42, sub : Dental Equipment Advisory Committee for the WPB. SG : 334.8-1.
170 DENTAL SERVICE IN WORLD WAR II

wherever possible, and the production of units was to be limited to the smaller,

simpler types similar to the Eitter "Tri-dent." These units provided only the

basic essentials: a dental engine, cuspidor, bracket table, warm water syringe,

hot and cold compressed air, and operating light. The amount of brass and

copper used was to be drastically reduced.

With the aid of a committee appointed by the ADA, and with the advice

of all interested parties, the Bureau of Standards also drew up "simplified

practice recommendations" aimed at eliminating minor and nonessential variations of standard articles. Steps recommended by this agency, such as the

reduction in the number of sizes and types of hypodermic needles produced,

were generally accepted voluntarily by manufacturers, though had they not it

would have been possible to enforce them through WPB's control over the

allocation of materials.

Improved Distribution of Dental Supplies

In the early part of the war supply officers with experience in handling

dental items were scarce, resulting in occasional poor distribution of even the

minimum stocks then available. An especially frequent defect was failure to

balance the equipment sent to each station; one post might receive all its units

and no chairs, while another received all its chairs and no units. Angle

handpieces were furnished which did not fit the particular straight handpieces

issued. To improve this situation the Director of the Dental Division recommended in March 1941 that a dental officer be assigned to the Supply Division,

SGO.36 Such an assignment was actually made in November 1942, but it was

terminated in March 1943. Subsequent improvements in the allocation of

dental supplies resulted mainly from the increasing experience of medical

supply officers.

In July 1941 The Surgeon General directed that stations with excess

stocks of dental items would report them for redistribution where more

urgently needed.37 Stations were also directed to turn in any handpieces in

excess of one per operator, plus a 25 percent station reserve.38

In January 1943 WPB issued a general limitation order controlling the

production and sale of dental units, chairs, x-ray machines, and sterilizers,39

and governmental agencies were thereafter given first priority in the purchase

of such items. Stocks of new equipment already in the hands of jobbers and

dealers had to be reported, and 54 chairs and 109 units were obtained for the

Army from this source.40

The storage and issue of porcelain teeth, involving hundreds of molds,

sizes, and shades, offered considerable difficulty in most supply depots. In

"Memo, Brig Gen Leigh C. Fairbank for Supply Div, SGO, 17 Mar 41. SG : 210.31.

37 SG Ltr 75, 25 Jul 41.

38 SG Ltr 83, 25 Aug 41.

» WPB General Limitation Order L-249, pt 3172, 20 Jan 43. In Federal Register, 21 Jan 43.

40 Ltr, Maj Robert E. Hammersberg to Purchase Div, Army Medical Procurement Office, 26

Feb 43. SG: 444.4-1.
DENTAL EQUIPMENT AND SUPPLY 171

March 1944 each base medical depot was authorized two dental prosthetic

clerks who were qualified to handle artificial teeth.4142In England, teeth were

first stocked in 18 separate depots for convenience in distribution, but without

skilled personnel the supply soon became badly mixed. Also, since each depot

could keep only a small stock, the supply of any individual mold might run

out quickly, necessitating a canvas of other depots to locate additional quantities. To eliminate these difficulties a single depot was finally designated to

handle all procelain teeth, and an expert was brought from the United States

to supervise their distribution.

It has already been noted that in the early part of the war units were

shipped overseas without their authorized dental field chests. This situation

was due primarily to the serious shortage of this item, but it was aggravated by

the policy of shipping personnel and equipment on different transports, in the

mistaken belief that if the equipment failed to arrive promptly the dentists

could readily draw new chests from theater supplies. This difficulty had been

encountered in the First World War, and a dental officer was finally assigned to

the New York Port of Embarkation with specific instructions to make sure that

no dentist left the United States without his dental equipment.43 Similar

action was taken in November 1942,44 but improvement in this situation was

slow until overseas depots were finally stocked with dental field outfits which

could be issued promptly on arrival. The difficulties encountered in both

World Wars indicate that every effort should be made to have dental equipment accompany dental officers as part of their personal baggage.

Purchase of Used Equipment

During the period when supply shortages were most acute The Surgeon

General was deluged with proposals that he purchase used dental equipment

for Army clinics. In particular, large numbers of dental officers who were

paying for items lying idle in storage, and who noted the scarcity of these same

items at the stations where they reported for duty, urged that the Army solve

both problems by purchasing or leasing such equipment. Widows of dentists,

and finance companies, were also eager to unload dental outfits for which the

market was poor at a time when dentists were entering the military service in

large numbers. Late in 1942 WPB made a preliminary investigation which

indicated that some 11,000 each, chairs and units, could be obtained from dentists entering the Army or Navy; and on the basis of this information it even

recommended, for a while, a complete suspension of the manufacture of the

« For training given enlisted men to qualify them as prosthetic supply clerks, see ch IV, p. 158.

«T/O & E 8-187, C 1, 24 Mar 44.

« The Medical Department of the United States Army in the World War. Washington, Government Printing Office, 1928, vol III, p. 624 (cited hereafter as The Medical Department ... in the

World War.)

** See footnote 22, p. 167.
172 DENTAL SERVICE IN WORLD WAR II

larger dental items during the war.45 In January 1943 ASF also urged all its

agencies to make maximum use of secondhand equipment.46

Superficially, the proposal to purchase the equipment of dentists entering

the service appeared to have considerable merit. The attitude of The Surgeon

General, however, was one of caution, typically expressed by Brig. Gen. C. C.

Hillman, assistant to The Surgeon General, in September 1942:

It appears to this office that medical and surgical supplies now in the possession of

civilian physicians might better be used to continue the care of the civilian population

than to be acquired for the Army. For military use a certain degree of standardization

is essential. You can well imagine the difficulties that the Medical Supply Division

would encounter if they attempted to gather up generally supplies and instruments

from civilian physicians and with them supply our military hospitals."

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

It is possible that dental units may be acquired in this manner, but the number

is questionable. The plan is an Utopian plan, but it would require more personnel

than The Surgeon General's Office has at its disposal, and in many instances [it]

would rob professional schools and recent graduates of the equipment they need in

their profession.48

Under pressure of the great need for dental equipment, however, The

Surgeon General did make an effort, beginning in the fall of 1942, to acquire

secondhand items. In October 1942 he reported that where suitable used

equipment was found it was being purchased,49 though such procurement was

certainly on a small scale, apparently by local supply officers.50 On 30 October

1942 questionnaires were sent to 3,000 new dental officers, asking if they owned

suitable equipment, and if they would sell it to the Army at a suggested price

of original cost, less 5 percent for each year of use. (Instruments were not to cost

over 80 percent of original price.) 51 Of the 3,000 officers questioned, only 496

were willing to sell any equipment. Of this latter number, only 184 had items

which the Army considered suitable. The remaining equipment was old, was

manufactured by firms which had gone out of business, or was otherwise

undesirable. It appeared that men with modern outfits were not anxious to

sell. The equipment offered was also scattered over 41 states, so that a con-

« Ltr, WPB to Col C. F. Shook, 18 Sep 42. SG : 444.4-1.

" Memo, Maj Gen Lucius D. Clay for Chiefs of Supply Services, SOS, 25 Jan 43, sub : Used equipment and supplies in the hands of jobbers, dealers, and users. SG : 400.139-1 (St. Louis Medical

Procurement District) M.

•" Ltr, Brig Gen C. C. Hillman to editor, Journal of the American Medical Association, 7 Sep 42.

SG : 400.139-1.

" 2d ind, Col C. F. Shook, on ltr 16 Sep 42, to SG from the surgeon, Camp Adair, Oregon, 1 Oct 42.

SG : 440.1 (Camp Adair) C.

49 Ltr, Col C. F. Shook to Mrs. Edna Francis, 29 Oct 42. SG :.400.139-1.

m

Formal authority to purchase used dental equipment without the usual advertising for bids was

not granted until January 1943. See Ltr, Col M. E. Griffin to CO, New York Medical Department

Procurement District, 21 Jan 43, sub : Purchase of second-hand dental equipment from dentists in

the Army. SG : 400.139-1 (St. Louis Medical Department Procurement District) M. This requirement appears to have been ignored by local purchasing agents, however.

11 Ltr, SG to all newly commissioned officers, 30 Oct 42, sub: Acquirement of dental equipment.

SG : 444.4-1.
DENTAL EQUIPMENT AND SUPPLY 173

siderable administrative organization would have been required to inspect it

and advise on acceptance or rejection.

In spite of these unfavorable developments The Surgeon General directed

medical depots, on 12 February 1943, to purchase used items when such action

seemed justified by sound business judgment.52 Kesults were poor, however,

and in April 1943 The Surgeon General reported that the amount of equipment being obtained did not justify further expenditure of time by military

personnel. He stated further that the replies to his questionnaire were being

turned over to WPB for use in its program of procurement for civilian needs.

WPB, in turn, followed up 100 offers as a test, and quickly decided to abandon

the whole project, leaving the purchase and resale of used equipment to established dealers.53 The Army-Navy Medical Procurement Office reported that

only 45 used chairs and 25 units were purchased by medical depots in 1943, and

all of these were obtained from dealers.54 It is probable that a few secondhand outfits were purchased locally, by medical supply officers of camps or

hospitals, but the number was certainly small, and played a very minor part

in meeting total requirements. By September 1943 all prospective sellers

were being referred to civilian agencies.

WPB sponsored a voluntary collection of instruments, as a test, in the

vicinity of St. Louis in October 1942, but the drive netted more scrap than

useable supplies.55

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

following:

1. Dental officers were reluctant to sell equipment without ironclad guarantees that they would be able to purchase the same or corresponding items at

the end of the war. However, World War I experience had shown that excess

dental items had not been available for sale until 2 years after demobilization

and the Army was therefore in no position to give prospective sellers the

assurance they required.

2. Much of the newer equipment offered was encumbered with liens

which so complicated purchase that the Legal Division, SGO, advised against

any attempt to procure such items.56

3. The attempt to use miscellaneous types of secondhand equipment involved serious problems of maintenance. Isolated posts could not conveniently

obtain the parts needed for the repair of older items which might break down

in use.

62 Ltr, SG to COs of all medical depots, 12 Feb 43, sub: Procurement by depots—purchase used

equipment. HD : 314 (Code R-3).

B3 See footnote 30, p. 168.

» 1st ind, Col M. E. Griffin, 3 Jun 46, on ltr, Brig Gen Thomas L. Smith to Army-Navy Medical

Procurement Office, 24 May 46, sub : Purchase of dental units and chairs. SG: 444.4-1.

K

Ltr, CO, St. Louis Medical Procurement District, to SG, 23 Oct 42. SG : 400.139-1 (St. Louis

Medical Procurement District) M. ,

66 Memo, Legal Div, SGO, for Col C. F. Shook, 1 Feb 43, sub: Purchase from Army officer of

secondhand dental chairs and equipment subject to liens. SG : 400.139-1.
174 DENTAL SERVICE IN WORLD WAR II

4. Inspection of items offered for sale involved long trips by dental officers,

and only a small proportion of the outfits offered proved suitable for purchase.

5. Used equipment was actually more expensive to the Government than

new. One officer inspecting an outfit in New York reported that the price

was reasonable by retail standards, but that the old chair would cost more than

the Army regularly paid for a new one, and that the small unit would cost

more than the quantity price for a new senior unit.57 Equipment was often

offered to the Army only because it was hoped that an even better price would

be obtained than in what soon became an inflated civilian market. Also, the

depots could not issue used items until they had been reconditioned, and such

reconditioning, with transportation charges, often cost almost as much as new

equipment.58

6. With the productive capacity of manufacturers strained to the limit

to meet military needs it was felt that the purchase of used equipment by the

Army would result in a critical shortage of items urgently needed by civilian

dentists. It was believed, further, that the sale, maintenance, and repair of

miscellaneous used equipment could better be handled by established dealers

than by the Armed Forces, and that such nonstandard items were better suited

to civilian needs, especially after the WPB stopped production of new equipment for civilian use in January 1943.

The easing of the supply situation in 1943 permitted the Medical Department to withdraw from a program which had originally been undertaken, as

an emergency measure, with strong misgivings.

Local Procurement of Dental Supplies

World War I attempts to obtain dental supplies by local purchase had not

been encouraging. The American Expeditionary Forces contracted for some

French equipment in 1918, but the French Government was soon forced to limit

sales to items totaling not over 1,000 francs per month to prevent a threatened

exhaustion of the civilian market. A considerable amount of laboratory supplies was then purchased in London, but the British War Office quickly prohibited further procurement from that source.59 It was apparent that local

markets, geared to peacetime needs, could not furnish any significant proportion of the supplies needed by a major force.

In World War II, medical supply officers in the Zone of Interior were

authorized to make emergency purchases of small items not obtainable from

medical supply depots, and this privilege was sometimes extended to include

dental units or chairs. The amount of material obtained by such means was

not an important factor in the overall supply situation in the United States.

5

' Ltr, Lt Col H. T. Marshall to SG, 14 Jan 43, sub : Purchase of secondhand dental equipment.

SG: 400.139-1.

»

s

Ltr, Brig Gen E. H. Mills to Dr. McCarthy, 29 Sep 42. SG : 444.4-1.

«»The Medical Department ... in the World War (1927), TOI II, p. 115.
DENTAL, EQUIPMENT AND SUPPLY 175

In overseas areas local purchase was restricted only by the need and by the

availability of stocks, and local procurement played a more important part in

supplying equipment required to establish initial dental installations. Cabinets, lathes, cuspidors, and angle handpieces were obtained in Australia; burs,

porcelain teeth, and acrylic resin in Palestine, and general dental supplies

through reverse lend-lease in England. The Chief Surgeon of the European

theater claimed that all the dental burs needed by the United States forces in

England in 1944 could be obtained through local purchase.60 The British Army

also loaned field chests to the United States Army units arriving in the

Middle East without dental equipment in 1942 and 1943. Supplies procured

abroad were important at a time when equipment was not plentiful, but in

general they did not go far to meet the total needs of the United States forces

overseas. Production in the less industrialized nations was often negligible,

and stocks on hand were quickly reduced to a point where civilian dental care

was threatened. In Cairo, for instance, a single representative of a United

States aircraft plant practically cleaned the shelves of the few dental supply

houses, and acrylic resin disappeared into the black market for the remainder

of the war, where it sold for approximately $20 a unit.61 Except in those rare

instances where a highly industrialized nation could assume full responsibility

for supplying one or more items, local procurement was little more than an

expensive and ineffective measure to meet emergency needs pending arrival of

standard Army supplies.

Measures to Insure ihe Maximum Use of Available Items

In April 1942 Brigadier General Huebner, AGF inspector for training,

reported that large numbers of men in the field were unable to chew the Army

ration because of dental defects.62 Since deficiencies in dental treatment at that

time were due mainly to lack of supplies, the Director of the Dental Division,

SGO, was forced to take radical action to insure full use of the limited equipment then available. He recommended that outfits in critical locations,

especially in replacementtraining centers, be used for from 15 to 24 hours a day,

by the employment of 2 or 3 shifts of dental officers.63 It is not known exactly

how many dental officers were used on night shifts during this period, but 916

additional dentists were requested at the time the system was initiated, and it

is believed that most of this number were so used, at least temporarily. The

use of double shifts could only be regarded as an emergency measure, however.

The output of dental officers at night was less than during daylight hours, the

proportion of broken appointments was nearly doubled,64 and patients were

Cable, Brig Gen Hawley to SG, 26 Oct 43. SG: 444.4-1.

« See footnote 6, p. 165.

«»Memo, Dir, Mil Pers, SOS, for SG, 27 Apr 42, sub: Dental supplies In the field. SPGAP/

10282-14 (G-l).

63 Memo, Brig Gen R. H. Mills for Exec Off, SGO, 27 Apr 42. SG : 703.1.

«Annual Report of the Medical Service, Camp Clalborne, La., 1944. HD: 319.1.
176 DENTAL SERVICE IN WORLD WAR II

tired and hard to handle after a full day's work. It was also difficult to arrange

meals and transportation for both dentists and patients at irregular hours.

The operation of multiple shifts did accomplish its primary purpose, which

was to increase the total amount of work completed in the face of a crippling

shortage of supplies.

In the field the contents of a single M. D. Chest No. 60 were often divided

so that two officers could utilize one set of equipment. One officer might devote

his time to operative procedures while the other handled extractions, gingival

diseases, and emergencies. The multiple shift system was also used to a limited

degree in some theaters until adequate supplies arrived.*5

Conservation of Scarce Supplies

Every effort was made to conserve critical items during the war. After

December 1942, dull burs were saved and returned to depots for resharpening

under contracts with civilian firms.66 Wax was collected, sterilized, and reused

in the larger laboratories, and scrap amalgam returned to depots for recovery of

the mercury and silver content. Items of rubber, brass, lead, tin, or other scarce

materials were saved for salvage.

In 1942 about 180 enlisted men were sentto dental manufacturing plants for

intensive 2-week courses in the maintenance and minor repair of dental

equipment.*7

In September 1944 The Surgeon General published a technical manual

covering the care, lubrication, and repair of dental handpieces.68

The repair of unserviceable handpieces was undertaken on a large scale.

At first it was anticipated that manufacturers would assume responsibility for

the reconstruction of their products, but they proved reluctant to use their

overburdened facilities for this purpose and the medical supply service had to

take over the program. Two shops equipped to rebuild handpieces were

established in the United States in 1944 but shortages of equipment and personnel hampered early operations so that only 3,500 handpieces were returned

to service that year. By early 1945, however, most of the previous difficulties

had been overcome and in February these shops together reconstructed a total

of 2,500 handpieces. Since only about 700 handpieces were received for repair

each month this capacity permitted a rapid reduction of the large backlog of

defective handpieces which had accumulated over the past months.69

65 In the Middle Bast theater and in England, RAF dentists sometimes used their outfits in

the mornings and early afternoons, lending them during the late afternoons and evenings to U. S.

Army Air Force dentists stationed nearby.

M

SG Ltr 176, 8 Dec 42.

67 Report of the Dental Division, SGO, for fiscal 1942. HD : 319.1-2.

«»TM 8-638, 23 Sep 44.

«»The problem of the repair of dental handpieces. Bulletin of the ü. S. Army Medical Department, 89 : 25 June 1945.
DENTAL EQUIPMENT AND SUPPLY 177

Substitution of Critical Items

The Army, like the civilian profession, made wide use of substitutes for

critical items of dental supply. Acrylic resin was substituted for vulcanite,

though this inevitable change was only hastened by the shortage of rubber.

The alginates were used in impression materials in place of scarce agar compounds. Various substitutes for tinfoil were evolved. An attempt to use

silver in place of nickel for plating instruments was unsuccessful, however, as

the coating tended to pit and was subject to attack by mercury particles. Very

early in the war diamond points were made available, to conserve dental burs.

Items of copper were almost eliminated from dental supply tables. In general, no item made of critical materials was purchased for the Dental Service

unless diligent research failed to reveal any acceptable substitute.

PACKING AND SHIPPING DENTAL SUPPLIES

General principles for the packing and shipping of dental supplies were

no different from those for other items, and the handling of dental material

offered few unique problems. Early in the war considerable breakage of heavy

equipment, especially of dental x-ray machines, was reported, but this situation

was remedied as the depots gained experience in preparing medical items for

shipment under wartime conditions.70 The handling of gold offered some difficulties. It was found that unless such materiel was placed in the custody of

a responsible ship's officer, to be delivered only to an authorized agent on

arrival, it was often "misplaced" either en route or at the docks were it was

unloaded.71

EFFECTS OF CLIMATE ON DENTAL SUPPLIES

Considering the wide variations of climate encountered by the United

States troops it is surprising that complaints of damage from extremes of

temperature were relatively few. Cements, especially the silicate cements,

set so rapidly in the hotter areas that their manipulation offered some difficulty ; when the humidity was high it was impossible to cool glass slabs to the

desired 70 degrees without precipitation of moisture. In the tropics the softer

brands of waxes and impression compounds proved unsatisfactory, but materials specifically designed for use in such areas gave no trouble. Anesthetic

solutions and x-ray film deteriorated rapidly when they could not be stored in

cool locations, necessitating care to use oldest stocks first and to avoid accumulating quantities which could not be utilized in a reasonable time.72 Small

'»For additional data on packing problems see annual reports of the Supply Division, SGO, for

fiscal years 1943 and 1944. HD : 319.1-2.

n

Personal Ltr, Dental Surgeon of the China-Burma-India theater, to Maj Gen R. H. Mills, 1 Jul 44.

This letter has been seen by the author but it was not made a permanent record.

72 See Essential Technical Medical Data Reports for China-Burma-India theater, 1943 and 1944.

HD: 350.05.
178 DENTAL SERVICE IN WORLD WAR II

carpules (ampules) of anesthetic solution were reported to be undamaged by

freezing in the Arctic, though later investigations indicated that the rubber

plugs sealing such carpules might be pushed out by exposure to extreme cold.73

In general, standard items on the supply tables proved satisfactory under any

conditions where dental treatment was practicable.

ZONE OF INTERIOR AND COMMUNICATIONS ZONE EQUIPMENT

Prior to World War I it was planned that in a mobilization only portable

equipment would be issued to dental officers, in the Zone of Interior as well

as overseas. By the fall of 1917, however, it was apparent that this policy

was not economical because dental officers could not operate as effectively

with equipment which had been designed primarily for portability as with

the more convenient chairs and units used routinely in civilian offices. Standard chairs, wall-bracket engines, cabinets, instruments, and laboratory equipment were therefore issued to all Zone of Interior training camps and to base

and general hospitals (fig. 4) ,

74 Teams of 10 dentists, with base equipment,

were also organized for use in favorable locations overseas.

Prior to World War II it was recognized that field units would require

outfits which were easily portable and could be used well forward in the combat

zone; on the other hand, it was clear that dentists outside the combat area

should not be required to use equipment designed to be set up in a tent or

dugout. It was therefore planned to provide standard base items in the Zone

of Interior and in fixed and semifixed installations in the communications zone.

(For establishments in that zone, it was expected that minor modifications,

such as substitution of a mobile engine and cuspidor for the dental unit, could

be effective.) This policy was actually carried out in the Zone of Interior,

where dentists generally worked with equipment similar to that in their own

offices. Zone of Interior camps and hospitals had units, chairs, cabinets, operating lights, x-ray machines, air compressors, and instruments which met

normal civilian standards for convenience and reliability.75 In the summer

of 1942, however, lack of shipping space became so acute that drastic restrictions were placed on equipment for overseas use.76 The large hospitals and

dispensaries of the communications zone were thereafter allowed only the

dental field chests, augmented with essential laboratory and surgical tools and

equipment,77 though many installations were later able to obtain captured base

outfits or to purchase chairs and engines locally.

« Ltr, Dr. J. Edward Gilda to Maj Ernest Fedor, 21 Jul 47. This letter was seen by the author

but not entered in permanent files.

» See footnote 43, p. 171.

75 U. S. Army Medical Department Supply Catalog, 1942.

« Personal Ltr, Brig Gen R. H. Mills to Lt Col Richard F. Thompson, 18 Jul 42. HD : 730.

« Memo, Brig Gen R. H. Mills for chm, Medical Department Sup'ply and Equipment Board, SGO,

25 Sep 43. SG : 444.4-1.
DENTAL EQUIPMENT AND SUPPLY 179

Figure If Zone of Interior dental equipment.

The primitive character of the communications zone equipment was soon

the target of much unfavorable comment. The Chief Surgeon of the European

•theater asked that hospitals and general dispensaries in his area be given

at least a minimum of base equipment.78 Another senior medical officer,

returning from an overseas inspection trip in November 1943, reported that

"Field observations and the opinions of qualified dental officers in the Southwest Pacific Area indicate the need for revision of equipment lists for fixed

installations to provide electric engines (portable), wall-bracket operating

lamps, and portable cuspidors, small type. It is recommended that the Dental

Division be consulted with reference to this matter." 79 The Dental Division

had already requested reconsideration of the restricting order in September

1943, but the recommendation had been disapproved. A new request for

authority to ship mobile dental engines, operating lights, and cuspidors overseas was now made, and this time approval was granted.80 Until then the

18 Ltr, Capt F. J. Reynolds, Overseas Supply Div, NTPOB, to SG, 2 Nov 42, sub : Dental equipment.

SG : 444.4-1.

Report of Col William Wilson on inspection trip to the Southwest Pacific theater. Quoted in :

Memorandum to the chairman, Medical Department Supply and Equipment Board from Maj Gen R. H.

Mills, 2 Nov 43. SG : 444.4-1.

80 Ltr, Capt M. H. Kannal to Overseas Supply Offleer, NYPOB, 13 Nov 43, sub: Dental equipment.

SG : 444.4-1.
180 DENTAL SERVICE IN WORLD WAR II

small amount of base equipment which had arrived overseas before enforcement of the embargo, or which had been obtained locally, had been spread very

thin, over a few important installations. Fixed and semifixed units now began

to receive items which materially increased their efficiency and output.

DENTAL FIELD EQUIPMENT

Dental Operating Chests

The basic dental field equipment issued in the First World War was bulky

and difficult to transport. It was packed in six chests, containing an engine,

a chair, a desk, instruments (two chests), and miscellaneous supplies.81 A

seventh chest containing a cuspidor was added in September 1917.82 For overseas use another five chests were added, containing an oil stove, a portable

table, a box of medicines, alcohol, and additional supplies. As delivered in

France the complete outfit occupied 39.28 cubic feet of space and weighed 775

pounds.83 Transportation of this "portable" equipment was always a problem,

and not infrequently the entire outfit had to be abandoned in a hurried move.84

In the period between World Wars I and II the dental field equipment was

considerably simplified. The Medical Supply Catalog of 1928 listed three

chests, occupying 8.7 cubic feet, and weighing 209 pounds.85 The chests contained a foot-engine, chair, and instruments and supplies. Development of a

dental field outfit which could be packed in a single, standard, Medical Department chest had been going on at the same time, however, and this same 1928

catalog listed, for the first time, the new M. D. Chest No. 60, which was essentially the item used during World War II. (Figs. 5 and 6.)

The M. D. Chest No. 60 occupied 5 cubic feet, and weighed from 157 to

187 pounds, depending upon variations in the constituent items.86 Total cost

was approximately $305. This chest contained a wood, aluminum, or steel

folding chair, a foot-engine, an alcohol sterilizer, and routine operative and

surgical instruments and supplies to a total of about 160 different items. It

contained no prosthetic equipment as such supplies were packed in other chests

not available to the smaller units. Issued to the dental officers of each tactical

command allocated dental facilities, it provided the minimum equipment

"Manual for the Medical Department, 1916, Washington, Government Printing Office, 1916 (cited

hereafter as Manual . . . Medical Department).

82 Manual . . . Medical Department, C dated 29 Sep 17.

83 See footnote 43, p. 171.

81 The Annual Report of The Surgeon General for 1919 states that "The transportation of dental

equipment and supplies has ever been a source of irritation to division commanders, transportation

officers, and division surgeons. . . . Much loss of equipment and consequent loss of dental service

in several divisions has resulted thereby. The First Division, moving into combat area in May 1918,

was forced to abandon their entire dental equipment through lack of transportation facilities. . . .

At that time it required the entire resources of our Medical Supply Depot No. 3 to resupply emergency

equipment for this division after its arrival in the new area." In Annual Report of The Surgeon General, ü. S. Army, 1919, vol II, Washington, Government Printing Office, 1920.

85 AR 40-1710, 23 Apr 28.

88 See footnote 75, p. 178.
DENTAL EQUIPMENT AND SUPPLY 181

«■■HHJpiI

|i

f - •« ••'—* -. -«*lPpFl*fIIP MB

1

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

needed for operation of a dental service where mobility was essential. When

restrictions were placed on the shipment of more elaborate outfits overseas,

Chest 60, augmented, was also supplied to general and station hospitals and

general dispensaries of the communications zone. It lacked many of the refinements which made for convenience in operation, but contained the basic

elements needed to meet routine needs in the combat zone. Patients requiring

major oral surgery or prosthetic replacements had to be sent to more fully

equipped installations, such as hospitals or mobile prosthetic teams.

Thousands of dentists who had always enjoyed every convenience in their

civilian offices soon found themselves operating with dental field chests on

tropical islands or at the edge of arctic glaciers. It is not surprising that their
182 DENTAL SERVICE IN WORLD WAR II

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

equipment was the subject of much thought and criticism. Many recommendations from the field were highly impractical, failing as they did to consider the

realities of procurement, maintenance, and transportation in time of war;

others were based on sound observation and suggested changes which were ultimately incorporated into the outfit as the war progressed.

Addition of an Electric Dental Engine. Older dentists who had operated

foot-engines had no difficulty with the engine in M. D. Chest No. 60. Younger

men mobilized in World War II had not had such experience, however, and

generally refused to use the foot-engine.87 The Dental Division resisted this

trend at first, and as late as September 1943 stated that "The addition of a small

electric engine is not recommended. It is no great hardship to operate a footengine and it can be used under most any condition. If at fixed or semifixed

installations an electric engine is considered necessary, a requisition can be

submitted for item 52530, Engine, electric, portable." 88 It was found, however,

that dental officers either used their assistants to pump the foot-engine, making

them unavailable for their normal duties, or they obtained some type of improvised motor for attachment to their engines. Shops wasted valuable time and

materials devising weird contraptions to mechanize this equipment. It was also

ST Personal knowledge of the author confirmed by numerous photographs in the files of the Signal

Corps Photographic Library. In no photograph is a dental officer shown pedaling his own foot-engine.

Dentists either improvised engines or had the assistant operate the foot-engine.

88 Memo, Dir, Dental Div, SGO, for Oprs Serv, SGO, 3 Sep 43, sub: Proposed plan for dental

service in an Armored Division. SG: 703.1.
DENTAL EQUIPMENT AND SUPPLY 183

rfound that modern warfare required electric current in a surprising number of

locations, even in the field. In March 1944 the Dental Division therefore

reversed its policy and recommended development of a motor which could be

attached to the foot-engine.89 Issue of a conversion unit for use on existing

foot-engines was authorized in November 1944.90

Addition of Operating Lamp. Dentists in the field usually had to work

under cover, often in dark buildings or tents. Natural light under such circumstances was completely inadequate for dental operations. In February

1944 the Dental Division requested development of a dental operating light

which could be packed in M. D. Chest No. 60,B1 and issue of this item was

authorized in June 1945.92 N

Reduction in Weight of M. D. Chest No. 60. Chest 60, weighing something

over 167 pounds, was too heavy to be hand-carried long distances in rough terrain or in jungles. In November 1944 a project was started to divide the contents of the field chest between two smaller containers weighing about 100

pounds each.93 Plans were being made at the same time to pack other medical

Department outfits in smaller chests, and progress on the dental equipment

was held up pending development of a basic container, so that little had been

accomplished on this development at the end of the w

Tar.94

Reduction in Weight of the Dental Field Chair. An aluminum field chair

had originally been authorized for the dental field chest, but when quantity

production was started the critical shortage of that metal forced the substitution

of steel.95 As a result the chair supplied during most of the period of hostilities

was too heavy for convenient use in a portable outfit. Aluminum did not

become available again until near the end of the war, and since the chair could

not be placed in production in time to be of much use in the current conflict

it was decided to redesign the entire item before resuming manufacture.96 This

project was commenced in October 1944, but had not been completed at the end

ofthe war.

Minor Changes in Contents of M. D. Chest No. 60. During the war a

number of minor changes were made in the contents of Chest 60. In May 1941

the old glass syringe designed for use with a fresh anesthetic solution made

from tablets was replaced with a cartridge-type syringe using prepared car88 Memo, Dir, Dental Div, SGO, for Oprs Serv, SGO, 15 Mar 44. SG : 700.2.

90 Medical Supply Catalog, ASF, C 2, Med 6, November 1944. Washington, Government Printing

Office, 1944 (cited hereafter as Medical Supply Catalog).

91 Memo, Col Eex McK. McDowell for Inspections Br, Oprs Serv, SGO, 29 Feb 44. SG : 350.05-1.

92 Medical Supply Catalog, C 5, Med 6, June 1945.

83 Ltr, Brig Gen R. W. Bliss to Dir, Medical Department Equipment Laboratory, 7 Nov 44, sub :

Item 9502500—Chest M. D. No. 60, Complete. SG: 428 (Carlisle Barracks) N.

91 Monthly Status Report on Medical Department Research and Development Projects for Period

1-31 May 1945. HD: 700.2.

E

The Corps Area Dental Surgeons' Conference. The Dental Bulletin. 13 : 254, October 1942.

96 Ltr, Brig Gen R. W. Bliss to CG, ASF, 6 Oct 44, sub: Chair, dental, field, folding—development

project on. SG : 444.4-1.

330324 0—55 13
Ifä. DENTAL SERVICE IN WORLD WAR II

pules of solution,97 making it much easier to maintain sterility of anesthetic

solutions in the field. Early in 1945 the alcohol burner for the sterilizer, for

which it had been difficult to obtain fuel, was replaced with a gasoline burner.98

A bone-file, rongeur forceps, and m-o-d matrix retainer were added at about

the same time.*9

Army Air Forces Operating Chest

In May 1944 the Army Air Force approved a special dental field chest for

use by its units. Complete, this chest weighed only 2 pounds more than the

empty M. D. Chest No. 60. Reduction in weight was accomplished partly by

using lighter materials, and partly by omitting certain heavy items, particularly the dental field chair, for which a headrest attachable to an ordinary chair

was substituted. The foot-engine was replaced with an electric dental engine.

Only 50 of these chests were produced since later modifications in the regular

Chest 60 made it better adapted to Air Force needs, and nonessential modifications of standard items were discouraged in the interests of maximum output.100

Prosthetic Field Chests

At the start of the First World War dental replacements were authorized

only for teeth lost traumatically in line of duty. Some laboratory equipment

was issued to base installations, but no field outfit was provided, and even at

Zone of Interior camps the dental surgeon had to draw teeth or gold for each

individual case. In March 1918 this policy was liberalized somewhat to

authorize the replacement, in time of war, of any teeth needed for mastication,

and thereafter a dental field laboratory set, weighing over 200 pounds, packed

in a single chest, was issued to each division.101 World War I prosthetic service

was supplied on a relatively small scale, however, and nearly three times as

many cases were completed overseas in the single month of October 1944 (35,-

657)102 as were completed in France during the entire period of hostilities in

the First World War (13,000) .

103

The World War II field laboratory set consisted of 2 chests (M. D. Chests

Nos. 61 and 62, figs. 7 and 8), which occupied 10 cubic feet of space with a

combined weight of 332 pounds. The cost of the complete outfit was about

$600. This equipment included a casting machine, a hand-operated lathe, an

assortment of teeth, and all the supplies needed for fabricating or repairing

« SG Ltr 47, 22 May 41.

»«New items of dental equipment. Army Medical Bulletin, No. 88, May 1945.

"» Ltr, Brig Gen E. W. Bliss to CG, ASF, 24 May 45, sub : Stock No. 9502500, Chest M. D. No. 60,

Complete ; Stock No. 9502600, Chest M. D. No. 61, Complete. SG : 444.4-1.

1M Memo, Col George R. Kennebeck for Plans and Services Div, Office of the Air Surgeon, 3 Jul 46.

SG: 428.

101 See footnote 84, p. 180.

182 See footnote 67 for fiscal 1945. HD: 319.1-2.

103 History of the Army Dental Corps, 1941-43, Equipment and Supply Section, p, 15. HD:

314.7-2.
DENTAL EQUIPMENT AND SUPPLY 185

the ordinary types of bridges or full or partial dentures.104 It could be set up

well forward in the combat zone where it helped dental officers reduce emergency evacuations for prosthetic treatment, but was not adequate for routine

quantity production because such conveniences as good lights, electric lathes,

handy benches, and well-arranged plaster bins could not be furnished in such an

outfit. The limited amount of expendable supplies included was also insufficient to maintain continued high output.

: *^

^tr *3t He T fäC *• l|w!'»» / /«<

* f T r y .\" i «•%

»

w*

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

The Chests 61 and 62 were at first supplied to field hospitals, evacuation

hospitals, surgical hospitals, the prosthetic teams of auxiliary surgical groups,

convalescent hospitals, general and aviation dispensaries, and to the medical

battalions of divisions. The later withdrawal of laboratory equipment from

most of these units, and its results, are discussed in the chapter on the operation

of the Dental Service overseas. The most important change in the Chests 61

and 62 was the substitution, in February 1945, of a motor-driven lathe for the

hand-driven type which required two men, working in relays, to operate. Since

it had become apparent that electricity would be available in most locations

where dental laboratories could function, the wisdom of this move was obvious.

104 See footnote 75, p. 178.
186 DENTAL SERVICE IN WORLD WAR II

35W

s

fr^»

- '* «Ä

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

Dental Pack Chests "A" and "B"

The dental pack chests contained operating equipment to meet the needs

of mounted units. The 2 chests, which occupied 6 cubic feet and weighed

less than 100 pounds, made a convenient load for 1 animal. They contained

a little over 100 items, compared with 160 items in the M. D. Chest No. 60,

but with a folding chair, foot-engine, sterilizer, and routine instruments they

could be used to perform the most common operations.105 No significant

changes were made in them during the war, but in a mechanized Army their

use obviously became more and more limited.

Dental Officer's and Assistant's Kits

The dental officer of each tactical unit was supplied 1 large shoulder

pouch, and his assistant carried 2 smaller pouches, containing instruments

for emergency use in combat when M. D. Chest No. 60 was not available. The

3 pouches were supplementary to each other, and together included items

required for the relief of pain, simple extractions, emergency treatment of

maxillofacial injuries, and temporary fillings. These kits were also useful

during the movement of large units, when regular equipment was crated, and

for that reason were frequently issued to general hospitals and other installations having base dental outfits. They were also used by dental officers serving

with ski troops or paratroops. The only important change in them was the

m

See footnote 75, p. 178.
DENTAL EQUIPMENT AND SUPPLY 187

•'<"

'• • ; ;*?/*£ * "' *^ " *" - &*

„ --'> : V>S -' • " ' ' ■■ •

.^•vr;^> •'- :v ~ ■■'■■'' .„'-V-'J?'.-^"' v "'''•;.' '••• •••'•

Figure 9. Dental offloer and assistant with field kits.
188 DENTAL SERVICE IN WORLD WAR II

replacement, in May 1941, of the glass-barrelled anesthetic syringes with

cartridge-type syringes. Contents of kits could be augmented or changed at

will to meet the individual ideas of dental officers. It was reported that very

little dental work was attempted in combat, and that dental officers often

carried kits of medical supplies in addition to, or in place of, the dental sets

(figs. 9,10, and ll).106

[0t)

\

Figure 10. Contents of dental officer's kit.

,%*-•

Maxillofacial Kit

The maxillofacial kit which provided the highly specialized instruments

needed for the care of wounds of the oral structures was designed for use by

the dental member of a maxillofacial team.107 It contained forceps, elevators,

rongeurs, chisels, hemostats, lances, wire ligatures, and anesthetic syringes.

The principal change in this set during the war was the introduction of the

cartridge-type anesthetic syringe (fig. 12).

The Mobile Dental Laboratory

(The complete story of the development of this important item is told in

a monograph by Lieutenants John B. Johnson and Graves H. Wilson.108 Much

M History of the Dental Division, Headquarters, ETOUSA, 1 Sep-31 Dec 44. HD : 319.1-2.

107 See footnote 75, p. 178. M

» Johnson, J. B., and Wilson, G. H.: History of wartime research and development of medical

field equipment. HD : 314.7-2.
DENTAL EQUIPMENT AND SUPPLY 189

16a***: 'v(

^#>i9

_ _____ __ I: f 1

ssSfn

/*

h»M_«MtatMt*w IP fc,

Figure 11. Contents of dental assistant's kit.

Figure 12. Contents of dental maxillofacial kit.
190 DENTAL SERVICE IN WORLD WAR II

of the material presented here has been taken from that monograph, and its

extensive documentation is not repeated.)

The need for improved dental laboratory facilities was based on a number

of considerations, some of which are discussed in greater detail in the chapter

on the operation of the Dental Service overseas. In brief, it was generally

agreed that prosthetic equipment had to be taken to the soldier whenever

possible, to prevent his evacuation to a rear area for the construction of dental

replacements. For tactical units this meant that laboratory service had to be

provided well forward in the combat zone, where frequent moves were necessary. The laboratory with such a unit had to be highly portable, it had to be

put in operation quickly after a move, and it had to turn out a maximum of

work in a short time when the opportunity was presented. M. D. Chests Nos.

61 and 62 were portable, but they failed to meet the other two requirements;

it took considerable time to find shelter and set them up in a new location, and

with no source of water, fuel, power, or light the only equipment which could

be used was wasteful of manpower and did not encourage the most accurate

work. Further, the two small chests could not contain enough supplies for

prolonged operation in an emergency. The Dental Division therefore recommended, as early as May 1939, that development of a more satisfactory, truckmounted outfit be initiated.109

For reasons which are not clear this project proceeded very slowly.

Approval was not granted until December 1941, and a pilot model, constructed

with the aid of $18,000 contributed by the manufacturers of precious metal

alloys, was not completed until February 1943. This model was tested in the

Tennessee maneuvers of May and June of the same year. The first delivery of

11 vehicles was made in March 1944, and distribution in foreign theaters did

not begin until near the end of 1944.

As finally adopted, the mobile dental laboratory (figs. 13 and 14) was

mounted on a 6-wheel drive, 2i/2-ton chassis, capable of maneuvering in all

but the roughest terrain. It carried a 1%-KW generator, 50-gallon water tank,

electrically heated boiling-out and curing apparatus, acetylene tanks, a folding dental chair, a dental engine, an electric lathe, a full assortment of teeth,

and all other equipment and supplies for completing or repairing ordinary

dentures or bridges. A small trailer was later supplied for carrying the

generator and other bulky equipment. It was operated by 1 officer and 3 dental

technicians, one of whom was also the driver.

Numerous improvised mobile laboratories had been placed in operation in

foreign theaters while the standard truck was being developed. Constructed

on vehicles ranging from captured German trailers to 30-passenger buses,

these units had already given valuable service, so it was no surprise that the

new trucks were highly commended from the start. A typical report was that

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

322.15-16.
DENTAL EQUIPMENT AND SUPPLY 191

Figure IS. Mobile dental laboratory.

,.. ,T

I

Figure H. Interior, mobile dental laboratory.
192 DENTAL SERVICE IN WORLD WAR II

from a division which saw combat in both North Africa and Italy, stating that

"The mobile laboratory has proved to be the only answer to the division's

prosthetic problem."110 Minor defects were reported, however, as follows:

1. While the mobile laboratory provided shelter for the operators in poor

weather it was badly crowded when the chair was set up inside for taking impressions. In practice the chair was usually set up in an adjoining building or

tent, and when time and circumstances permitted some of the laboratory equipment was removed as well.

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

3. The laboratory was tied to its vehicle, so that no transportation was

available for picking up supplies and mail, or for carrying water for the storage

tank.

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

5. The li/2-KW generator proved inadequate, and a 2%-KW model had

to be substituted.

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

authorized.

1. The small tanks of acetylene were quickly exhausted, and larger ones

had to be provided.

8. Trouble was experienced in obtaining "white gas" (i. e. without a leaded

additive) for the burners.

The most fundamental defects were those noted in "3" and "4." These

might have been eliminated by placing the laboratory in a trailer, pulled by a

truck which could also be used for other transportation. This possibility was

considered, but it was rejected because:

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

in unfavorable terrain.

2. It was feared that the truck might be commandeered in an emergency,

making it necessary to abandon the entire laboratory.111

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

areas.

A total of 107 laboratory trucks were ordered, and the last was delivered

in October 1945. It cannot be determined at this time just how many of these

units were shipped overseas, though the distribution authorized in December

1944 was as follows:

European Theater of Operations 30

Southwest Pacific Area 15

Pacific Ocean Area , 5

China-Burma-India theater 4

South Pacific Base Command 4

North African theater 2

110 Dental Service with a Division in the Army. J. Am. Dent. A. 32 : 1475-1476, Nov-Dee 45.

111 Statement of Col Rex McK. McDowell to the author, May 1946.
DENTAL EQUIPMENT AND SUPPLY 193

It has already been noted that many theaters had improvised large numbers of

mobile laboratories in addition to those standard trucks authorized by the War

Department, and it is probable that the number of these unofficial units considerably exceeded the number shipped from the Zone of Interior.

The Dental Operating Truck

(The history of the development of the dental operating truck has been

told in a monograph by Lieutenants John B. Johnson and Graves H. Wilson,

to which the reader is referred for greater detail and documentation than will

be given here.) 112

Dental operating trucks, which were not made available until near the

end of World War II, had been used to a limited extent in the First World

War. In the summer of 1917 the Cleveland Chapter of the Preparedness

League of American Dentists suggested a project for the construction of "dental

ambulances" which would be presented to the Army in the name of the Eed

Cross. Plans drawn up by the League were approved by The Surgeon General,

and the first two units presented in October 1917.113 Other chapters of the

League cooperated until contracts had been let for a total of 13 trucks, at

a unit cost of about $4,000. These dental ambulances were constructed on a

standard ambulance chassis, and contained a chair, 6-volt electric engine operated by storage batteries, cuspidor, air compressor and tank, bracket table,

sterilizer, and cabinet. Eunning water was supplied from a storage tank to

a small washbasin. The sides of the ambulance opened out and canvas flies

were available to cover additional operating space adjoining the vehicle. Four

dentists and 1 or 2 assistants could thus operate from each ambulance. Folding

chairs and field equipment were provided for the three officers who worked outside the unit.114 The World War I dental operating truck was therefore a compromise which provided efficient equipment and utilities for 1 dentist and

transported the regular equipment of 3 others.

Unfortunately, the dental ambulances constructed in the United States in

the First World War never saw service in France. A shortage of transportation held them at an American port of embarkation in spite of urgent requests

for their delivery by the dental surgeon of the AEF.115 Two dental ambulances were presented in France, however, and they were assigned to duty

with motor transport troops and with the Air Service, where they rendered

very satisfactory service. The chief surgeon of the AEF commented upon these

units as follows:lie

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

1MSee footnote 108, p. 188.

ii3 Weaver, S. M.: Standardized motor dental car and equipment. J. Am. Dent. A. 5 : 3-19, Jan

1918.

114 Ibid. See also Dental ambulances and Christmas roll call. J. Am. Dent. A. 5 : 1283-1284, Dec

1918.

115 See footnote 59, p. 174.

116 See footnote 84, p. 180.
194 DENTAL SERVICE IN WORLD WAR II

times during the campaign. . . . The use of dental ambulances with outlying commands or detachments within divisional training areas, in the rear of combat sectors,

or with the Air Service, would have proven of great value inasmuch as these mobile

units could proceed to the various localities with little loss of time, either in actual

transport or in the unpacking and repacking of equipment ordinarily required of dental

officers on itinerary dental service.

So far as is known, no effort was made to develop a standard dental operating truck in the period between World Wars I and II. When the Dental Division requested such a project in May 1939 it was rejected within the Office of

The Surgeon General, and later numerous requests for a mobile dental unit

from overseas theaters did not affect this decision. The Air Force particularly

desired such equipment, and in December 1943 it finally undertook development of a dental unit on its own initiative. Johnson and Wilson imply that

this action precipitated a sudden change of opinion in the Surgeon General's

Office. In any event the Dental Division resubmitted its recommendations;

they were approved by the SGO, submitted to the Commanding General, ASF,

and accepted as a research project by the end of the month. When the Air

Force asked for equipment for 50 dental trucks on 30 December 1943 it was

told that a standard model was already being developed, and its model was

dropped.117 The Medical Department Equipment Laboratory completed a

pilot model which was tested and accepted as a standard item by 16 March

1944. Contracts were immediately let for 35 trucks, the first of which was

delivered in October 1944.

The mobile dental clinic (figs. 15 and 16) was mounted on a 6-wheel drive,

2!/2-ton chassis, similar to the one used for the mobile laboratory. In a space

13 x 7 feet were installed a unit, chair, cabinet, sink, sterilizer, 50-gallon

water tank, hot-water heater, and an operating light. Equipment included all

items needed for extractions, operative procedures, and for taking impressions

for dentures. A 2%-KW generator supplied electric current. No x-ray machine was provided. One hundred and thirty-eight operating trucks were purchased, at a unit cost of about $9,000, including equipment. It is not known how

many trucks were actually shipped overseas, but the allotment authorized in

December 1944 was:

European Theater of Operations 33

North African theater 18

China-Burma-India theater 18

Southwest Pacific Area 15

Pacific Ocean Area 5

South Pacific Base Command 4

The standard operating truck was not available soon enough to receive extensive

testing under combat conditions and estimates of its performance are based

117 Ltr, Col Gustave E. Ledfors, Chief of Supply Div, Air Surgeon's Office, to SG, 30 Dec 43, sub :

Requirements of equipment to be installed on mobile dental units. SG : 444.4-1. See also 1st and 2d

inds to above, 30 Dec 43 and 11 Jan 44.
DENTAL. EQUIPMENT AND SUPPLY 195

K^

i.*-. " «»''«

»41it

fe^l

te:A^'

Figure 15. Mobile dental clinic.

mainly on reports on similar improvised units which had been used in almost

every theater since early in the war. There was little doubt, however, that this

item met an important need. The Director of the Dental Division stated in

1945 that "The success of the mobile operating units in the several theaters,

especially in Italy, warrants the conclusion that such units are essential to

modern warfare." On the other hand, he did not consider that the final word

had been written on the subject. He especially recommended that further

thought be given to a possible combination of a light trailer and truck.118 A

German trailer of this type had been towed by a United States unit from the

Rhine to Pilsen in Czechoslovakia, behind no more powerful a vehicle than a

weapons carrier. If practical, a trailer clinic would not tie up transportation

needed to carry supplies and would not have to be closed down when the truck

needed repairs or maintenance. It would also be unnecessary for the dental

operating team to drive a 2%-ton truck to pick up mail or supplies. The objections to the use of a trailer are the same as those enumerated for the laboratory

truck; decreased maneuverability and the danger of losing the prime mover in

an emergency if it were detachable from the operating equipment.

"» See footnote 21, p. 167.
196 DENTAL SERVICE IN WORLD WAR II

*

Jr.--..-'-.;" '.""

Figure 16. Interior mobile dental clinic.

In spite of the fact that it was not accepted for production, the operating

truck developed by the Air Force was believed by officers of that organization

to have certain features which should be considered in designing new models.

Some of these features were:

1. Provision of a few laboratory items forsimple acrylic repairs.

2. Use of a pressure-type water tank located under the body, where it was

easily accessible, rather than the gravity-type tank which had to be mounted

on the roof.

3. Installation of the unit at floor level instead of about 6 inches above

the general floor level, as was necessary in the 2y2-ton truck body.

4. More window space, better natural lighting.

Nonstandard Impression Chests

Units equipped only with the dental field chest had no supplies for taking

impressions for prosthetic appliances. Normally, prosthetic patients could be

transferred to nearby hospitals for this service, but in some circumstances such a

procedure meant the loss of a man to his organization for extended periods. To

meet this situation the dental surgeon of the European theater assembled chests
DENTAL EQUIPMENT AND SUPPLY 197

containing materials and equipment for taking impressions and pouring models

which could in turn be sent to a central dental laboratory. A chest would be

loaned to an organization for a week or two at a time, and when all prosthetic

cases had been cleaned up the chest was returned to a depot for replacement of

missing or damaged items and for issue to another unit. Later in the war the

mobile laboratory units were often able to bring prosthetic service to these

isolated organizations, and the improvised impression chests never became a

standard item of issue. At the time they were devised, however, they filled a

definite need.

THE DENTAL WARD CART

In hospital practice it was often necessary to provide dental care at the

bedside of patients. Personnel who were bedridden for considerable periods

of time frequently required definitive treatment which could not be provided

with a few instruments carried in a tray, and dentists improvised carts to

carry the more essential equipment from patient to patient and from ward

to ward. Some of the more elaborate outfits carried a dental engine, operating lamp, sterilizer, air compressor and spray bottles, and drawers of instruments and supplies for most operative and oral surgical procedures. These

improvised carts proved so efficient that a project for their development as a

standard item was authorized in May 1945.119 This project was of course not

completed before the end of hostilities, but the standard ward cart promised

to add to the comfort of patients and the convenience of operators as soon

as it should become available.

SUMMARY

Experience in dental supply problems during World War II emphasized

the following points:

1. In an emergency calling for the mobilization of many millions of men

and thousands of dentists, requirements for dental equipment and supplies

will far exceed normal peacetime needs. At the same time production will

be hampered by shortages of manpower and materials, and imports are

likely to be cut off. Adequate production of such essential items as burs

should be insured in advance, and some control of distribution established

to prevent such irresponsible buying, by both civilians and the military, as

increased the demand for burs from 33 million a year before the war to nearly

100 million in 1943. To insure that minimum needs of the population will

be met, plans to stop the production of any item, such as operating units,

as nonessential, should be considered carefully and cautiously before being

adopted; in many cases it will actually be necessary to increase production

to meet new military requirements. It is possible of course, that new types

«• See footnote 94, p. 183.
198 DENTAL SERVICE IN WORLD WAR II

of warfare will eliminate mass mobilizations, and hence reduce military needs;

it is also possible that the manufacture of dental supplies could become one

of the casualties of a war for survival. It must be noted, however, that

treatment received by the American public in peacetime is far from adequate,

and any further reduction, even in time of war, would have serious results

which should be weighed carefully before deciding to cut the production

of items used by dentists.

2. Availability of supplies and equipment may well prove to be the factor

which will determine the rate of mobilization of dental facilities in an emergency. Nothing will be gained by taking dentists on active duty to stand

idle at their camps because they have no handpieces or chairs. The procurement of dental supplies in sufficient quantities will therefore be one of the

first responsibilities of officials directing the establishment of an emergency

Dental Service.

3. A considerable amount of dental equipment in the hands of civilian

dentists will become idle when they are taken into the Armed Forces in a

mobilization. It is possible that such equipment will have to be purchased

or leased for the military. The individual purchase of thousands of outfits,

of widely varying types and degrees of serviceability, is in itself no small

problem, however, and the cost of using secondhand equipment will generally

exceed the cost of purchasing new items. It should not be assumed that large

quantities of dental supplies will be available from civilian sources until test

projects have shown that such is actually the case.

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

5. Convenient and complete dental equipment should be supplied as far

forward in the theater of operations as is consistent with the operational

situation. Mobile operating and laboratory units will make it possible to

provide efficient equipment within easy reach of the fighting men.

6. In major moves dentists should not be separated from their equipment

if their outfits can possibly be forwarded as personal or unit baggage. Too

many dentists spent from 1 to 4 months in idleness after their arrival overseas

in World War II because their field chests had been shipped on different

vessels or in different convoys.
r

CHAPTER VI

Operation of the Dental Service—General Considerations

DENTAL STANDARDS FOR MILITARY SERVICE

In time of peace the Army tends to establish physical standards for

military service which cannot be maintained in time of emergency. This

policy is not inconsistent since it ensures that time and money will not be

wasted in training poor physical specimens, but when these rigid standards

are carried over into a general mobilization difficulties may result.

The dental standards for full military duty which were in effect at the

end of the First World War were not significantly altered prior to World

War II. The early Mobilization Eegulations (MK 1-9, dated 31 August

1940) which established the physical criteria to be used by Selective Service

in time of emergency, prescribed dental requirements which were substantially the same as those published in AE 40-105 for the Kegular Army in time

of peace. Section VII of these regulations reads as follows:

DENTAL REQUIREMENTS

31. Classes 1-A and 1-B.—a. Class 1-A. (1) Normal teeth and gums.

(2) A minimum of 3 serviceable natural masticating teeth above and three below

opposing and three serviceable natural incisors above and three below opposing.

(Therefore the minimum requirements consist of a total of 6 masticating teeth and 6

incisor teeth.) All of these teeth must be so opposed as to serve the purpose of

incision and mastication.

(3) Definitions.

(a) The term "masticating teeth" includes molar and bicuspid teeth and the

term "incisors" includes incisor and cuspid teeth.

(&) A natural tooth which is carious (one with a cavity), which can be restored

by filling, is to be considered a serviceable natural tooth.

(c) Teeth which have been restored by crowns or dummies attached to bridgework, if well placed will be considered as serviceable natural teeth when the

history and appearance of these teeth are such as to clearly warrant such

assumption.

6. Glass 1-B. Insufficient teeth to qualify for class 1-A, if corrected by suitable

dentures.

32. Class 4.—a. Irremediable disease of the gums of such severity as to interfere

seriously with useful vocation in civil life.

&. Serious disease of the jaw which is not easily remediable and which is likely

to incapacitate the registrant for satisfactory performance of general or limited

military service.

c. Extensive focal infection with multiple periapical abscess, the correction of

which would require protracted hospitalization and incapacity.

d. Extensive irremediable caries.

330324 O—55 14
200 DENTAL SERVICE IN WORLD WAR II

(Note: Class I-A was acceptable for full military duty, class I-B was eligible only for

limited duty, and class IV was rejected for any military service. No registrants found

acceptable for limited service were called for military service prior to July 1942. )*

These regulations did not specify whether or not teeth replaced on removable

bridges would be counted as serviceable natural teeth, and this point was not

made clear until March 1941, when Selective Service Medical Circular No. 2

provided that either fixed or removable bridges were acceptable if supported at

least in part by the remaining teeth.2

When the preceding regulation was published the United States was still

more than a year from actual participation in the war. The partial mobilization then in progress was for training purposes only, and fairly strict physical

standards were necessary to avoid waste of effort in the instruction of men who

might later prove unfit for military service. However, the Dental Division

did not expect the criteria of the prewar MK 1-9 to apply in case of actual conflict, for as early as May 1941 Brig. Gen. Leigh C. Fairbank, Director of the

Dental Division, stated:

It is estimated that a large percentage of men, inducted into the Army in the operation of a compulsory draft law, would require extensive dental replacements. The

men of military age today will certainly show the [effects of] lack of dental care during

the depression years. This condition must not be permitted to constitute a disqualifying factor. . . . However great our desire to maintain high dental standards for

military service, we must realize that the safety of our nation depends on trained

manpower. If the situation at present indicates a lowered state of dental health among

those of military age, we must provide the means for adequate dental service to correct the dental health of drafted men. The entire plan for dental service in time

of mobilization has been revised to meet the conditions which we are certain will exist

in every Army camp.3

The number of men actually disqualified for dental reasons under ME 1-9

far exceeded all expectations. About 8.8 percent of the registrants examined

during the period from November 1940 through September 1941 could not

qualify for general service. About one-third of these disqualified registrants

were classified as IV-F, namely, as totally unfit for military service, and the

remainder as I-B, fit for limited service only.4Since no registrants with limited service qualification were called for military service during this period,

the 8.8 percent was the actual disqualification rate for dental reasons. In

addition to those registrants who were disqualified for strictly dental conditions (8.8 percent), about 0.4 percent of the examined registrants were rejected

by the local boards for serious pathology of the mouth or gums, and while

1 Teeth, month, and gum defects of men physically examined through the Selective Service System, 1940-1944, 28 Dec 45, p. 11. Natl Hq, Selective Service System.

2 Medical Circular No. 2, Dental, 28 Mar 41; Natl Hq, Selective Service System.

3

Fairbank, L. C.: Prosthetic dental service for the Army in peace and war. J. Am. Dent. A, 28 :

798-802, May 1941.

4 Causes of rejections and Incidence of defects, Medical Statistics Bulletin No. 2, 1 Aug 43, pp.

6 and 9. Natl Hq, Selective Service System.
OPERATION OF THE DENTAL SERVICE 201

the proportion disqualified by the induction stations for such pathology is not

known it is apparent that about 1 of each 11 registrants examined was disqualified at that time for military service because of dental or oral diseases.

These disqualification rates refer to rejections where the dental defects were

the principal disqualifying cause. It should be noted, however, that in establishing the disqualification rates, only one disqualifying reason was given as

the cause of rejection. Obviously, whenever there was more than one disqualifying defect, an order of precedence was followed in determining the

principal disqualifying cause. In this respect, dental defects had a low priority. Therefore, if it were assumed that the frequency of disqualifying dental

defects was the same among the registrants who were disqualified for reasons

other than dental, it seems that about 1 out of 8 examined registrants would

have failed to meet the early dental standards for general service.

During 1940 and 1941, when 89 percent of all dental rejections were made

by local boards, dental and oral disqualifications by these boards were based on

the following specific conditions:5

Defects of the teeth:

Percentage of all dental rejections

Total White Negro

Missing teeth, replaced by dentures 23.1 23.8 6.3

Missing teeth, no dentures 64.0 63.6 73.6

Excessive caries 10.0 9.7 16.1

Other defects of the teeth 2.9 2.9 4.0

Percentage of all oral rejections

Defects of the mouth and gums: Total white Negro

Periodontoclasia 71.7 71.4 73.8

Gingivitis 5.1 4.7 8.2

Congenital defects, lips and palate 8.6 9.6 1.6

Other defects of the mouth and gums 14.6 14.3 16.4

For a year and a half after the early MR 1-9 (1 August 1940) was published, changes in dental standards were relatively unimportant. In October

1940 the War Department directed that the provisions of ME 1-9 which had

previously applied only to inductees would thereafter also constitute the physical standard for voluntary enlistment in the Regular Army and the National

Guard.6In March 1941 both Selective Service and the Office of The Surgeon

General published circulars of interpretation directing that (1) the specified

minimum number of teeth were required to be in occlusion only during movements of the mandible, as long as there was no impingement on soft tissues

while the jaw was at rest, (2) missing teeth replaced by either a fixed or removable bridge could be counted as serviceable teeth if at least part of the stress of

mastication was carried by the remaining natural teeth, (3) teeth with pyorrhea

» See footnote 1, p. 200.

« WD Clr 110, 4 Oct 40.
202 DENTAL SERVICE IN WORLD WAR II

pockets would be considered unserviceable if the pockets involved the bifurcation of multirooted teeth or the apical third of single-rooted teeth, and (4)

teeth with caries involving the pulp would be considered unserviceable.7 8In

May 1941 dental requirements for officers of the Medical Department Reserve

and the Chaplains' Reserve were relaxed to authorize commissioning of men

with less than the minimum 12 teeth if the missing teeth were replaced by full

or partial dentures.9

After Pearl Harbor it was apparent that the manpower needed to fight

a global war could be obtained only if dental standards for induction were

drastically relaxed. The War Department and Selective Service therefore

directed, in February 1942, that pending revision of MR 1-9 the following

would be acceptable for general military service:10 n

Registrants who lack the required number of teeth as set forth in paragraph 31a,

Mobilization Regulations 1-9, 31 August 1940, when, in the opinion of the examining

physician, they are well nourished, of good musculature, are free of gross dental

infections, and have sufficient teeth (natural or artificial) to subsist on the Army

ration.

This modification, interpreted literally, temporarily authorized the induction

of edentulous individuals provided they had procured the necessary dental

replacements.

The revised MR 1-912 which was published 15 March 1942 provided for

acceptance for general military duty:

Individuals who are well nourished, of good musculature, are free from gross dental

infections, and have the following minimum requirements:

1. In the upper jaw—Edentulous, if corrected or correctible by a full denture.

2. In the lower jaw—A minimum of a sufficient number of natural teeth in proper

position and condition to stabilize or support a partial denture which can be removed

and replaced by the individual and which is retained by means of clasps, with or

without rests, to stabilize or support the denture.

Malocclusion was a cause for rejection only when it interfered with the individual's health or resulted in damage to the soft tissues. Registrants with less

than the required number of natural teeth were to be placed in Class I-B, for

limited military service, if the condition was correctible by the construction

of dentures. In April 194213these revised standards were made applicable to

graduates of officer candidate schools and, after October 1942,14 applied to

Reserve and National Guard officers.

7

See footnote 2, p. 200.

8

SG Ltr 26, 28 Mar 41.

8

SG Ltr 39, 5 May 41.

10 Memo, Dir, Selective Service System, for all State Directors, No. 1-372, 13 Feb 42, sub: Revised

physical standards. Natl Hq, Selective Service System.

" WD Cir 43, 12 Feb 42.

" MR 1-9, 15 Mar 42.

13 WD Cir 126, 26 Apr 42.

"AR 40-105, 14 Oct 42.
OPERATION OF THE DENTAL SERVICE 203

In a further revision of MR 1-9 in October 1942, dental requirements for

induction were practically eliminated.18 Thereafter the prospective inductee

needed only "at least an edentulous upper jaw and/or an edentulous lower jaw,

corrected or correctible by a full denture or dentures." No dental conditions

were thereafter to warrant classification for limited service, and the only disqualifying dental defects were "diseases of the jaws and associated structures

which are irremediable or not easily remedied, or which are likely to incapacitate the individual for the satisfactory performance of military duty" or "extensive loss of oral tissue in an amount that would prevent replacement of missing

teeth by a satisfactory denture." The effects of the relaxed dental standards

soon became evident. The available statistics for 1942 (beginning with April)

indicate that the disqualification rate for dental reason during that year was

around 1 percent. It decreased from 2.9 percent in April 1942 to about 0.1

percent in December 1942.16 In 1953, the disqualification rate for dental defects

fluctuated around 0.1 percent, and it remained practically at that level for the

remainder of World War II.17 Selective Service Headquarters estimated that

out of 4,828,000 registrants aged 18-37 who were still classified as IV-F on

1 August 1945, 36,000 registrants were so classified because of dental defects.

An additional 12,500 registrants were disqualified by mouth and gum defects.

In other words, according to this estimate defects of the teeth accounted for

0.7 percent of the IV-F category, and mouth and gum defects accounted for

another 0.3 percent, together amounting to 1.0 percent of the entire IV-F class.

These data refer to the entire period since the enactment of the 1940 Selective

Service Act.18

At the end of hostilities higher dental standards were still maintained for

commission in the Regular Army, for divers, for cadets, and for airborne duty;

other components, including flying personnel, were subject only to the relaxed

provisions of MR 1-9.

Selective Service Regulations of World War II did not at first provide for

dentists to serve on induction boards, but the mounting importance of dental

defects as a cause for rejection, plus the fact that many men accepted by the

local boards were subsequently disqualified at induction stations, led to the decision in March 1941 to include dentists in the local and advisory boards whenever feasible.19 By 7 December 1941,8,040 dentists had been officially appointed

to this voluntary duty,20 and a Selective Service memorandum of 1 August

1941 noted that dentists were then available on all local boards.21 After Febru15 MK 1-9, 15 Oct 42.

16 Unpublished data from the Medical Statistics Division, SGO.

17 Induction Data, Results of Examination of Selectees at Induction Station, during 1943, Army

Service Forces, Office of The Surgeon General, Medical Statistics Division.

" Medical Statistics Bulletin No. 4, Natl Hq, Selective Service System, Table 4.

18 Selective Service Regulations, vol. I, sec V, amendment 12 to par 134. In Selective Service

Regulations, 23 Sep 40 to 1 Feb 42. Washington, Government Printing Office, 1944.

20 Camalier, C. W.: Preparedness and war activities of the American Dental Association. J. Am.

Dent. A. 33 : 84, 1 Jan 46.

21 Memo, Dir, Selective Service System, for all State Directors, 1 Aug 41, sub: Dental examination.

Natl Hq, Selective Service System.
204 DENTAL SERVICE IN WORLD WAR II

ary 1942 local boards limited their dental examinations to a gross screening

for obviously disqualifying pathology.22 The more detailed examination necessary to chart all defects and finally determine eligibility for military service

wasthereafter carried out at Army induction stations.23

MISSION AND CAPABILITIES OF THE DENTAL SERVICE

At the start of World War II, available information on the dental condition of young adults of military age was at best fragmentary and often

contradictory. Though studies on the dental needs of the civilian population had been conducted by various agencies,24 25 2e 27 w

these had been restricted

to small segments of the population which were not representative because

of age, economic status, or geographical distribution. No governmental

or private agency had attempted the nationwide examination of hundreds

of thousands of persons from all income, age, and racial groups, both urban

and rural, which alone could have given a complete picture of the dental

needs of the American public. However, the one conclusion accepted by all

researchers was that the dental attention received by the average citizen

during the preceding decade had been anything but adequate. The reasons

for this inadequacy were not primarily the concern of the Armed Forces, but

since the dental care of the average inductee had not been sufficient to prevent

the steady accumulation of serious, preventable dental defects, this accumulation

materially complicated the problems of the Army Dental Service during the

emergency. Thus in formulating a policy for the dental care of military

personnel, the Dental Service had a choice of one of three principal alternatives.

First, it might have continued to furnish only such treatment as the average

inductee had received in civilian life. Sporadic attention of this type, limited

very often to the relief of intolerable conditions, was being provided the American public with a ratio of only 1 dentist for each 1,850 persons, including

infants and the aged.29 The Dental Corps could have supplied such symptomatic treatment without serious difficulty.

22 See footnote 10, p. 202.

23 Though induction stations operated under Army supervision they were often staffed with

contract civilian medical and dental personnel.

24 Beck, D. F.: Costs of dental care for adults under specific clinical conditions. Under the

auspices of the Soeio-economics Committee of the American College of Dentists. .Lancaster, Lancaster

Press Inc., 1943.

25 Walls, R. M.; Lewis, S. R., and Dollar, M. L.: A study of the dental needs of adults in the

United States. Chicago, American Dental Association, Economics Committee, 1941.

26 Collins, S. D.: Frequency of dental service among 9,000 families, based on nationwide periodic

canvasses, 1928-31. Pub. Health Rep. 54 : 629, Apr 1939.

27 Dollar, M. L: Dental needs and the cost of dental care in the United States. 111. Dent. J. 14:

185-199, May 1945.

28 Klein, H., and Palmer, C. E.: The dental problem of elementary school children. Milbank Mem.

Fund Quart. 16 : 281, Jul 1938.

28 O'Rourke, J. T.: An analysis of the personnel resources of the dental profession. J. Am.

Dent. A. 30: 1002, 1 Jul 45.
OPERATION OF THE DENTAL SERVICE 205

Unfortunately, such a low standard of dental health was not acceptable

for military personnel. The civilian whose health was being undermined by

oral sepsis might conceivably follow his normal sedentary pursuits without

noticeable inconvenience, but in the Army he had to function at top efficiency

under the most adverse conditions, and disease which would reduce his physical

endurance or cause him to be lost to his unit at a critical time, had to be

eliminated. Moreover, the soldier had to be able to masticate any rough food

which might be available in the field. Disregarding all humanitarian considerations, the Army could expect the most effective service from inductees

only if their oral health was maintained at a much higher level than was

common in civilian life.

As a second alternative, the Dental Service might have provided only such

regular annual care as was essential to prevent further deterioration of the

soldier's dental health, ignoring old defects except when treatment became

urgently necessary for the relief of pain. It had been estimated, on the basis

of the ADA study of 1940, that 267,000 dentists, or a ratio of 1 dentist for each

493 persons, would be able to furnish such attention for the civilian population.30 This figure was of course not directly applicable to the military

population, but it is certain that all regular maintenance care could have been

provided Army personnel with the authorized ratio of 1 officer for each 500

men. However, this policy was undesirable because the average inductee as

he was received in the Armed Forces was dentally unfit for military service

even if the development of new defects could be checked. In addition, it was

open to all the objections discussed in the preceding paragraph.

The remaining alternative was for the Dental Service to undertake the

complete dental rehabilitation of every inductee, providing not only annual

maintenance care, but correcting as far as possible the old defects which had

resulted from earlier neglect. In view of the demand for top physical condition in military personnel this was the only objective which could be accepted,

but based on fundamental considerations of available dental personnel and

supply, it was necessarily a long-term project, not to be achieved in a few

months, or even in a year.

The first goal of the Army Dental Service was to correct conditions which

might cause a man to become a dental casualty, adversely affect his health, or

result in further serious damage to dental structures. The precedence for this

care was determined by the following dental classification:31

Classification Treatment required

Class I Extractions, other treatment urgently needed for the relief

of pain or the maintenance of health.

Class I-D Replacement of missing teeth for the necessary restoration

of function.

30 See footnote 27, p. 204.

31 AR 40-510, 31 Jul 42.
206 DENTAL SERVICE IN WORLD WAR II

Classification Treatment required

Class II Fillings or other routine, preventive care.

Class III Replacement of missing teeth not urgently required for the

restoration of function. Care for chronic conditions.

Class IV No treatment required.

Though this classification gave some indication of the amount of treatment

needed, the information was qualitative rather than quantitative; a man in

Class II might have one carious tooth, or a dozen. Nor did it indicate all the

types of work required; a single individual might have defects coming under

three or more groupings, but only the most urgent classification was reported.

Furthermore, different camps reported widely varying dental classification,

indicating a lack of uniformity in application of the specified criteria.

Sample surveys of men arriving at three large replacement training centers

at different periods from 1942 through 1945 show that they fell into approximately the following categories. These figures are given in round numbers

because the available statistics do not justify more detailed conclusions:32

Class I 15 percent

Class I-D 5 percent

Class II 40 percent

Class III and IV (combined) ' 40 percent

It must be noted, however, that a large proportion of the men in Class I eventually required prosthetic replacements; similarly the men in Classes I and I-D

often required routine fillings as well.

Treatment was normally rendered while the soldier was in training, and,

in any event had to be completed before his departure for an active theater.33

After urgent work was taken care of the next objective was to provide men

destined for a combat area as much routine treatment as possible. By the

latter part of 1943 one major theater was able to report that 85 percent of

new replacements were in Class IV, requiring no dental attention.34

The final goal of the Dental Service was to provide all essential treatment

for every soldier, no matter where located. The extent to which this objective

was attained is difficult to determine. It is known that the number of men

needing the most urgent types of treatment, including the construction of dentures, was reduced from 20 percent on entry into the service to 3 percent

at time of discharge; the number requiring routine care was correspondingly

reduced from 40 percent to 14 percent.35 These figures fail completely to

reveal the actual improvement in dental health, however, since the man who

32 Calculations based on unpublished data in the files of the Dental Division, SGO, covering the

initial classifications of 25,000 men examined at Ft. Sill, Oka., in 1944 and 1945 ; 5,884 men examined

at Ft. Meade, Md., in Jan. 1945 ; and 5,000 men examined at Camp Robinson, Ark., in 1942. Obviously

a high proportion of these men came from the states in which the incidence of caries was low.

33 Preparation for overseas movement, 1 Aug 43. HD : 370.5-1.

34 History of the Dental Corps in the Southwest Pacific Area, World War II. HD: 314.7 (Southwest Pacific). 35 See footnote 32, above. The dental classification of separatees was calculated on data covering 12,000 men discharged at Ft. Dix, N. J., in 1946.
OPERATION OF THE DENTAL SERVICE 207

entered the Army with 10 carious teeth and left it with 1 small cavity

detected at the time of examination for discharge, would still be recorded as

"needing routine treatment," and statistically no change in his dental condition would be noted. It is probable that many of the dischargees listed as

still needing dental care fell in this category, but pending a study of individual induction and separation records, it is possible to say only that the

average soldier returned to civilian life in much better condition than when

he left it.

PERSONS AUTHORIZED TO RECEIVE DENTAL CARE

Military Personnel

During World War II dental treatment was authorized on an equal basis

and without cost for all Army personnel on active duty without respect to rank

or component.30 At least once a year, and usually more often, members of

each organization were examined in a "dental survey" and placed in the appropriate category as listed on pages 205-206. First priority was given to emergency conditions; other personnel, beginning with those in Class I, were treated

in accordance with their classification established on the survey. Eetired personnel were authorized dental care when facilities were available, but total

requirements for this group were so small that they were a negligible factor

in planning the Dental Service.

Civilian Dependents

Prior to the war, dependents of military personnel were authorized dental

treatment in Army clinics. Most of this treatment was maintenance care for

persons receiving fairly regular attention, but it accounted for about 25 percent

of all work completed by the Dental Corps.37 To have continued this type

of treatment for the dependents of the millions of men being taken into the

Armed Forces for the emergency would have required a minimum of 5,000

additional dentists, with equipment and housing, at a time when both manpower and supplies were critically short. The Dental Division therefore

recommended that treatment for Army dependents be limited to the care of

emergencies, and then only when such care would not interfere with the

treatment of military personnel.38

However, enforcement of the limitations on dental care for dependents

sometimes led to considerable embarrassment for dental officers. The Dental

Division had recommended that only "emergency care for the actual relief

of .pain1'' be authorized, and the application of even this provision would

probably have required the exercise of a great deal of tact. But through

36 For a detailed list of persons entitled to dental treatment see AR 40-505, 1 Sep 42.

«Summary of dental attendance (Dental Corps, Ü. S. Army, 1939). Dental Bulletin, supp.

to Army Medical Bulletin 11: 128, Jul 1940.

38 Memo, Brig Gen Leigh C. Fairbank for Exec Off, SGO, 8 Oct 40. SG: 337.-1.
208 DENTAL SERVICE IN WORLD WAR II

error or intent the published directive merely provided for "emergency

treatment," leaving a loophole for strong and continuous pressure for all

kinds of care.39 A wife who lost a bridge-facing on the day before a dinner

party had no trouble in convincing herself that hers was an emergency situation, and patients demanded, and sometimes received, permanent fillings,

denture repairs, and even the replacement of missing teeth. Some contended

that dental care was authorized by Army regulations and that it could not

be denied by an emergency directive, but the Legal Division of the SGO decided that medical attention for dependents was "a matter of discretion and

not a matter of right."40

Even with the above defect rigid application of the directive would

have eliminated almost all dental work for dependents since it also prohibited such care when it would interfere with the treatment of military

personnel, and very rarely could it honestly be said that any work for dependents would not be at the expense of the troops. But the dental surgeon

who tried to refuse civilian dental care on this basis sometimes found that he

did not have the support of either the surgeon or the commanding officer.

He could legally enforce the restriction, but such action frequently had to

be taken on his own responsibility and against the fairly clear wishes of the

superiors who made out his efficiency reports, assigned his duties, and approved or disapproved recommendations for promotion. This situation was

understandable since officers outside the Dental Service seldom understood

the time-consuming nature of dental work. Few realized that the request to

"just take a look at this tooth" usually meant at least a half-hour lost from

a busy day. Only the dentist knew that in spite of his best efforts some of

his men would leave for combat areas with uncorrected dental defects, and

that every minute devoted to nonmilitary personnel was taken from a soldier.

But the knowledge that he was in the right was very little consolation to a

dental officer who had to enforce a regulation which was unpopular with his

immediate superiors.

In spite of these deficiencies, the directive against wartime treatment

of dependents accomplished its primary purpose fairly well. Only 1.4 percent of all care rendered during 1942-1945, inclusive, went to nonmilitary

personnel, and much of that to civilian employees overseas.41 Its principal

defect was ambiguity; a flat prohibition against any care for dependents was

enforceable, but a compromise attempt to provide only a little treatment was

not. The very fact that only 2 or 3 percent of dependents received any

3

» Ltr. TAG to CGs all CAs and Depts and COs of Exempted Stas, 14 Jan 41, sub : Dental service

during the national emergency. AG : 703.1.

» Memo, Lt B. R. Taylor, Legal Div, SGO, for Col McDowell, 25 Jan 45, sub : Dental attendance

for dependents of military personnel. SG : 703.

41 Data on the treatment of civilians assembled by author from data in the files of the Dental

Division, SGO.
OPERATION OF THE DENTAL SERVICE 209

dental care at all is in itself evidence that dental surgeons could not provide

even the minimal authorized treatment on an equitable basis. The dentist

was forced to select a very few patients from the hundreds needing attention,

and under such circumstances charges of favoritism were inevitable. Dependents of overseas personnel who had no one to support their requests for

assistance, and dependents of men in the lower grades, who could least afford

to pay for civilian dental care, generally fared worst of all.

The few dependents who received the scanty treatment authorized were

seldom satisfied, while the majority who did not, felt that they had been

arbitrarily denied a valuable privilege because they lacked influence or because the dentist was lazy. Wives of Army personnel published lurid accounts of the "run-around" they had experienced, describing graphically how

they had waited all day for consultation, only to be told to come back the

following day. The net result of this attempt to do just a little work for

dependents was inadequate treatment for a very few, and widespread ill will

for the Medical Department and the Dental Corps. It appears that a complete suspension of treatment for dependents during the emergency would

have been fairest to all concerned and would have created less bad feeling

than the temporizing policy actually in effect. The Navy has successfully

enforced such a policy for many years, in peace as well as in war.42

Civilian Employees and Associated Personnel

Dental care for civilian employees of the War Department in the continental United States was limited to emergency treatment for the relief of

pain until definitive care could be provided by a civilian dentist.43 Overseas, however, where satisfactory dental attention could not be obtained from

nonmilitary agencies, the Army had to assume responsibility for the dental

care of its civilian specialists. Under these conditions, civilian employees

were authorized the same treatment as soldiers, without cost.44 Eed Cross

personnel in the United States, where civilian facilities were available, were

authorized dental care only when hospitalized and when such dental treatment was an essential part of therapy.45 In no case was replacement of

42 Statements concerning defects in the policy regarding dental treatment for dependents are very

hard to document. Those who received no treatment had no legal basis for complaint, and those

who received more than emergency care did not court publicity, for obvious reasons. The author

gained personal knowledge of this problem while serving as dental surgeon of two large ZI posts.

Most of the facts stated were also common knowledge among dental officers.

43 Policy in respect to dental treatment for civilian employees in the ZI was published by 1st ind,

SG on Ltr, CG, 9th SvC, to SG, 5 Mar 43. Both the original letter and indorsement have been

lost, but the latter is quoted verbatim in History of the Army Denal Corps, 1941-43, Professional Sec,

p. 42. HD: 314.7-2 (Dental).

44 Ltr, SecWar to SG, 14 Sep 42, sub : Medical attention for civilians on foreign military missions.

SG: 703.1.

« 1st ind, TAG, 3 Oct 42, on Ltr, TAG from CO, Sta Hosp, Ft. Lewis, Wash. 21 Sep 42, Bub :

Dental treatment for Eed Cross personnel. SG : 703.1 (Ft. Lewis) N.
210 DENTAL SERVICE IN WORLD WAR II

missing teeth permitted. Overseas, Red Cross personnel were entitled to

all types of dental care without cost.46

AUTHORIZED DENTAL TREATMENT

Extent of Authorized Treatment

In deciding what care should be provided military personnel, the Dental

Divisjon had to compromise between what was theoretically desirable and what

was possible with the maximum resources available. Such operations as the

replacement of single missing teeth with fixed bridgework, the treatment of

pulpless teeth, the restoration of anteriors with porcelain jacket crowns, and

the construction of full-cast, precision-attachment partial dentures could of

course be defended as good dentistry, but the expenditure of time on such

procedures could not be justified while other soldiers suffered from oral sepsis

or were threatened with the loss of additional teeth from rapidly progressing

caries. It was therefore necessary to limit the care provided by following the

principle of "the greatest good for the greatest number," with primary attention to those conditions which affected the health of the individual or which

would resultin permanent damage if neglected.

In 1940 the United States was not involved in actual hostilities, and it was

expected that inductees would return to civilian life after one year of training.

Also, these inductees were required to meet minimum standards of dental health

before they were called to active duty. The Dental Division therefore felt that

it was both unnecessary and unwise to attempt, in a short time, the complete

dental rehabilitation of every individual entering the service in a temporary

status. In October 1940 the attitude of the Director of the Dental Division

was expressed as follows:47

Under no circumstances is it believed desirable to set up a policy requiring that every

man drafted into the Army receive complete dental attention to place him in class

IV. . . . It is believed that it is only right that we should adopt a policy that any

Reserve Officer or draftee or National Guard personnel in the Army for a period of one

year's training is not to receive dental service replacing teeth lost prior to his entrance

into the military service, except in the case of dental pathology involving other teeth

or oral tissue where the replacement is necessary to maintain health. In other words,

a man who has been able to carry on his business or hold a job in civilian life with

46 Authority for the outpatient dental care of Red Cross personnel overseas has proved impossible

to document. Such treatment was obviously essential and to the personal knowledge of the author

who served in two theaters, it was rendered without question, but flies of The Adjutant General or The

Surgeon General fail to reveal any clear-cut reference to the subject. In a telephone interview of 21

August 47, Miss Jeanette Ross of the Insular and Foreign Hospital Service, -National Headquarters,

Red Cross, stated that it was her understanding that Red Cross employees were authorized hospitalization under AR 40-590, that 40-505 approved medical attention for anyone hospitalized under 40-590,

and that AR 40-510 in turn provided for dental attendance for anyone hospitalized under AR 40-505.

If strictly interpreted, however, even this complicated series of regulations does not specifically

authorize outpatient dental care for Red Cross personnel overseas. It appears that this was a situation where no formal objection was ever raised or a specific directive published.

" See footnote 38, p. 207.
OPERATION OF THE DENTAL SERVICE 211

his mouth in a neglected state cannot and should not anticipate that a complete and

perfect dental service will be given him in the Army, placing his mouth in perfect

condition when he would not have gone to the expense to secure such service had he

remained in civilian life.

On the basis of this opinion, The Surgeon General recommended to The

Adjutant General that dental attendance for temporary personnel be limited to

the treatment of emergency conditions, the filling of cavities with routine materials, and the replacement of teeth lost in the performance of duty or as a

necessary part of treatment.48 The Adjutant General disapproved this recommendation, however, because it was against "War Department policy to distinguish in any way between temporary and permanent personnel.49 The

Surgeon General then agreed to make the proposed restrictions applicable to

all Army personnel50and the following policy was published by the Office of

The Adjutant General (AGO) on 14 January 1941:61

a. Dental attendance for all military personnel will be confined to the treatment of

emergency cases, infectious conditions, and the restoration of carious teeth with amalgam, silicate, or cement fillings, except as provided in & below.

&. Replacement of missing teeth will not be made, except when teeth were damaged

or lost in the performance of duty, while engaged in athletic games, or as a necessary

part of treatment. Such replacements will be the standard type of partial or full

dentures provided for Army personnel.

c. Dental attendance for dependents will be limited to emergency treatment. Such

treatment will interfere in no instance with the routine dental treatment of military

personnel.

With the lowering of dental standards in February 1942, large numbers

of men entered the service whose teeth did not meet minimum requirements for

health, and it became necessary to remove some of the restrictions against the

construction of dentures. On 8 April 1942 the Director of the Dental Division

recommended that subparagraph (b) of the aforementioned letter be amended

to read as follows:52

Replacement of missing teeth for military personnel will be made when in the opinion of the dental surgeon it is necessary from a health or functional standpoint; that

is, insufficient natural or artificial teeth to satisfactorily masticate the Army ration.

Such replacements will be the standard type of full or partial dentures provided in

the Army, except that anterior teeth lost in line of duty may be replaced by fixed

bridgework when in the opinion of the dental surgeon it is advisable. This type of

replacement is to be kept at a minimum consistent with the best interests of the Government and the individual.

This change was published verbatim in an AGO letter of 25 April 1942.53

48 Ltr, Exec Off, SGO, to TAG, 30 Nov 40, sub: Dental service during the national emergency.

SG: 703.1.

191st Ind, 26 Dec 40, TAG on ltr cited In footnote 48, p. 211.

» 2d Ind, 3 Jan 41, SG on ltr cited In footnote 48, p. 211.

« See footnote 39, p. 208.

« Memo, Brig Gen R. H. Mills for Gen McAfee, 8 Apr 42. SG : 703.-1.

M Ltr, TAG to CGs all CAs and Depts, COs of Exempted Stas, 25 Apr 42, sub: Dental service

during and for six months after the war. AG : 703.1.
212 DENTAL SERVICE IN WORLD WAR II

Limitations on the construction of fixed bridges were still further liberalized by a War Department directive of March 1945 providing that "A fixed

bridge may be inserted in the anterior segment, in limited cases, as a morale or

functional factor in those instances where extraction has caused a disfiguring

space." Bi

Under the terms of War Department policy every soldier was authorized

all the care necessary to preserve dental health, though the single missing tooth

of one patient would not be replaced as long as other men had insufficient teeth

for proper mastication, nor would an inlay be supplied at an expenditure of

time that might better be used to save several teeth with standard amalgam

fillings.

Quality of Treatment Rendered

Though expensive and time-consuming operations were not authorized

when simpler procedures would be effective, the Dental Division consistently

demanded that treatment rendered in Army dental clinics be of the highest

quality. This policy was partly altruistic in that it was felt that the soldier

was entitled to care at least as good as he would receive in civilian life; it was

partly selfish because it was believed that work of high quality would prove

most economical of both time and money. The attitude of the Dental Division

was expressed in the Army Medical Bulletin as follows:55

There is no substitute for quality in the service rendered the soldier by the Army

Dental Corps. The Dental Division has on many occasions emphasized that, above

all, quality and not quantity is the real objective of the dental service in every hospital, camp or post. There are times and situations which demand an extended effort

on the part of the dental officer to complete a certain assignment, but regardless of

the circumstances, the dental service cannot afford to be jeopardized by permitting

inferior work to leave the dental clinic.

Only standard, high-grade materials were furnished dental clinics, and

gold was available when the more common items were not satisfactory. Dentures were normally made of acrylic resin, with gold bars and clasps when required. No charge was made for Special materials or treatment, and the practice

of having military personnel pay civilian laboratory costs, except in extreme

emergency, was specifically prohibited.56 Surgical procedures were carried out

by qualified personnel with due attention to asepsis, and the incidence of infections following oral surgery was very small.57 Officers with special qualifications were also designated as prosthodontists in all the larger installations.

Teeth which could be saved in a healthy condition were not extracted, and the

54 TB Med 148, Mar 1945.

M Dental service-accepted procedures no experimentation. Bulletin of the U. S. Army Medical

Department 82 : 20, Nov 1944 (cited hereafter as Army Medical Bulletin).

M Ltr, SG to CGs, SvCs, 26 Nov 42, sub : Prosthetic dental appliances. SG : 703.1.

" Control of dental infections. Army Medical Bulletin 69 : 33, Oct 1943.
OPERATION OF THE DENTAL SERVICE 213

number of teeth replaced during the war exceeded the number lost.58 Liberal

use of protective bases under deep fillings was encouraged, but very little rootcanal treatment was attempted, both because of the time required and because

of the risk that a later acute infection might incapacitate the soldier when he

could not get dental care. Only a limited amount of porcelain work was done,

though anterior jacket crowns were routinely provided after the acrylic resins

became available.

With the exception of hygienists and x-ray technicians, only officers of the

Dental Corps were permitted to work on patients at the chair. Army regulations provided that in the absence of a dental officer, medical officers might

render dental care "to the extent that their training and skill justify," but such

treatment was very rarely given.59 It was specifically directed that "except as

otherwise prescribed ... the selection of professional procedures to be followed in each case, including the use of special dental materials, will be left

to the judgement of the dental officer concerned." 60

It was especially directed that the soldier would not be used as a guinea pig

for testing untried procedures.61

Of the 15,000 dentists on duty there were inevitably a few who failed to

attain expected standards. There were also a few who mistakenly tried to set

records for quantities of work completed, without due regard for quality. As

these situations came to the attention of higher authority, men of the first type

were placed under responsible supervision or relieved from duty; those of

the second were informed that high production, without quality, was not the

route to advancementin the Dental Corps.

But while the quality of Army dentistry was generally satisfactory, the

amount supplied during the first part of the war was the subject of some critical

comment. Due to supply difficulties, and to the enormous accumulation of untreated defects in the civilian population, the Dental Service had to defer a

considerable amount of elective treatment during the period of rapid mobilization, before dental facilities reached peak strength. The Director of the Dental

Division admitted that:62

The Army Dental Corps has accepted the most momentous job in the history of dentistry, since one man in every four, when inducted, is in a dental state which requires

emergency treatment. . . . Time is the biggest handicap since men must be ready

and trained in a few months. Then, about three out of every four boys had little

dental attention prior to entrance into the service, and about one-half rarely went to

M Exact figures on the number of teeth replaced are not available, but If the reasonable assumption Is made that an average of 8 teeth were replaced by each partial denture, a total of

18,000,000 teeth were supplied soldiers from Jan 1942 through Äug 1945. In the same period

15,000,000 teeth were extracted.

" See footnote 31, p. 205.

«° Ibid. 61 Accepted dental therapeutics and procedures. Army Medical Bulletin 69: 14, Oct 1943.

« 1st ind, SG, 10 Oct 43, on Ltr, Mrs. Walter R. Agard to Gen George C. Marshall, 29 Sep 43.

SG: 703.1.
214 DENTAL SERVICE IN WOULD WAR II

the dentist. ... It is humanly impossible to complete all of the dental work for all

of the inductees.

This statement should not be interpreted to mean that the dental health of

military personnel suffered because of their induction into the Army. It merely

confirms the knowledge acquired during the World War II period that, in the

event of any future mobilization, the Dental Service should not promise the

complete dental rehabilitation of every soldier until it has adequate information

on the dental needs of inductees, and on the factors which may affect its own

ability to mobilize a large number of dentists in a limited time.

The Dental Corps was also accused of being more interested in extracting

than saving teeth. This impression was probably gained during mobilization

when the first objective was to make men fit for military duties, necessitating

the extraction of large numbers of septic or nonrestorable teeth. As any dentist

or physician knows, the worst dental infections, chronic in nature, are often

painless, and it is easy to understand how soldiers might assume that symptomless teeth had needlessly been extracted. One criticism which came to the

attention of The Surgeon General was answered as follows:6S

It is the opinion of this office that Dr. . . . has not been correctly informed as to

the constructive dentistry now being accomplished by the Dental Corps. ... A ratio

of approximately 27 permanent fillings to every tooth extracted was established during

the month (May 1942). The dental reports for the armed forces for the month of May

show that conservative constructive dentistry is carried out in every Army dental

clinic. Since the lowering of dental requirements for inductees has been in effect, an

enormous amount of work has devolved upon the Dental Corps, and many of the men

now being inducted into the military establishment present oral conditions which

require extensive treatment, and the extraction of many badly broken down teeth.

Qualified civilian dental consultants reported that in general the treatment

rendered in the Army met the accepted standards of the American dental profession. The editor of the Journal of the American Dental Association stated

in April 1944 that:64

... a beneficial result from the preventive and corrective dental program now in

operation in the Army and Navy will be that an enormous number of men heretofore

dentally deficient will be rehabilitated for military service and a large percentage of

them will return from war in improved physical condition as a result of improvement

in dental health.

The attitude of enlisted men toward the dental service was not as favorable

as the quality of the treatment rendered seemed to justify. In October 1942,

5,538 enlisted men in the AGF and AAF answered questions concerning the

medical and dental service as follows:65

88 Ltr, SG to Hon. Clyde L. Herring, 20 Jul 42. SG : 703.-1.

M

Is the Dental Corps meeting its obligations to the Armed Forces? J. Am. Dent. A. 31: 537-540,

Apr 1944.

65 Attitude of enlisted men toward medical, dental, and hospital services, among white enlisted

men forming a cross section of Ground Forces and Air Forces, 2 Nov 42. Research Div, Office of

Armed Forces Information and Education.
OPERATION OF THE DENTAL SERVICE 215

Question: "Do you think good medical (dental) care is provided by the Army?"

MedicaL

Dental _ _

Yes No

Can't

decide No reply

percent percent percent percent

80 5 14 1

68 9 19 4

Question-' "Do you think Army dentists try as hard as civilian dentists to keep from

hurting their patients?"

Can't

Yes No decide No reply

percent percent percent percent

44 27 24 5

Question: "Do Army dentists prefer to pull teeth rather than fill them?"

Can't

Yes No decide No reply

percent percent percent percent

22 45 31 2

Later surveys in England and Alaska showed an even smaller percentage

completely satisfied with the dental service, though in all of these studies except

the one listed previously the dental service was preferred over the medical

service.66 67 Some of this dissatisfaction was based on general discontent and

the normal tendency of the soldier to "gripe." Much of it was based on hearsay

rather than personal experience for the percentage who thought that the dental

service was good was much higher among men who had actually been patients.

Nevertheless, too many enlisted patients had grave doubts concerning the Army

dentist's use of the forceps and his humanitarian qualities. More detailed

analysis of specific complaints showed that most men felt the end results of

treatment were excellent, but they apparently believed that the military practitioner lacked a personal interest in his patient, that he tended to be rough,

and thatit was sometimes hard to get desired care.

The enlisted patient, lacking the professional knowledge on which to base

an informed evaluation of his dental treatment, attached an understandable

importance to details which the dental officer considered unimportant. The

dentist tended to regard the patient as "another Class II," to be rehabilitated

as rapidly as possible, with a minimum of nonessential conversation or explanation ; the patient, on the other hand, felt that the situation called for a more

sympathetic attitude. There is every evidence that conscientious, careful treatment was the rule in Army dental installations, but it also seems certain that

the patient was not made to realize this clearly. Since the soldier's whole

attitude toward the Army may be colored by his opinion of the medical care

M European Survey No. 17, Dec 1943, of a cross section of men in lettered infantry companies

in a division in training in England. Research Div, Office of Armed Forces Information and

Education.

" Report No. 12, Morale Services Division, Research Unit, Headquarters, Alaskan Department,

Aug 1944. Research Div, Office of Armed Forces Information and Education.

330324 0—55 15
216 DENTAL SERVICE IN WORLD WAR II

he receives, it seems that this factor should be given attention in the event of

a future mobilization.

THE PROSTHETIC SERVICE IN WORLD WAR II

Period Prior to World War II

Prior to the First World War, military personnel were expected to have

sufficient teeth for mastication when they entered the service. If replacements

later became necessary they had to be obtained by the individual. Regulations

published in 1916 authorized restorations at Government expense. This, however, applied only to those individuals whose teeth had been lost by traumatic

injury in line of duty. Prior approval of a department surgeon or of The

Surgeon General was required in each instance and materials had to be obtained

by special request to a medical supply depot.68

With the entry of the United States into the First World War, however,

large numbers of men in poor dental condition were drafted into the Army and

more adequate provision had to be made for the construction of prosthetic

appliances. After May 191769complete laboratory equipment was issued to

the larger installations. In October 1917 The Surgeon General authorized

dental officers in base hospitals, general hospitals, and certain larger camps, to

repair bridges or dentures for men originally accepted with these appliances

and to construct new restorations for soldiers for whom such work was considered essential by a regimental surgeon or dental surgeon. In March 1918 this

regulation was further liberalized to permit the replacement, in time of war

only, of any teeth essential to mastication. In time of peace, restoration was

still to be restricted to teeth lost by traumatic injury in line of duty.

After March 1919 teeth lost otherwise than by traumatic injury in line

of duty could also be replaced by the Army but no gold or other precious

metals could be expended on these appliances.70 In October 1920 it was provided that gold could be used for:71

Replacements for teeth lost by traumatic injury in line of duty, in peace or war.

Partial dentures requiring gold clasps for their retention.

Repair of crowns or bridges which were originally necessary to establish eligibility

of an enlisted man for entry into the service.

Routine inlays, crowns, or bridges for officers and nurses and for enlisted men with

at least 5 years service.

Finally, in 1925, the use of any prosthetic material was authorized for

any person entitled to receive dental care at Government expense, including

the dependents of military personnel.72

68 Manual for the Medical Department. Washington, Government Printing Office, 1916, p. 261.

89 The Medical Department of the United States Army in the World War. Washington, Government Printing Office, 1928, vol III, p. 611 (cited hereafter as The Medical Department ... In the

World War).

70 SG Ltr 126, 6 Mar 19.

« SG Ltr 129, 27 Oct 20.

" SG Ltr 9, 6 Feb 25.
OPERATION OF THE DENTAL SERVICE 217

Prior to 1927, prosthetic appliances for soldiers were generally completed

by small laboratories in the individual station dental clinics. In these a single

assistant often worked on cases under construction whenever he could be

spared from other duties. The dental officer commonly had to exercise close

supervision over all procedures even if he was not required to do the work

personally. Very little organization was possible and technicians were expected to perform all operations, yet men sufficiently skilled to pour up impressions, set teeth, fabricate gold skeletons, and polish the completed dentures

were seldom attracted by the wages offered in the Army. As a result, dental

officers wasted much time and effort in work which the civilian dentist routinely delegated to trained auxiliary personnel.

In 1927 central dental laboratories (CDL) were established at the Army

Medical Center, Walter Reed General Hospital; Letterman General Hospital; and the Station Hospital, Fort Sam Houston.73 During calendar year

1933 another was installed at Corozal in the Panama Canal Zone, but the

laboratory at Fort Sam Houston was closed for lack of personnel while the

one at Letterman General Hospital produced only 38 cases.74 At the end

of fiscal year 1935 only the Army Medical Center CDL remained in effective

operation.75 At the same time, however, it was announced that a plan for

expanding central dental laboratory facilities was under consideration. By

the end of fiscal year 1937 the CDL at Fort Sam Houston was again functioning and another had been established at Fort Clayton in the Panama Canal

Zone. On 16 March 1938 The Surgeon General announced a general plan

for initiating central dental laboratory service on a large scale76and a War

Department circular of 16 September 1938 stated further that CDL's would

be established in Washington, D. C.; Atlanta, Ga.; St. Louis, Mo.; San Antonio, Tex.; and San Francisco, Calif.77 By January 1939 all the new CDL's

were in operation except the one at St. Louis, completion of which was delayed until July.7879 Two subcentral laboratories were also established—at

Beaumont General Hospital in El Paso, Tex., and at Fitzsimons General Hospital in Denver, Colo.80

All the CDL's except the one in Washington functioned under the control

of the respective corps area commanders, but personnel were assigned by The

Surgeon General and it was specifically provided that technicians would not

"Annual Eeport of The Surgeon General, U. S. Army, 1927. Washington, Government Printing Office, 1927, p. 241 (cited hereafter as Annual Eeport . . . Surgeon General).

"Annual Report . . . Surgeon General, 1934. Washington, Government Printing Office, 1934,

p. 163.

"Annual Eeport . . . Surgeon General, 1935. Washington, Government Printing Office, 1935,

p. 156.

SG Ltr 9, 16 Mar 38.

« WD Cir 53, 16 Sep 38.

18 Central dental laboratories. The Dental Bulletin, supp. to The Army Medical Bulletin 10:

30, Jan 1939.

Ibid.

»Annual Eeport . . . Surgeon General, 1939. Washington, Government Printing Office, 1939,

p. 200.
218 DENTAL SERVICE IN WORLD WAR II

be used for other duties except in case of urgent emergency. The standard

allotment of personnel was set at 2 officers, 1 staff sergeant, 1 sergeant, 2

privates first class, and 2 privates. Extra men and higher ratings were authorized for the CDL at the Army Medical Center, where vitallium cases

were constructed.81

By the beginning of World War II a central dental laboratory system

had thus become well established.

Policies Concerning the Provision of Prosthetic Treatment, World War II

Another major problem which confronted the Dental Service in World

War II was the determination of the extent to which it should attempt to provide prosthetic appliances for inductees. Previously this question had been

left to the judgment of individual officers, but with the enormous increase in

requirements incident to mobilization a more definite policy was necessary.

The first directive on this subject was issued by the AGO in January 1941. At

that time inductees were expected to be in the Army for only one year, and

they were required to meet at least minimum dental standards at the time they

entered training. The Dental Division, SGO, felt that it was neither feasible

nor necessary to undertake the complete rehabilitation of almost a million men

a year when it was expected that most of them would revert to civilian status

almost as soon as treatment could be completed. Therefore, the amount of

prosthetic treatment to be rendered was limited by the order of 14 January

1941 (see page 211, subparagraph b).

By April 1942 the situation had changed radically. The United States

was in the war, inductees were in the Army for the "duration," and dental

standards for induction had been lowered to admit men who would require

extensive replacements before they could perform their military duties. To

meet these new conditions a more liberal dental care policy was established by

AGO directive of 25 April 1942 (see page 211) and a subsequent War Department directive of March 1945 (see page 212) .

!2 M

For all practical purposes, the interpretation of these directives was again

left to the individual dentist. An attempt was generally made to apply the

peacetime standard for enlistment which provided that a man with less than 3

posterior teeth above and below in occlusion, and 3 anteriors above and below in

occlusion, was not fitted for service. However, one meeting these minimum

requirements might actually be a dental cripple. Also the decision in any

doubtful case might depend to a considerable degree upon intangible personal

factors. One man would wear a denture which was necessary only to preserve

the health of the remaining teeth; another would not. One would feel the need

of a replacement when only a few teeth were missing; another would wear an

81 SG Ltr 1, 2 Jan 40.

82 See footnote 53, p. 211.

»See footnote 54, p. 212.
OPERATION OF THE DENTAL SERVICE 219

appliance only after all his posterior teeth and most of his anteriors had been

lost. An SGO circular letter of 22 June 1943 attempted to clarify the situation,

but after calling attention to certain fundamental considerations it left the principal responsibility just where it had been before, on the individual dental

officer.84 No rigid formula was found to be universally applicable in World

War II and it is doubtful if any fixed standard could ever prove entirely

satisfactory.

In view of the difficulty in determining which cases should receive dental

replacements it is not surprising that military personnel were sometimes furnished dentures which subsequently rested in a barracks bag or footlocker.

One separation center reported that about 1 percent of the men discharged

after less than 6 months' service were classified "I-D" (needing prosthetic

appliances) but were found, on investigation, to have been provided replacements which they were not wearing. Of the men discharged after more than 6

months' service approximately 4i/2 percent neglected to wear the dentures

which had been supplied them.85 If we accept the estimate that 10 percent

of all military personnel had been provided with dentures, the findings of this

separation center indicate that some 40 percent of those for whom appliances

had been constructed did not wear them. This figure is admittedly based on a

small sample and must be considered highly tenuous; the actual proportion may

have been much smaller. But is cannot be said that the dentures which were

not worn were "unnecessary" since in most cases their use would have prevented further damage to mouths already partly crippled.

Experience has shown, however, that the policy of relative liberality in

authorizing dental replacements, applied reasonably, was in the best interest

of all concerned even though some men undoubtedly failed to wear the dentures

provided them. The great benefit to the large number who did, justified the

extra effort involved. Further, the knowledge that teeth lost would subsequently be replaced, instilled in the soldier a greater confidence in the efforts

of the Dental Service.

Requirements for Prosthetic Service

as Revealed by Wartime Experience

During the period of hostilities (1942-1945 inclusive) 109 dentures, 32

denture repairs, and 8 bridges were completed each year for each 1,000 men.

This average rate was far from constant, however, and actual yearly output

from 1938 through 1945 varied as follows:M 87 88

M SG Ltr 114, 22 Jun 43. *„.,.,„.

»

B

Information on 7,469 men separated at an unspecified separation center from Nov 1944 through

16 Mar 45. Given to Lt Col John C. Brauer by Maj Gen Robert H. Mills, 27 Mar 45. SG : 703.

8« Figures from 1938-40 taken from annual reports of The Surgeon General for those years.

«Data for 1941-43 taken from: A history of The Army Dental Corps, 1941-1943, Professional

Service Section. HD: 314.7-2 (Dental).

ss Figures for 1944-45 calculated by author from data in the files of the Dental Division, bttU.
220 DENTAL SERVICE IN WORLD WAR II

Prosthetic Operations per 1,000 Men Per Year

Dentures

Year Dentures repaired Bridges

1938 36.6 12.1 7.2

1939 41.9 13.8 6.7

1940 26.1 9.1 4.8

1941 14.1 5.1 2.2

1942 45.4 12.6 3.6

1943 125.0 23.8 5.8

1944 , 129.6 40.0 11.3

1945 96.1 40.0 13.1

The cited figures cannot be interpreted to mean that the need for prosthetic appliances was low in 1940, 1941, and 1942, and high in 1943, 1944,

and 1945. The small output of 1941-1942 represented inadequate capacity,

which in turn was due mainly to lack of equipment and trained technicians.

With the start of mobilization in 1940 the laboratories were unable to increase their facilities to keep pace with the increase in the strength of the Army,

and production did not again reach even the per capita rates of 1938-1939

until 1942. In this same period very few bridges were constructed since only

the more urgent cases could be handled and the proportion of full dentures

to partial dentures was much higher than in the later years of the war.

Improvements in the supply and personnel situation in 1943 made it

possible for the prosthetic service to meet current needs and also to start

reduction of the accumulated backlog of prosthetic treatment, so that the per

capita output of dental appliances reached a figure many times that of the

prewar average. At the same time, the number of bridges constructed increased rapidly and the proportion of partial dentures to full dentures approximately doubled, showing that less urgent cases were receiving attention.

By 1945, the backlog of treatment accumulated earlier in the war had been

substantially depleted and the demand for new dentures began to fall off.

[Requirements for denture repairs remained high, however, due to the large

number of appliances in use, and the high proportion of bridges constructed

showed that more optional treatment was being provided as the need for

urgent replacements diminished. Unfortunately, pending a detailed study

of individual medical records there is no way to break down the preceding

figures into requirements for initial rehabilitation and requirements for annual maintenance care.

During the war about 2,566,000 dentures were constructed for military

personnel.89 Since 38 percent of all patients received 2 appliances, about

1,860,000 patients were given dentures. If there had been no replacement

of broken, lost, or unsatisfactory prostheses, this would have meant that 19

percent of all soldiers wore artificial replacements. The Dental Division ac89 Information compiled by author from monthly reports of dental service on file in the Dental

Division, SGO.
OPERATION OF THE DENTAL SERVICE 221

tually estimated that 15 percent of all military personnel wore prosthetic

devices,90 but since loss and breakage were inevitably high under wartime

conditions, it seems probable that the proportion of men wearing dentures

at any one time was somewhat less than that estimated. If 50 percent of all

dentures were replaced during the war, the proportion of soldiers wearing

these would have been closer to 10 percent, a figure which corresponds

more closely with the few available reports from tactical units.

Of the appliances constructed for one group of 107,542 patients in 1943,

17.0 percent were full uppers, 7.4 percent full lowers, 37.5 percent partial

uppers, and 38.1 percent partial lowers.91 Thirty-eight percent of all patients

required more than one appliance. These figures were accumulated early

in the war, however, and the later trend was toward fewer full dentures and

more partial dentures. During 1942, the proportion of partial dentures to

full dentures was 2.1;92later a more liberal attitude was adopted and in

January 1944, 4.4 partial dentures were being supplied for each full denture.93

The average ratio over the 4 years 1942-1945 was 3.5 partial replacements

for each full denture.94

The evidence of World War II experience was clear on one point: During

a mobilization the need for prosthetic service may be expected to increase

out of all proportion to the increase in the strength of the Army. From the

end of 1940 to the end of 1943 the strength of the Army increased by about

1,105 percent;95during the same period the number of prosthetic cases completed per month increased nearly 5,600 percent, or 5.1 times the increase in

the strength of the Army. The number of dentures supplied each 1,000 men

in 1944 was 3.5 times the number supplied in 1938.96 Though some increase

had been expected because of lowered dental standards, it certainly was not

foreseen that a thousand inductees would require approximately four times

as many prosthetic appliances as an equal number of men in the peacetime

establishment.

Professional Standards of the Prosthetic Service

Certain "luxury" types of denture service, such as full-cast gold appliances,

cast-base full dentures, and those involving the use of special attachments were

obviously out of place in the wartime prosthetic service. However, every effort

was made to provide soldiers with replacements which met the standards of

ethical civilian practice. Materials employed were of the highest quality and

included all of the commonly accepted types. The usual partial denture was

constructed on an acrylic resin base, with assembled gold clasps and a gold

» Final Ept for ASF, Logistics in World War II. HD: 319.1-2 (Dental).

M

See footnote 87, p. 219.

83 Army reveals data on denture construction. J. Am. Dent. A. 15 Aug 45, p. 1080.

83 Ibid. M Calculation by author from monthly reports in the files of the Dental Division, SGO.

95 Strength of the Army, 1 Mar 46. M Calculation by author from monthly reports in the files of the Dental Division, SGO.
222 DENTAL SERVICE IN WORLD WAR II

lingual bar. Cast gold and vitallium dentures were available when no other

materials would be satisfactory, though their use was kept to a minimum.

Little ceramic work was done in Army laboratories but acrylic resin was used

in the construction of crowns and bridges when indicated. Whenever possible,

specially skilled dentists were put in charge of the prosthetic service, and laboratories operated under the close supervision of full-time dental officers. Each

model sent to a laboratory was surveyed and the necessary replacement designed

by a dentist before being turned over to a technician.

No attempt was made to prescribe any uniform technique for taking impressions or constructing dentures. So long as acceptable standards were

maintained each dental officer was free to use the methods with which he was

familiar. However, inferior models and registrations were sometimes received

in the laboratories, and certain generally recognized requirements were therefore established by directives published in July 1943 and March 1945.Sr 98 These

did not state hoio results were to be attained, but did prescribe certain essential

objectives (e. g. all full denture impressions to be muscle-trimmed, relations to

be taken with well-fitted bite rims, etc.).

Prosthetic consultants reported that in general the dentures constructed

by the Army met all requirements for health, comfort, function, and appearance. In isolated instances, however, the overwhelming demand for prosthetic

service and the need for completing cases in a limited period resulted in the

adoption of methods which left much to be desired. Such practices as the use

of acrylic resin in place of gold lingual bars, the use of one-armed clasps,

and soldering clasps on the same model which was later to be used for vulcanization were rare, but sufficiently frequent to warrant some criticism." Dentures

were occasionally inserted before the ridges had become reasonably stabilized

after extractions, though the dental surgeon usually had no choice but to supply

a replacement to a soldier who would soon leave for an active theater, even

when he was certain that the appliance would have a short useful life.100

Since these difficulties were due in large part to such factors as inadequate dental

care for the civilian population and inability to obtain equipment during the

early part of the war, it is surprising that they were not more common. On

the other hand, the fact that they existed, even temporarily, emphasized the

importance of planning for an extensive prosthetic service from the start of

any future mobilization.

From 1 January 1942 until the end of August 1945, the prosthetic service

completed the following operations for military personnel:101

« SG Ltr 128, 17 Jul 43.

"• See footnote 54, p. 212.

9

" Personal knowledge of the author who was successively the dental surgeon of a replacement

training center, an overseas theater, and a large permanent post In the ZI.

1M Memo, Col Eex McK. McDowell for Exec Off, SGO, 18 Jan 44. SG : 703.-1.

M1 Information assembled by the author from monthly reports in the files of the Dental Division,

SGO.
OPERATION OF THE DENTAL SERVICE 223

Dentures 2, 566,000

Denture repairs 743,000

Bridges 206,500

About 800,000 of the above operations were carried out overseas. An additional

10,300 full dentures, 35,500 partial dentures, and 16,600 denture repairs, were

completed for prisoners and nonmilitary personnel.

REFUSAL OF DENTAL TREATMENT

No soldier could refuse dental treatment if failure to correct the dental

defect could normally be expected to interfere with the efficient performance

of his military duties. A "War Department General Order of 31 January 1942

provided that:102

In time of war if a person in the military service refuses to submit to dental or

surgical operations or dental, surgical or medical diagnostic procedures or dental or

medical treatment, such person will be examined by a board of three, medical officers

convened by a corps area or department commander or a commander of a base or general

hospital or a commanding officer of any post, camp, or station where there are four

or more officers of the Medical Department on duty. If, in the opinion of the board,

the operation or diagnostic procedure or medical or dental treatment advised is necessary to enable such person to perform properly his military duties and will normally

have such effect, and he persists in his refusal after being notified of the findings of

the board, he may be tried by court martial.

In practice, it was seldom necessary to apply the provisions of this order, but

it recognized that a soldier had no right to maintain a condition which might

damage his health or make him unavailable in some future emergency.

"QUOTA" DENTISTRY

A persistent problem of the Dental Service during the first part of the war

was the tendency of dental surgeons to prescribe daily quotas of operations to

be performed by their subordinates. The plans proposed ranged from a simple

requirement that each dental officer complete from 10 to 30 fillings a day, to

ingenious schemes under which the dentist received "points" of credit for each

different operation, with a minimum total established for the day's work. The

pressure on the dental clinics, especially in the camps which were preparing

men for duty overseas, was so formidable that it is not surprising that heads of

clinics sometimes fell back on desperate measures to speed treatment. The

Dental Division did not minimize the need for maximum output of all clinics,

but the defects of any quota system were so serious that all such plans were

disapproved individually and in principle. Among these defects the following

were most important:

io2 WD GO 8, 31 Jan 42.
224 DENTAL SERVICE IN WORLD WAR II

1. The dentist who produced superior work was made to appear inferior

to the careless operator.

2. Dentists varied greatly in the speed with which they normally operated.

If a moderate quota was set the fast operator might reduce his output, feeling

that he was expected to accomplish no more than the prescribed average. The

slow operator could increase his speed only at the expense of quality.

3. When too high quotas were established the conscientious dental officer,

who required no spur, became discouraged and apathetic. The lazy operator

could easily take refuge in such practices as falsifying records, selecting only

the smallest cavities for attention, polishing old fillings to make them appear

new, and generally doing slipshod work.

The Dental Division wanted to handle the question of quota dentistry with

as little publicity as possible and no specific prohibition against it was ever

published, but repeated statements of policy in respect to "quality versus quantity" could have left no doubt of its official position. The War Service Committee of the American Dental Association reported in November 1944 that:103

It was called to the attention of the committee that, in some Army (and Navy)

installations, certain dental officers were required to perform services under a "speedup" system. These complaints were presented to officials of the armed services in

Washington, who stated that they would be thoroughly investigated and, if such practices did exist, they would be discontinued. The officials further stated that this was

not the policy of the Corps, which was to encourage quality and not quantity dentistry,

and thatthey would cooperate in every way possible.

The Dental Division went further to condemn even the appearance of quotasetting by registering its disapproval of such schemes as that established by the

Control Division, Seventh Service Command, under which the "efficiency" of

various hospitals was reported, even though no minimum output was prescribed.

This Service Command had determined that a dentist should see 1.58 patients

an hour. Using this figure as a norm, it rated the relative production of the

various hospitals on the basis of the number of patients actually seen. The

response of the Dental Division to this plan was clear and to the point. In a

memorandum to the Control Division, SGO, on 12 March 1945, it stated that:1M

The principal criterion used in making such an analysis is sittings. A sitting is

recorded for every visit to the dental clinic, and with a large turn-over of patients in

a hospital it is possible to show a large number of examinations recorded as sittings.

Likewise, a post-operative treatment is recorded as a sitting, and an inefficient oral

surgeon might have ten (10) post-operative treatments (sittings) when a very competent surgeon could accomplish the same with one POT (sitting). Furthermore, an

inefficient dental officer or one who wants to see the total number of sittings high can

insert one small filling per appointment (15-20 minutes), when the more efficient

operator, who is vitally interested in the patient and the service, would place several

fillings which would require an hour or more. Then too, the operator who places a

103 Report of the War Service Committee. J. Am. Dent. A. 15 Nov 44, p. 1551.

lm Memo, Maj Gen Eobert H. Mills for Control Div, SGO, 12 Mar 45, sub : Efficiency of work

measurement reports of dental service, general hospitals. SG : 703.-1.
OPERATION OF THE DENTAL SERVICE 225

superior filling, produces a superior denture, or who is more considerate of his patient

in oral surge/y, will require more time with resultant less fillings than the careless,

fast, inconsiderate operator.

A method which attempts to evaluate the efficiency of a dental service on sittings is

decidedly unfair and impractical. Such a method places a premium on poor work,

injudicious consideration of the patient and the service, and will terminate in an

inferior quality of dental service. This method, or any method where mathematical

figures are employed, leads to false impressions, and the true values cannot he analyzed.

Anyone can pile up an impressive figure in sittings, but it is an inaccurate, incomplete,

and dangerous criterion to use in determining the efficiency of work measurement. . . .

The Army Dental Corps has been stigmatized wrongly and criticized editorially as

being interested only in, and sponsoring, quantity. This office has continually emphasized quality with a full measure of service and duty hours, but never quantity at the

expense of quality. Efficiency reports such as those instituted by the Seventh Service

Command . . . can only lead to an inferior service and an inadequate evaluation of

the dental service.

Recommend that suitable steps be taken to eliminate such unwarranted ratings

which deal with mathematical evaluation of the dental service.

Whenever the quota system was reported in operation at any installation, the

Dental Division took prompt and vigorous action, usually in the form of a

personal letter from the Director, so thatthe practice was gradually and quietly,

but effectively, eliminated.108

DENTAL REHABILITATION OF SELECTIVE SERVICE

REGISTRANTS BEFORE INDUCTION

World War I

In the First World War, the Preparedness League of American Dentists,

operating under the auspices of the National Dental Association, proposed a

plan for completing as much dental work as possible for draftees before they

were called for active duty. Members of the League pledged themselves to

assist in the program on a voluntary basis, without cost to the Government or

to the individual, and The Surgeon General and The Provost Marshal General

authorized the local boards to refer registrants needing care to the cooperating

dentists. By 30 June 1918, 375,000 operations had been carried out by league

members106 and a total of nearly 1,000,000 operations were performed by 1,700

civilian dentists during the entire war.107

World War II

During World War II no plan similar to that of the Preparedness League

of American Dentists was attempted. In the first place, the Army Dental Corps

105 Statement of Maj Gen Robert H. Mills (Ret) to author, 8 Sep 47.

106 Annual Report . . . Surgeon General, 1918. Washington, Government Printing Office, 1918,

p. 413. 107 The Medical Department ... in the World War. Washington, Government Printing Office,

1923, vol I, p. 193.
226 DENTAL SERVICE IN WORLD WAR II

was much better prepared to assume the burden in 1941. Also, it seems to have

been the general opinion of all concerned that the dental rehabilitation of military personnel was a responsibility of the entire nation and was too big a

problem to be delegated to any limited group. From the start of the war, however, the American Dental Association offered to cooperate in any matter

affecting the dental health of inductees.

In February 1941 Selective Service announced that a Dental Advisory

Committee of prominent members of the profession had been appointed "to

guide us in all matters pertaining to dentistry."10S With the assistance of this

Committee a tentative plan for the "prehabilitation" of registrants was proposed in July 1941.109 Initially this plan was very limited in scope, and was

designed to accomplish little more than to acquaint dentists with the requirements for military service and encourage them to give special attention to the

care of men of military age. Eesponsibility for obtaining and paying for dental

treatment remained with the Selective Service registrant.

On 2 July 1941 a more elaborate program was proposed by the Commission

on Physical Eehabilitation, a subcommittee of the Health and Medical Committee of the Federal Security Agency. The principal provisions of this plan

were as follows:110

1. Congress to appropriate sufficient funds to defray the cost of treatment

for men not able or willing to obtain care attheir own expense.

2. State and local rehabilitation committees to be formed under the joint

auspices of the Federal Security Agency and the Selective Service System.

These committees would administer the program in their areas, determine how

payment for treatment would be made, and designate the facilities which would

render dental care. Private dentists, semipublic clinics or hospitals, or any

combination of dental facilities might be utilized.

3. Local Selective Service boards to indicate on examination records

whether or not disqualifying defects found were correctible, the registrant to

be directed to his own dentist or to a designated agency for treatment. The

board would also set a time-limit within which treatment would have to be

completed.

The Commission on Physical Eehabilitation recognized that:

Only a small percentage of the population can afford to pay or will be willing to pay

for corrective measures which may make them available for military or industrial

service, but which do not as yet interfere with their present civilian occupations. . . .

Because of widespread shifting of population during and after the National Emergency,

the responsibility is national as well as local. In order to meet the situation realistically it is recommended that Congress enact legislation to defray the cost. . . .

Without federal legislation of this nature, it can be predicted that little progress in

voluntary rehabilitation is to be expected.

M» Rowntree, L. G. : Dentistry and Selective Service. J. Am. Dent. A. 28 : 636-638, Apr 1941.

M

» Plan for the prehabilitation of registrants. J. Am. Dent. A. 28 : 1161, Jul 1941.

lw Report of the Commission on Physical Rehabilitation. J. Am. Dent. A. 28 : 1362-1364, Aug

1941.
OPERATION OF THE DENTAL SERVICE 227

The Commission stated that:

... the alternative to such a program is lower physical standards of eligibility for

selective service and compulsory physical rehabilitation after induction into the Army.

Action is required along the lines of one or the other of these alternatives, for the

present standards of physical eligibility have reduced the nation's reservoir of eligible

registrants to a number far lower than had been expected.

In August 1941 the President of the American Dental Association urged

consideration of the problem of dental rehabilitation in the following

discussion:m

It is well-known, of course, that many registrants under the Selective Service and

Training Act of 1940 have been rejected for active military service because of dental

defects. The large number of such rejections has been a matter of grave concern to

officials of the American Dental Association as well as to our military authorities.

A good deal of study has been devoted to the development of a practicable plan through

which the correction of dental defects, either before or after the registrant has been

examined by his local draft board, can be promoted.

The problem of rehabilitation, in its initial stage, proposed certain questions of a

jurisdictional nature in addition to many others. Was a program of rehabilitation

to be set up by the Selective Service System or was such a program to be developed

by the American Dental Association in consultation with the proper governmental

agencies? What types of dental care would be made available under such a program?

By whom and under what conditions was dental care to be provided for a deficient

registrant? Was the financial burden of such a rehabilitation program to be borne

by the dentist, the registrant himself, the government or the organized profession?

The President of the American Dental Association went on to state that the

National Health Program Committee of that organization had been directed

to cooperate with the governmental agencies and that the American Dental

Association had officially offered its services to the Coordinator of Health,

Welfare, and Eelated Activities in the National Defense Program, to The

Surgeon General of the United States Public Health Service, and to the

Director of the Selective Service System.

On 3 August 1941 the President of the American Dental Association called

a joint meeting of the board of trustees and members of the committees on

Dental Preparedness, Legislation, and the National Health Program. After

an all-day session this group made the following recommendations:112

1. It was believed that dental rehabilitation would be most effectively

accomplished by inducting deficient registrants into the Armed Forces under

lowered physical standards, necessary treatment to be rendered subsequent to

induction by dental officers of the respective services.

2. If a "prehabilitation" program was considered necessary by Selective

Service, consideration should be given to a plan similar to that proposed by

the Commission on Physical Eehabilitation. If the latter program were

»« Eobinson, W. H. : President's Page. J. Am. Dent. A. 28 : 1332-1333, Aug 1941.

IM program for rehabilitation of registrants rejected for dental defects under the Selective

Service Act. J. Am. Dent. A. 28 : 1518-1519, Sep 1941.
228 DENTAL SERVICE IN WORLD WAR II

adopted, however, it was recommended that the state rehabilitation committees

contemplated in the proposed plan should be headed by the ranking dental

officer in the state government as executive officer and that they should include

representatives of the appropriate state agencies, the organized dental profession, and such other groups and agencies as were deemed necessary. The

American Dental Association also recommended that the majority of the members of these committees should be dentists nominated by the organized dental

profession. Local committees would be organized along similar lines under

the jurisdiction of the state committees. Standards of fees, methods of payment, and the designation of the agencies to render treatment would be largely

the responsibility of the local committees.

On 9 October 1941, the Presidenttold a conference of the Secretary of War,

the Chief of Staff, and Selective Service officials, that he desired action to

effect the rehabilitation of an estimated 100,000 men with correctible dental

defects out of a total of 188,000 rejected.113 The following day the President

announced a program to "salvage" 200,000 men out of 1,000,000 rejected for all

causes. He stated that treatment would be made available by the registrant's

own dentist or physician, with the cost borne by the Government through funds

made available to Selective Service.114 The President also stated that it was

believed that care could be provided by local medical personnel at less cost than

by the Armed Forces.

In February 1942 the Selective Service System inaugurated a test rehabilitation program in the states of Maryland and Virginia. From February to

September about 300 men received medical care, but reports from the pilot test

headquarters did not distinguish between medical and dental cases, so the

number of inductees who had dental defects corrected is not known.115 Average

time required for dental cases was 38.5 days.116 Keports on the cost are conflicting; one official placed the average expense at $54.19,117 another at $78.00.118

The .reasons why this test was considered a failure are not clear, but as

early as June 1942 General Lewis B. Hershey, Director of the Selective Service

System, told the annual meeting of the American Medical Association that

"results of the pilot test did not justify the current adoption of a rehabilitation

program on a nation-wide basis. . . ."119 In July 1944 a representative of

Selective Service told a Senate Subcommittee on Wartime Health and Education that:

It appears that dental rehabilitation by the armed forces during the basic training

period of personnel offered a more logical method than the slower method contemplated

113 Wells, C. H.: Role of dentistry in the war effort. J. Am. Dent. A. 29 : 835-841, May 1942.

114 Plans for rehabilitation of rejected draftees. J. Am. Dent. A. 28 : 1884-1885, Nov 1941.

118 Ltr, Brig Gen Carlton S. Dargusch to Brig Gen Thomas L. Smith, 5 Dec 46. SG : 702.

116 Hearings before a subcommittee of the Committee on Education and Labor, United States Senate,

Seventy-eighth Congress. Washington, Government Printing Office, 1944, pt. 5.

"' Ibid.

See footnote 115, above.

119 Ibid.
OPERATION OF THE DENTAL SERVICE 229

in the offices of civilian dentists, particularly since the ranks of civilian dentists were

becoming rapidly depleted due to the demand for thousands of dentists by the Armed

Forces and the lowering of dental standards made more men available for military

service without prior dental rehabilitation.120

The Senate Subcommittee itself found that:

Early in the war, test rehabilitation programs were undertaken by the Selective

Service System, but yielded meager results and were abandoned. In sharp contrast to

the results of the Selective Service efforts are those of the Army rehabilitation program. Here remarkable success has been achieved. Approximately one and one-half

million men with major defects have been inducted and rendered fit for duty, including

1,000,000 men with major dental defects.121

It has been hinted, but not specifically stated, that the civilian prehabilitation

program was unsatisfactory because:

1. Selective Service was too deeply involved in other matters to be able to

devote the time and effort necessary.122

2. The time required fortreatmentin busy civilian offices was too long.123

»3. Civilian dentists were already working at top capacity and could not

accept new patients without neglecting essential civilian needs.124

In any event, it seems clear that if the Armed Forces take approximately onethird of the dentists in the country, the remaining dentists will be too busy to

assume responsibility for preinduction care of Selective Service registrants.

The poor results attained in the Selective Service test program discouraged further efforts to promote large-scale dental rehabilitation by

civilian agencies. The American Dental Association, which had from the

first favored rehabilitation by the Army, continued to sponsor a "Victory"

program to encourage high school students to maintain dental health on a

voluntary basis, but the care of inductees became the sole responsibility of

the Armed Forces.

DENTAL CRITERIA FOR OVERSEAS SERVICE

The Dental Service of World War II was organized to provide approximately twice as many dental officers per capita in the United States

as were alloted to overseas theaters. This ratio was justified by the obvious

fact that it would be more satisfactory to carry on dental rehabilitation during training rather than after the soldier had assumed his military duties in

the field. The basic authorization of 1 dentist for each 1,200 men in tactical

units was expected to provide only routine maintenance care of troops who

were in good dental condition when received into the organization. Un120 See footnote 116, p. 228.

m

'Keport of Senate Committee on Wartime Health and Education. J. Am. Dent. A. 32: 270-284,

1 Mar 45.

122 See footnote 116, p. 228.

123 See footnote 116, p. 228.

124 Ibid.
230 DENTAL SERVICE IN WORLD WAR II

fortunately, shortages of personnel, equipment, and lack of a definite dental

standard for foreign service led to the shipment overseas during 1942 and

1943 of large numbers of men with serious dental defects. The reports

of almost all theaters during this period note that their dental facilities

were unable to cope with the unexpected demand. The Southwest Pacific

Area, for instance, found that up to 80 percent of the men arriving in Australia early in the war needed some form of dental treatment.125 The Director of Training, ASF, stated as late as May 1943 that "... men were

still leaving replacement training centers and replacement depots for subsequent shipment overseas prior to the completion of apparently necessary

dental work." 126

On 20 June 1942 the War Department directed that all enlisted men

designated for combat units overseas must meet physical standards prescribed

in MR 1-9, though limited service categories could be sent to overseas hospitals and other Zone of Interior-type installations.127 However, this publication was rescinded in November of the same year.128 In October of 1942

it was provided that nonprogressive dental defects would not bar shipment

of officers overseas, implying, though not stating specifically, that other

serious dental defects would prevent transfer to a foreign theater.129 Neither

of these directives was sufficiently explicit in respect to dental deficiencies.

On 26 March 1943 War Department Circular No. 85 provided that "all

replacements so ordered [overseas] will be mentally and physically qualified

for service in an overseas combat theater"; limited service categories were

not to be shipped outside the continental United States.130 A subsequent

War Department circular stated that officers were still arriving for overseas

shipment with Class I dental conditions and that the provisions of the

previous circular were not being complied with, so it would appear that

Circular No. 85 was intended to prevent shipment of Class I dental cases

overseas. Its very general terms were not always so interpreted, however,

and about a month after it was published the Commanding General, AGF,

notified the Assistant Chief of Staff G-l that great difficulty was being experienced because of differences of opinion as to what constituted "dental

fitness." He recommended that "definite standards of dental requirements

relative to overseas eligibility be established."131 This recommendation was

forwarded to The Surgeon General for comment, and on advice of the Dental

Division, The Surgeon General suggested that:

125 See footnote 34, p. 206.

1M Memo, Brig Gen Walter L. Weible for Brig Gen Robert H. Mills, 13 May 43. SG : 703.

1W WD Cir 198, 20 Jim 42.

m WD Cir 363, 4 Nov 42.

J» WD Cir 349, 19 Oct 42.

m WD Cir 85, 26 Mar 43.

M1 Memo, Maj Theodore R. Pitts, Asst Ground Adj Gen, AGF, for ACofS, G-l, 24 Apr 43, sub :

Eligibility of enlisted men as overseas replacements. SG : 702.-1.
OPERATION OF THE DENTAL SERVICE 231

... the following should be accomplished for military personnel prior to departure for

staging areas and ports of embarkation for service overseas: "Dental correction of all

Class I cases to include those with 'insufficient teeth to masticate the Army ration' as

outlined in Change 1, dated September 10, 1942, of AR 40-510 and so far as practical

correction of Class II cases." m

On 13 May 1943 the Director of Military Personnel, ASF, recommended to the

Assistant Chief of Staff G-l that approximately the same provisions be published as a change to War Department Circular No. 85.133 This request was disapproved on technical grounds as it was desired to keep War Department

Circular No. 85 couched in general terms, with specific requirements on any

individual point to be published separately.134 Definite requirements for dental

health of personnel ordered overseas were finally established in "Preparations

for Overseas Movement," in August 1943, as follows:135

All necessary dental treatment, from a health and functional standpoint, will be

provided troops prior to their departure from home station. The following policy will

govern dental qualifications for overseas service: dental correction of all Class I cases

as outlined in AR 40-510, including Change 1 and, as far as practicable, correction of

Class II cases.

The same provisions were essentially repeated in War Department Circular No.

189, published 21 August 1943.136 These directives remained in effect during the

remainder of the war, though a slight modification was made in June 1945 when

the suspicion that some men were intentionally destroying their dental appliances to delay shipment caused the War Department to direct that soldiers

requiring dentures were not to be withheld from shipments if they had been able

to perform their military duties previously and if their history indicated that

replacement was not absolutely essential.137

It will be noted that the published standard did not make mandatory the

completion of all dental treatment. In fact, the Director of the Dental Division

stated in September 1943 that it was physically impossible to complete all work

prior to shipment.138 Routine care of nonemergency conditions was to be

rendered whenever possible, but a man was not to be kept from shipment overseas for such treatment.

The order directing that essential dental care would be rendered before

departure for a combat area was aimed more directly at commanding officers

than at dentists. Prior to its publication, unit commanders had been extremely

reluctant to release men from training schedules for dental appointments; now

132 1st ind, SG, 5 May 43, on memo cited In footnote 131.

153 Memo, Brig Gen Rüssel B. Reynolds, Dir, Mil Pers Div, SOS, for ACofS, G-l, 13 May 43, sub:

Eligibility of enlisted men as overseas replacements. SG : 702.-1.

1MMemo, R. W. Berry, Exec Off, ACofS, G-l, for TAG, 17 May 43, sub: Eligibility of enlisted

men for overseas service. SG: 702.-1.

135 See footnote 33, p. 206.

13° WD Cir 189, 21 Aug 43.

»»WD Cir 196, 30 Jun 45.

138 Memo, Ma] Gen Robert H. Mills for Brig Gen W. L. Weible, 8 Sep 43. [D]

330324 O—55 16
232 DENTAL SERVICE IN WORLD WAR II

they knew that they would lose the men anyway if the latter did not meet

required standards when the unit went overseas, and they vigorously supported

the dental surgeon's efforts to provide urgent treatment.

As a result of improvements in dental facilities, and the establishment of

definite standards for foreign service, men received as replacements overseas

after 1943 were in much better dental condition than those who preceded them.

The change was so marked, in fact, that the Southwest Pacific Area, which had

claimed that 80 percent of new troops needed dental care, now reported that

85 percent were in Class IV on arrival.139 In general the shipment of men in

poor dental condition ceased to be a serious problem in the latter part of 1943.

USE OF CIVILIAN DENTISTS

The amount of dental care rendered military personnel by civilian dentists

during World War II was not important in spite of the fact that such attendance had been authorized, in an emergency, for many years. In October 1925,

AE 40-510 provided that when no dental officer was available, emergency

civilian dental treatment could be obtained by military personnel on a duty

status at Government expense and without prior authority. Routine dental care

could be provided with the prior authorization of The Surgeon General.140

Military personnel on duty overseas without troops could procure civilian

dental attendance without prior authority, subject to later approval by The

Surgeon General. In July 1942, it was further authorized that personnel on

leave or furlough could procure emergency dental care at Government expense.141

The cited regulations were not interpreted to authorize civilian dental

treatment as a routine procedure when Army facilities were inadequate due

to shortages of equipment or personnel, though such an interpretation was

possible and it was actually the basis for the use of civilian dental laboratories

on a large scale at one stage of the war.

EXCESSIVE LOSS OR DESTRUCTION OF DENTURES

The careless loss or intentional destruction of dentures was an annoying

problem throughout the war. Varying circumstances led to this waste of effort

and materials. In many cases dentures were lost through simple failure to

observe normal precautions in caring for a fragile and expensive appliance.

The soldier who daily saw millions of dollars worth of property destroyed

was not likely to be impressed with his responsibility for such a small item as a

denture. In time of stress the denture often went into a hip pocket, where

it suffered irreparable damage when its owner rode in a truck or hit a fox139 See footnote 34, p. 206.

140 AR 40-510, 10 Oct 25.

M1 See footnote 31, p. 205.
OPERATION OF THE DENTAL SERVICE 233

hole. Some were lost because soldiers neglected to remove them when they

became nauseated on a sea-crossing. Also, since the appliance cost the soldier

nothing, he was likely to be very impatient of defects. It was reported that in

some cases men discarded dentures if a single tooth was broken because they

knew that a new one would be forthcoming without delay.142 It has also been

stated that partial dentures containing gold were occasionally sold in France,

where they brought a good price.143

Even more serious in its effect on morale was the intentional destruction

of dental appliances to avoid dangerous duty or to delay departure for an

overseas theater. The Commanding General of the Army Ground Forces

stated in April 1943:

Although it is not possible to obtain positive evidence in any considerable number

of cases, this headquarters has observed indications that individual enlisted men in

proper dental condition upon departure from Replacement Training Centers have

destroyed their dental fittings and rendered themselves unsuitable for overseas shipment, with a view to shirking hazardous duty."4

The North African theater reported in January 1944:

It is impossible to say that men break or lose their dentures intentionally, but the

incidence of this type of accident is so high that the suspicion seems warranted.145

The Seventh Army, in the Mediterranean area, noted that:

Accurate figures were not available as to the deliberate loss or breakage of dentures

in order to be evacuated from combat, but it was believed that the rate was highest

just before and during amphibious operations.146

One step recommended to give dental surgeons information on past prosthetic treatment was to record dental appliances in individual service records.147

The Dental Division did not concur in this plan since it was believed that even

with a clear record that a denture had existed, it would be impossible to prove

intent in case of loss or destruction.148 The further course of this recommendation is not certain, but a War Department directive of 1 August 1943 provided

that dentures would be listed in the service records of enlisted men going overseas.149 In October 1943 it was further provided that prosthetic appliances

of officers be listed in the Immunization Kegister.150 In January 1945 the War

i« The fact that soldiers discarded dentures on slight provocation was reported by the 5th

Auxiliary Surgical Group in Europe. This report was seen by the author in 1946 but it was subsequently lost or misplaced. The situation noted has since been confirmed, however, in conversations

between the author and numerous senior dental surgeons.

143 Information from Maj Gen Thomas L. Smith who was dental surgeon in Europe during the

war.

144 See footnote 142, above. 145 Essential Technical Medical Data Report, Headquarters, North African Theater, 27 Jan 1944.

HD : 350.05.

148 Seventh Army Section, supp. to the Dental History, MTO. HD: 314.7-2.

"' Ltr, Dental Surg, Sta Hosp, Et. McDowell, Calif, to TAG, 19 Mar 43, sub : Entry in service

record. SG: 703.

1481st ind, Col McDowell, 14 Apr 43, on footnote 147.

"»See footnote 33, p. 206.

IM preparation for overseas movement, 1 Oct 43.
234 DENTAL SERVICE IN WORLD WAR II

Department finally directed that a record of all prosthetic appliances be entered

in the individual's Immunization Eegister.151

Late in 1943 the question of charging military personnel for dental appliances lost through carelessness or intent was brought up by the Army Ground

Forces Keplacement Depot No. 1, at Fort George G. Meade, Md. This station

reported that men who had been given replacements were arriving without

them and stated its intention to enter a statement of charges in such cases.152

At about the same time the Army Service Forces Eeplacement Depot at Camp

Reynolds, Pa., reported that in a recent shipment to that station 18 men were

found not to meet dental requirements for overseas duty. Investigation

showed that 9 of these men had been supplied dentures within the past 3

months. One had been given his replacement only a few days before. None

had any reasonable excuse for the shortage. This station therefore recommended that dentures be entered on the individual soldier's record of personal

equipment and that a charge be made in case of negligent loss.153 On the basis

of these recommendations the Commanding General, Army Ground Forces,

asked The Adjutant General for an opinion as to the legality of making a

charge for dentures and spectacles lost through carelessness. Noting that

"There have been cases where it is apparent that enlisted men have wilfully

destroyed or wrongfully disposed of dentures and spectacles in order to forestall their shipment overseas" and that "such acts are highly prejudicial to

good order and military discipline" AGF recommended that "in the event that

soldiers cannot be penalized under present regulations for loss or destruction

of the subject items . . . regulations be changed so that punitive action may

be sustained, at least to the extent of requiring enlisted men to pay for such

losses."1B* The Adjutant General referred the matter to The Surgeon General

for comment and the latter stated that in the opinion of his Legal Division

dentures and spectacles became the personal property of the soldier and that

there was no basis for a charge even if the man deliberately destroyed the

appliances. He stated further that his Office would be opposed to establishing

property accountability for dentures since it was believed that the procedures

involved would be too cumbersome to justify the effort. The Surgeon General

recommended, as an alternative, that court martial action be taken to punish

offenders.165 The Adjutant General concurred in the recommendations of The

Surgeon General and notified the Commanding General, AGF, that men could

not be charged for destroyed dental appliances.156 In March 1944 a Bulletin

151 WD Cir 32, 27 Jan 45.

182 Ltr, CG, AGF Replacement Depot No 1, Ft. George G. Meade, Md, to CG, AGF, 5 Nov 43, sub:

Eeplacement of dentures and spectacles. SG : 413.75-2 (Ft. George G. Meade).

153 Ltr, Hq, ASF Eeplacement Depot, Camp Eeynolds, Pa, to TAG, 12 Nov 43, sub : Issue of dentures and corrective appliances to replacements. SG : 220.31-1 (Camp Eeynolds).

1511st ind. CG, AGF, 2 Dec 43, on ltr cited in footnote 152, above.

155 Ltr, Chief, Oprs Br, SGO, to Enlisted Br, AGO, 15 Jan 44, sub : Eeplacement of dentures and

spectacles. SG : 413.75-2 (Ft. George G. Meade).

1M 2d ind, TAG, 22 Feb 44, on ltr cited in footnote 152, above.
OPERATION OF THE DENTAL SERVICE 235

of The Judge Advocate General's Office confirmed the opinion of the Legal

Division, SGO, that military personnel could not be charged for dental

appliances under existing regulations.157

As a result of the above opinions no further attempt was made to penalize

soldiers for the loss or destruction of dental appliances. It was true that a man

could be tried for such action, but the burden of proof was on the prosecution

and the very nature of the offense was such that no matter how strong the

presumptive evidence it was practically impossible to prove intent to the degree

required for conviction before a court martial.

The chief of the Operations Service, SGO, suggested in 1944 that port

medical officers should hold as few men as possible for the replacement of dentures;

158 and a War Department circular of June 1945 provided that Class I

dental patients who needed only replacement of missing teeth would not be

held back when they had previously performed their military duties satisfactorily and if their history indicated that restoration was not necessary.159

In May 1944 it was directed that all dentures would carry the names and serial

numbers of their owners, partly to assist in the return of lost appliances and

partly to aid in identification of the patient in case of accident.160 All of these

measures did not greatly deter the few men who were inclined to use any means

to avoid shipment overseas, or any other dangerous assignment, from "losing"

or destroying their dentures.

It would appear that a practical solution to this problem would be to enter

dental appliances on the list of articles for which the soldier is responsible, to

be paid for if lost through negligence. Under such circumstances, a commanding officer could collect the cost of a denture through a simple administrative

action. No charge would have to be made if negligence were not involved, but

the soldier would have the same responsibility for a dental appliance as for

any other valuable piece of equipmentissued for his use.161

ROLE OF THE DENTAL SERVICE IN THE DEVELOPMENT

OF THE ACRYLIC RESIN ARTIFICIAL EYE

In the latter part of 1943 the Army was faced with a critical shortage of

satisfactory artificial eyes. Replacements were needed for the casualties which

were arriving from the battle zones and physical requirements had been lowered

to permitthe induction of men with only one eye. At the same time, the normal

supply of glass eyes from Europe had been cut off. Ordinary glass eyes had

many disadvantages for military use. They were extremely fragile and even

«'Bulletin of the Judge Advocate General of the Army, 1944-45. Washington, Government

Printing Office, 1944, vol. 3-4, p. 126.

«

8

See footnote 155, p. 234.

159 See footnote 137, p. 231.

wo TB Med 44, May 1944.

M1 Brig Gen Thomas L. Smith, Chief of the Dental Consultants Division, in 1947, in a statement

to the author said that he favored some system for property accountability for dental appliances.
236 DENTAL SERVICE IN WORLD WAR II

small factors like sudden changes in temperature might result in breakage;

they became etched in the fluids of the socket so that they required frequent

replacement; custom-fitted eyes for difficult conditions required as much as 2

months for construction and some men lost up to 8 months' duty in a single year

while getting successive eye replacements; stocks of as many as a hundred

thousand eyes were required for the proper fitting of only a thousand patients.162

As a result of this situation which was almost as serious for the civilian population as for the military, several agencies undertook investigations to develop an

artificial eye which would readily be available and which would be superior to

the glass eye in common use.

A clear synthetic resin (methyl methacrylate) had been in use for some

years for the construction of artificial dentures. It was strong, well tolerated

by human tissues, and easy to form into irregular shapes. It is not surprising,

therefore, that the idea of using this material for ocular prostheses suggested

itself to several persons at approximately the same time.163 As early as 1941

the pink acrylic resin used in denture work was made up into temporary eyes

to maintain socket form until a permanent appliance could be placed.164

Captain Stanley F. Erpf, DC, on duty with the 30th General Hospital in

England, was probably the first Army officer to produce a satisfactory acrylic

eye; Captain Erpf's own statement of his work is as follows:165

May 1943 to December 1943. Initial research begun. Forty prostheses constructed

for patients of the 30th General Hospital.

December 1943. Research report and training manual written and submitted to the

Office of the Chief Surgeon, ETOUSA.

January 1944 to May 1944. Training program conducted at the 30th General Hospital

for 40 U.S. Army and 10 British Army dental officers.

June 1944- Training center at 30th General Hospital terminated and Capt. Erpf

en route to the United States to aid in setting up center at Valley Forge General Hospital in the United States.

July 1944 to December 1944- Research and training program conducted at Valley

Forge General Hospital in collaboration with Major Victor Dietz and Major Milton

Wirtz who had also been working independently on development of the acrylic

prosthesis.

At approximately the same time that Captain Erpf was doing his work in

England, Major Victor H. Dietz and Major Milton S. Wirtz were experimenting along similar lines at Thomas M. England General Hospital, Atlantic City,

N.J., and at Camp Crowder, Mo.166 It appears that these two officers of the

Dental Corps produced acrylic eyes for patients somewhat later than Captain

182 Randolph, M. E. : History of the artificial eye program (glass and plastic), 2 Jan 46. HD:

314.7-2.

103 At least three Army Dental Corps officers and an unknown number of Naval officers and

civilian investigators apparently worked independently along similar lines.

164 Holmes, A. G. : Use of acrylic resins in the construction of temporary artificial eyes. Dental

Bulletin, supp. to Army Medical Bulletin 12 : 265-266, Oct 1941.

105 Personal letter from Dr. Stanley F. Erpf to the author, 9 Oct 46. HD : 422.2.

tee Erpf, S. F., et al. : Prosthesis of the eye in acrylic resin. Army Medical Bulletin 4 : 76-86,

Jul 1945.
OPERATION OF THE DENTAL SERVICE 237

Erpf, but determination of this point must await decision by the United States

Patent Office. In any event, each worked on his own initiative and each was

awarded the Legion of Merit for his contribution. In July 1944 both officers

joined Captain Erpf in developing a standard technique.

The acrylic eye proved so superior in every respect that it was eventually

adopted as the exclusive type of replacement by the Army. In October 1944

it was announced that 12 Eye Centers would accept patients for acrylic eyes,

though glass eyes were still furnished on request.167 By August 1945, 29 general hospitals and 1 regional hospital were rendering this service.168 The exact

number of acrylic eyes constructed is not known, though 7,500 appliances had

been made in the United States alone by October 1945.16917° Captain Erpf

estimated that about 10,000 eyes were made in the first 18 months of the program.171 The Army technique was adopted by the Veterans Administration

when it took over responsibility for the continued care of former soldiers. The

part played by dental officers in developing and staffing the artificial eye program reflected great credit on the Dental Corps and the Medical Department.172

ROLE OF THE DENTAL SERVICE IN THE DEVELOPMENT

OF THE ACRYLIC HEARING-AID ADAPTER

For a decade or more before the war it had been known that the efficiency of hearing-aids depended to an important extent on the accuracy

with which the receiver was adapted to the external auditory canal. An ear

mold custom-fitted to the individual case eliminated outside noise, prevented

"feedback" to the receiver, and channeled sound waves directly to the

tympanum without loss of intensity. At the start of the war, ear molds were

being constructed by civilian laboratories from individual impressions of the

canal, but this system was not altogether satisfactory for the following reasons :

173

1. Patients had to be held in the hospital while time was lost in mailing

work to commercial laboratories.

2. Impressions were subject to distortion or breakage in the mail.

3. Commercial laboratories could not take chances on their ear molds impinging on the tympanum so they habitually shortened the mold to a degree

which sometimes resulted in loss of efficiency.

»' WD Ctr 398, 11 Oct 44.

168 SG News Notes 26, 15 Äug 45.

109 Erpf, S. F., et al.: Plastlc-artificial-eye-program, Ü. S. Army. Am. J. Ophth. 29 : 984-992, Aug

1946.

170 The Army technique was adopted by the Veterans Administration when it took over responsibility for the continued care of former soldiers. SG News Notes, 15 Jan 47. HD: 000.71.

1,1 See footnote 165, p. 236.

172 The subject of the chronological development of the acrylic eye is not considered in detail in

this discussion because it is believed that only the U.S. Patent Office can evaluate claims of the

military and civilian personnel involved.

173 McCracken, G. A.: Construction of ear molds for hearing-aid appliances. HD : 314.7-2.
238 BENTAL SERVICE IN WORLD WAR II

Late in 1943 the Chief of the Aural Rehabilitation Service and Col. Gerald A. McCracken, Chief of the Dental Service at Deshon General Hospital,

Butler, Pa., consulted on the possibility of constructing ear molds in a laboratory established in the hospital itself. The project appeared practical and it

was presented to the Dental Division and The Surgeon General for approval.

The Surgeon General not only concurred in the plan but also directed that

laboratories be established at Borden General Hospital (Chickasha, Okla.)

and Hoff General Hospital (Santa Barbara, Calif.).174 The laboratories were

supervised and operated by dental personnel because of their experience in taking impressions and handling plastics. Improvements were made in the techniques commonly used by the commercial laboratories and the work produced

was eminently satisfactory. While it is not yet known how many ear molds

were fabricated, it was reported that Deshon General Hospital alone employed

6 technicians on 2 shifts to turn out from 250 to 350 cases a month while the plan

was at peak operation.175

ROLE OF THE DENTAL SERVICE IN THE FABRICATION OF

TANTALUM PLATES FOR THE REPAIR OF SKULL DEFECTS

Tantalum plates for the repair of skull defects were first used in the Army

in September 1942. They were found to be strong and well-tolerated, but the

fabrication of a plate with irregular outline and contour offered considerable

difficulty. Lt. Col. Arthur J. Hemberger, of the Dental Service at Walter

Reed General Hospital, suggested that dental procedures might be applicable

to the problem and thereafter dental officers were given the responsibility for

taking impressions of cases before operation and forming appliances which

could be adapted with a minimum of alteration at the time of repair. Impressions were first made of the area involved. A model was then poured and

built up to the desired contour. From this model dies were formed which

were used to mold the sheet of tantalum under high pressure. The plate was

then trimmed to the desired outline on the model and was ready for insertion

after cleaning and sterilization.

Thistechnique was described to Army neurosurgeons atthe annual meeting

at Walter Reed General Hospital in 1943. Motion pictures of the process were

distributed throughout the Army and Navy and the method was reported in

the Journal of Neurosurgery in 1945.17fi 177

"* Ibid.

175 Ibid.

176 Hemberger, A. J.: The fabrication of tantalum plates for the repair of skull defects. HD:

314.7-2.

1,7 Hemberger, A. J. ; Whitcomb, B. B. ; and Woodhall, B. : The technique of tantalum plating of

skull defects. 3. Neurosurg. 2 : 21-25, Jan 1945.
OPERATION OF THE DENTAL SERVICE 239

INCIDENCE OF THE PRINCIPAL DENTAL DISEASES AND

THE AMOUNT OF TREATMENT RENDERED

Tables 4 through 6 show the incidence of some of the more important dental

diseases during the period 1 January 1942 through 31 August 1945. Tables 7

through 14 show the more significant treatments rendered in the same period.

(In some instances, reports on the incidence of dental diseases, and the amount

of treatment rendered, contained no breakdown for military and "other" personnel; however, the number of "others" treated was generally so small that

the rates for military personnel were not greatly affected.) The incidence of

five important dental diagnoses are shown graphically in Charts 2 through 6.

Considerable confusion has existed in the dental profession concerning the

diagnosis of Vincent's infection. It is probable that the rates reported for

this disease were excessive and included many cases which should properly

have been listed as "gingivitis." The statistics shown for Vincent's stomatitis

are probably no more nor less accurate than those which would have been obtained from a similar group of civilian dentists.

OHAET 2. INCIDENCE* OF CELLULITIS OF DENTAL ORIGIN IN THE UNITED STATES ARMY,

1938-1945.

RATE PER THOUSAND PER YEAR

1938 39 40 41

•Includes new cases, readmissions, and both in- and out-patients.

Source: Bar graphs (1938-40), prepared from statistical data obtained from Annual Reports

of The Surgeon General, U. S. Army, 1938-41. Washington, Government Printing Office, 1938-41.

Other graphic presentation, including bar graph for 1941, prepared by the author from reports

received in the Dental Division, SGO.
240 DENTAL SERVICE IN WORLD WAR II

CHART 3. INCIDENCE* OF FRACTURED MANDIBLES IN THE UNITED STATES ARMY, 1938-1945.

RATE PER THOUSAND PER YEAR

RATE RATE

1938'39'40'41 J A J 0

1942

A J 0 0

1945

•Includes new cases, readmissions, and both in- and out-patients.

Source: Bar graphs (1938-40), prepared from statistical data obtained from Annual Reports

of The Surgeon General, U. S. Army, 1938-41. Washington, Government Printing Office, 1938-41.

Other graphic presentation, including bar graph for 1941, prepared by the author from reports

received in the Dental Division, SGO,
OPERATION OF THE DENTAL SERVICE 241

CHART 4. INCIDENCE* OF FRACTURED MAXILLAE IN THE UNITED STATES ARMY, 1938-1945.

RATE PER THOUSAND PER YEAR

feHHi LTOTAL ARMY

CONTINENTAL UNITED STATE!

1938 '39 '40'41

Includes new cases, readmissions, and both in- and out-patients.

Source: Bar graphs (1938-40), prepared from statistical data obtained from Annual Reports

of The Surgeon General, U. S. Army, 1938-41. Washington, Government Printing Office, 1938-41.

Other graphic presentation, including bar graph for 1941, prepared by the author from reports

received in the Dental Division, SGO.
242 DENTAL SERVICE IN WORLD WAR II

CHART 5. INCIDENCE* OF OSTEOMYELITIS OF ORAL STRUCTURES IN THE UNITED STATES

ARMY, 1938-1945.

RATE PER THOUSAND PER YEAR

Includes new cases, readmissions, and both in- and out-patients.

Source: Bar graphs (1938-40), prepared from statistical data obtained from Annual Reports

of The Surgeon General, TJ. S. Army, 1938-41. Washington, Government Printing Office, 1938-41.

Other graphic presentation, including bar graph for 1941, prepared by the author from reports

received in the Dental Division, SGO.
OPERATION OF THE DENTAL SERVICE 243

CHART 6. INCIDENCE* OF VINCENT'S STOMATITIS IN THE UNITED STATES ARMY, 1938-1945.

RATE PER THOUSAND PER YEAR

100

TOTAL. ARMY

CONTINENTAL UNITED STATES

•——• OVERSEAS

1938 39 40 41 A J 0 0

1945

Includes new cases, readmissions, and both in- and out-patients.

Source: Bar graphs (1938-40), prepared from statistical data obtained from Annual Reports

of The Surgeon General, TJ. S. Army, 1938-41. Washington, Government Printing Office, 1938-41.

Other graphic presentation, including bar graph for 1941, prepared by the author from reports

received in the Dental Division, SGO,
244 DENTAL SERVICE IN WORLD WAR II

TABLE 4. INCIDENCE OF CELLULITIS OF DENTAL ORIGIN, UNITED STATES ARMY, AND

OTHER PERSONNEL, 1 JANUARY 1942-31 AUGUST 1945

Area

Army ! Others3

Number

Number per

1,000 mean

strength

per year

Number

1942-45

4

41, 320 1.7 * 3, 643

4

26, 080

* 15, 240

1.9

1.6

4

1, 865

4

1, 778

194^

Total 7,416 2. 1 147

6,949

467

2.5

0.7

147

194S

4

13, 647 2.0 (

4

)

4

10, 595

4

3, 052

2. 1

1.8

(

4

)

«

1944

Total 12, 561 1.6 1, 236

6,061

6,500

1.5

1. 6

866

370

1945 s

Total 7,696 1.4 2,260

2,475

5,221

1.2

1.4

852

1,408

1 Includes new cases, readmlssions, and both inpatients and outpatients.

* Except where otherwise indicated, consists of Army personnel and a negligible number of Navy and Allied military

personnel.

" Consists of dependents, civilian employees, prisoners of war, and all other personnel not part of the Allied Armed

Forces.

* During 1943, data for "Other" personnel were not reported separately from "Army" personnel. The statistics

shown for "Army" for this year include therefore, data for both "Army" and "Other" personnel.

* Data are for 1 January-31 August only.

Source: Compiled by the author from reports received in the Dental Division, SQO.
OPERATION OF THE DENTAL SERVICE 245

TABLE 5. INCIDENCE ' or VINCENT'S STOMATITIS, UNITED STATES ABMY, AND OTHES

PERSONNEL, 1 JANUARY 1942-31 AUGUST 1945

Area

Army 2 Others"

Number

Number per

1,000 mean

strength

per year

Number

1942-45

Total

United States

4 958, 940 40 4

18, 203

4

657, 482

4

301, 458

47

31

4

6, 993

4 Overseas _ __ _ _ _ . _ _ _ 11, 210

1942

Total

United States__

102, 133 30 957

96, 519

5,614

35

9

957

Overseas . _ .

1943

Total

United States _ ., . .

4

277, 174 40 (

4

)

4

228, 932

4

48, 242

45

28

(

4

)

(

4 Overseas )

1944

Total ..

United States _.

327, 116 41 3, 106

215, 183

111,933

54

28

1,813

Overseas __ . 1,293

1945 s

Total

United States _

252, 517 46 14, 140

116, 848

135, 669

59

39

4,223

Overseas 9,917

1

Includes new cases, readmissions, and both inpatients and outpatients.

2 Except where otherwise indicated, consists of Army personnel and a negligible number of Navy a

personnel.

' Consists of dependents, civilian employees, prisoners of war, and all other personnel not part of

Forces.

' During 1943, data for "Other" personnel were not reported separately from "Army" personn

shown for "Army" for this year include therefore, data for both "Army" and "Other" personnel.

« Data are for 1 January-31 August only.

Source: Compiled by the author from reports received in the Dental Division, SGO.

nd Allied military

the Allied Armed

el. The statistics
246 DENTAL SERVICE IN WORLD WAR II

TABLE 6. INCIDENCE ' OF OSTEOMYELITIS OF OEAL STEUCTDRES, UNITED STATES ARMY, AND

OTHER PERSONNEL, 1 JANUARY 1942-31 AUGUST 1945

Area

1942-45

Total.

United States.

Overseas

1942

Total,

United States.

Overseas

19<4S

Total.

United States.

Overseas

1944

TotalUnited States.

Overseas

1945 '

Total.

United States.

Overseas

Army'

Number

4

2, 136

1,372

* 764

507

458

49

500

4

376

4

124

689

344

345

440

194

246

Number per

1,000 mean

strength

per year

0.08

0.09

0.08

0. 15

0. 17

0.08

0.07

0.07

0.08

0.08

0.08

0.09

0.08

0. 10

0.07

Othersä

Number

4

213

121

4 92

19

19

(

4

)

113

83

30

81

19

62

i Includes new cases, readmissions, and both inpatients and outpatients.

a Except where otherwise indicated, consists of Army personnel and a negligible number of Navy and Allied military

personnel.

» Consists of dependents, civilian employees, prisoners of war, and all other personnel not part of the Allied Armed

Forces.

i During 1943, data for "Other" personnel were not reported separately from "Army" personnel. The statistics

shown for "Army" for this year include therefore, data for both "Army" and "Other" personnel.

« Data are for 1 January-31 August only.

Source: Compiled by the author from reports received in the Dental Division, SGO.
OPERATION OF THE DENTAL SERVICE 247

TABLE 7. PERMANENT FILLINGS PLACED BY THE UNITED STATES ARMY DENTAL SERVICE,

1 JANUARY 1942—31 AUGUST 1945

Army ' Others>

Area

Number

Number per

1,000 mean

strength

per year

Number

1942-45

Total 68, 092, 479 2,880 1, 454, 081

United States . _ _ __

Overseas _

55, 393, 744

12, 698, 735

4,000

1,290

1, 266, 310

187, 771

1942

Total 7, 768, 357 2,300 91, 851

United States _____ 7, 122, 475

645, 882

2,580

1,030

68, 808

Overseas __ 23, 043

1943

Total 23, 643, 902 3,420 176, 962

United States. __ ____ 20, 898, 379

2, 745, 523

4,060

1,560

149, 352

Overseas __ _ 27, 610

1944

Total__ ___ 24, 426, 685 3,080 594, 258

United States- 19, 306, 933

5, 119, 752

4,860

1,290

540, 333

Overseas __ ____ 53, 925

1945 3

Total 12, 253, 535 2,250 591, 010

United States _ __ 8, 065, 957

4, 187, 578

4,050

1,210

507, 817

Overseas ___ 83, 193

1 Except where otherwise indicated, consists of Army personnel and a negligible number of Navy and Allied military

personnel.

2 Consists of dependents, civilian employees, prisoners of war, and all personnel not part of the Allied Armed Forces.

The great Increase in treatment after 1943 largely represents care given prisoners of war.

a Data are for 1 January-31 August only.

Source: Compiled by the author from reports received in the Dental Division, SGO.

330324 0—55- -17
248 DENTAL SERVICE IN WOULD WAR II

TABLE 8. EXTRACTIONS PERFORMED BY THE UNITED STATES ARMY DENTAL SERVICE,

1 JANUARY 1942-31 AUGUST 1945

Area

Army 1

Number

Number per

1,000 mean

strength

per year

Others»

Number

1942-45

Total.

United StatesOverseas

1942

Total.

United States.

Overseas

1948

Total .

United States.

Overseas

1944

Total.

United States_

Overseas

194BTotal.

United StatesOverseas

15, 189, 936

12, 627, 293

2, 562, 643

3, 246, 910

3, 030, 146

216, 764

6, 007, 658

5, 316, 079

691, 579

3, 842, 788

2, 919, 953

922, 835

2, 092, 580

1,361, 115

731, 465

643

912

262

960

1,099

347

870

1,032

393

484

735

233

384

684

212

1, 041, 328

705, 900

335, 428

53, 940

40, 945

12, 995

164, 005

118, 612

45, 393

395, 105

282, 813

112, 292

428, 278

263, 530

164, 748

i Except where otherwise indicated, consists of Army personnel and a negligible number of Navy and Allied military

personnel.

> Consists of dependents, civilian employees, prisoners of war, and all other personnel not part of the Allied Armed

Forces.

s Data are for 1 January-31 August only.

Source: Compiled by the author from reports received in the Dental Division, SGO,
OPERATION OF THE DENTAL SERVICE 249

TABLE 9. FULL DENTURES CONSTRUCTED BY THE UNITED STATES ARMY DENTAL SERVICE,

1 JANUARY 1942-31 AUGUST 1945

Army ' Prisoners of war

Area

Number

Number per 1,000

mean strength

per year

Number

1942-45

Total 568, 669 24 10, 359

United States __ _ _ _ _ 467, 108

101, 561

34

10

9, 103

Overseas __ _ _ _ _ 1,256

1942

Total 41, 208 12

United States _ _ 39, 530

1,678

14

Overseas __ _ 3

1943

TotaL ... 214, 368 31

United States 196, 708

17, 660

38

Overseas 10

1944

Total __ _ _ 208, 263 26 3,023

United States _ _ _ 159, 594

48, 669

40

12

2, 939

Overseas _____ _ ___ 84

1945 2

Total 104, 830 19 7,336

United States-- _ 71,276

33, 554

36

10

6, 164

Overseas __ .. 1, 172

1

In addition to Army personnel, consists of dependents, civilian employees, and a negligible number of Navy and

Allied military personnel.

2 Data are for 1 January-31 August only.

Source: Compiled by the author from reports received in the Dental Division, SGO.
250 DENTAL SERVICE IN WORLD WAR II

TABLE 10. PARTIAL DENTURES CONSTRUCTED BY THE UNITED STATES ARMY DENTAL

SERVICE, 1 JANUARY 1942-31 AUGUST 1945

1942-45

Total.

United States.

Overseas

1942

Total.

United States.

Overseas

1943

Total.

United States.

Overseas

1944

Total.

United States.

Overseas

1945'

Total.

United States.

Overseas

Army'

Number

1, 997, 162

269, 984

153, 174

Number per

1,000 mean

strength

per year

85

1, 636, 757

360, 405

118

36

25, 247

10, 275

115, 648 34 1,860

108, 072

7,576

39

12

1,691

169

638, 435 92 1,598

588, 951

49, 484

114

28

1, 137

461

819, 921 103 18, 226

669, 750

150, 171

169

38

9,985

8,241

423, 158 78 13, 838

136

44

Others'

Number

35, 522

12, 434

1,404

i Except where otherwise indicated, consists of Army personnel and a negligible number of Navy and Allied military

personnel.

2 Consists of dependents, civilian employees, prisoners of war, and all personnel not part of the Allied Armed

Forces.

a Data are for 1 January-31 August only.

Source: Compiled by the author from reports received in the Dental Division, SGO.
OPERATION OF THE DENTAL SERVICE 251

TABLE 11. DENTURES REPAIRED BY THE UNITED STATES ARMY DENTAL SERVICE,

1 JANUARY 1942-31 AUGUST 1945

Army ' Others >

Area

Number

Number per

1,000 mean

strength

per year

Number

1942-45

Total - _. _ 743, 261 31 16, 596

United States . 464, 699

278, 562

34

28

10, 841

Overseas 5,755

1942

Total _ 39, 507 12 1,020

35, 858

3,649

13

6

874

Overseas _ _ . . 146

1948

Total . . _. . 160, 978 23 1,495

125, 972

35, 006

24

20

750

745

1944

Total ... _ _ 316,711 40 4,787

United States . 200, 058

116, 653

50

29

3,255

1,532

1945 3

Total - . - .. .. 226, 065 41 9,294

102,811

123, 254

52

36

5,962

3,332

1 Except where otherwise indicated, consists of Army personnel and a negligible number of Navy and Allied military

personnel.

2 Consists of dependents, civilian employees, prisoners of war, and all personnel not part of the Allied Armed

Forces.

3 Data are for 1 January-31 August only.

Source: Compiled by the author from reports received in the Dental Division, SGO.
252 DENTAL SERVICE IN WORLD WAR II

TABLE 12. FIXED BRIDGES CONSTRUCTED BY THE UNITED STATES ARMY DENTAL SERVICE,

1 JANUARY 1942-31 AUGUST 1945

Area

Army' Others '

Number

Number per

1,000 mean

strength

per year

Number

Total

1942-45

206, 484 8.7 1,584

169, 980

36, 504

12. 3

3.7

1, 178

406

1942

Total 11, 110 3.3 175

10, 038

1,072

3. 6

1.7

148

27

1943

Total 39, 235 5.7 192

34, 549

4,686

6.7

2.7

139

53

1944

Total 89, 488 11.3 600

74, 057

15, 431

18.7

3.9

426

174

1945*

Total 66, 651 12.2 617

51, 336

15, 315

25.8

4. 4

465

152

i Except where otherwise indicated, consists of Army personnel and a negligible number of Navy and Allied military

personnel.

2 Consists of dependents, civilian employees, prisoners of war, and all personnel not part of the Allied Armed

Forces.

s Data are for 1 January-31 August only.

Source: Compiled by the author from reports received in the Dental Division, SQO.
OPERATION OF THE DENTAL SERVICE 253

TABLE 13. TEETH REPLACED BY THE UNITED STATES ARMY DENTAL SERVICE,

1 JANUARY 1942-31 AUGUST 1945

(Based on an estimated 8 teeth replaced per partial denture)

Army '

Prisoners of

war Teeth replaced

for Army

Area

Number

Number per

1,000 mean

strength per year

Number

personnel and

others2per 100

extractions

1942-45

Total 18, 306, 800 775 309, 305 115

United States __ _

Overseas _ _ _

15, 060, 978

3, 245, 822

1,086

332

284, 195

25, 110

115

113

1942

Total - 980, 769 290 30

931, 293

49, 476

338

79

30

22

1943

Total 6, 466, 248 936 105

5, 953, 376

512, 872

1, 156

292

110

70

1944

Total .. - -_ 7, 067, 700 891 103, 697 169

United States _____ 5, 721, 652

1, 346, 048

1,441

339

101, 847

1,850

182

130

1945 3

Total 3, 792, 083 696 205, 608 159

United States_ 2, 454, 657

1, 337, 426

1,232

387

182, 348

23, 260

162

Overseas 152

' In addition to Army personnel, consists of dependents, civilian employees, and a negligible number of Navy and

Allied military personnel.

2

"Others" include prisoners of war, in addition to those listed in footnote 1.

3 Data are for 1 January-31 August only.

Source: Compiled by the author from reports received in the Dental Division, SGO.
254 DENTAL SERVICE IN WORLD WAR II

TABLE 14. DENTAL PROPHYLAXES PERFORMED BY THE UNITED STATES ARMY DENTAL

SERVICE, 1 JANUARY 1942-31 AUGUST 1945

Army'

Number

Number per

1,000 mean

strength

per year

Others»

Number

1942-45

Total.

United States.

Overseas

1942

Total.

United States _

Overseas

1943

Total.

United StatesOverseas

1944

Total,

United States.

Overseas

1945'

Total.

United States.

Overseas

8, 187, 932

5, 999, 091

2, 188, 841

978, 769

880, 458

98,311

2, 301, 367

1, 865, 542

435, 825

2, 995, 851

2, 109, 597

886, 254

1, 911, 945

1, 143, 494

768, 451

346

433

224

290

319

157

333

362

248

377

531

223

351

574

222

271, 347

229, 653

41, 694

19, 089

14, 050

5,039

31, 123

24, 356

6,767

88, 824

77, 876

10, 948

132, 311

113,371

18, 940

i Except where otherwise indicated, consists of Army personnel and a negligible number of Navy and Allied military

personnel.

s Consists of dependents, civilian employees, prisoners of war, and all personnel not part of the Allied Armed

Forces.

3 Data are for 1 January-31 August only.

Source: Compiled by the author from reports received in the Dental Division, SGO,
OPERATION OF THE DENTAL SERVICE 255

DISCHARGES FOR DENTAL DEFECTS

Discharges for physical disability due to dental defects were negligible during the war. Of 956,232 enlisted men separated from the Army for disability

from January 1942 through December 1945, only 312 were separated due to

pathology of the teeth."8 This figure, however, does not cover other possible

losses due to dental or oral defects since oral structures may have been involved

for some of the men reported as separated for other diseases or traumatic

injuries.

CASH VALUE OF TREATMENT RENDERED BY DENTAL OFFICERS

Table 15 gives the average number of five of the more important operations

completed per dental officer per year in the continental United States, overseas,

and in the Army as a whole, for the period 1 January 1942 through 31 August

1945. Under Veterans Administration fee-schedules published in May 1946

the average yearly work of each dentist, for these five items only, would be

valued at over $16,000 a year. The value of the other miscellaneous care given

cannot be determined with accuracy, but since it constituted numerically more

than half of all treatments rendered, an estimate of $4,000 a year would seem

conservative, bringing the gross value of the dental officer's yearly work to about

$20,000.

178 Separations from the Army for Physical and Mental Reasons, Health of the Army, Vol 1, No.

2, Aug 1946, pp. 20-23.
256 DENTAL SERVICE IN WORLD WAR II

TABLE 15. AVERAGE NUMBER OF FIVE PRINCIPAL OPERATIONS COMPLETED PER DENTAL

OFFICER PER YEAR, 1 JANUARY 1942-31 AUGUST 1945

Operation 1943 1945 « Total >

Permanent fillings:

Total Army

United States,

Overseas

Extractions:

Total Army

United States _

Overseas

Dentures:

Total Army

United States.

Overseas

Dentures repaired:

Total Army

United States.

Overseas

Fixed bridges:

Total Army

United States.

Overseas

1, 307

549

26

1, 950

2,058

1,392

505

531

370

70

77

34

13

12

18

3

3

2

1,678

1,944

1,099

284

314

220

70

83

44

22

20

25

6

7

3

1,315

1, 630

948

258

309

199

56

68

42

24

21

28

7

10

3

1, 630

1,898

1,067

340

391

232

65

77

42

20

17

26

6

7

3

i Accurate statistics are not available on the number of dental officers overseas and in the continental United States.

* Average based on figures for the period 1 January-31 August 1945.

' Average based on figures for the period 1 January 1943-31 August 1945.
CHAPTER VII

Dental Service in Zone of Interior

FACILITIES PROVIDED, ZONE OF INTERIOR

General Considerations

From the start of mobilization the Dental Division recommended that

wherever possible dental facilities should be centralized into large, efficient,

clinics which would permit specialization and skilled supervision. In July

1940 the Director of the Dental Division proposed:1

1. That the plan for the professional service of divisional camps and other new

stations include a central dental clinic.

2. That the War Department be asked to include in its building program suitable

housing for such a clinic.

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

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

authorized:

DC-1 25 chairs DC-4 3 chairs

DC-2 15 chairs DC-5 1 chair

DC-3 8 chairs DC-6 1 chair

DC-? Clinic

The DC-1 clinic of 25 chairs was authorized for divisional camps or other

stations with a strength of approximately 15,000 men.2It was housed in a

separate, 2-story, frame building 110 feet long and 30 feet wide. The floor

plans of the DC-1 are shown in figure 17. This clinic (figs. 18 and 19) was

furnished with the most modern base equipment, including laboratory (fig. 20),

x-ray, prosthetic, and oral surgical facilities. Each operator was supplied a

standard chair, unit, cabinet, and operating light.

DC-2 Clinic

The DC-2 clinic consisted of a separate, single-story building with space

for 15 chairs. It was a smaller edition of the DC-1, designed to meet the needs

of camps of about 10,000 men.3It was also used as a dental clinic in all station

hospitals of 250 beds or more,4In camps of less than 10,000 men, but large

enough to have a 250-bed hospital, the hospital DC-2 supplied all dental care

1 Memo, Brig Gen Leigh C. Fairbank for SG, 17 Jul 40, sub : Definitive dental service in divisional

camps and other large installations. AG : 632.

2 Dental expansion program. The Dental Bulletin, supp. to the Bulletin of the U. S. Army Medical

Department (cited hereafter as Army Medical Bulletin) 11 : 177, Oct 1940.

3

Ibid. 4

3d ind, TAG to SG, 20 Nov 40, on ltr, SG to TAG, 2 Nov 40, sub : Dental service in cantonment

hospitals—dental laboratory service, divisional areas. AG: 632.
258

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DENTAL SERVICE IN WORLD WAR II

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DENTAL SERVICE IN ZONE OF INTERIOR 259

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

Figure 20. Dental laboratory, DC-1.
260 DENTAL SERVICE IN WORLD WAR II

for the camp. If the installation had a population of more than 10,000 men,

but less than 15,000, additional facilities were provided in the troop area.

Equipment of the DC-2 was comparable to that of the DC-1. See figure 21 for

the floor plan of the DC-2 clinic.

FLOOK. PLAN

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

GRAPHIC SCAt-E

a * 4 b 9 to iz '4 K «ao22 Zf

DC-3 Clinic

The DC-3 clinic, occupying a separate building with space for eight chairs,

was developed about the middle of 1941 to meet the needs of posts of intermediate size.5

Policy for its use was not definitely stated, however, until early

1942, when The Adjutant General approved these installations for camps of

from 3,000 to 6,000 men. The DC-3 clinic was also used in hospitals of from

100 to 200 beds. See figure 21 for the floor plan of the DC-3.

DC-4 Clinic

The DC-4 clinic, with three chairs, was authorized early in 1943, primarily

for use in small unit dispensaries. No separate building was provided and the

clinic occupied space in the regular dispensary quarters. The DC^4 was supplied base-type equipment, with an x-ray machine and some laboratory supplies.6

5 The dental clinic number three. The Dental Bulletin, supp. to Army Medical Bulletin 12: 249,

Jul 1941.

« MD Equipment List No. 95058, 6 Dec 44.
DENTAL SERVICE IN ZONE OP INTERIOR 261

DC-5 Clinic

The DC-5 clinic, with 1 chair, was also authorized in 1943 for use in the

smaller dispensaries where the 3 chairs of the DC-4 were not needed. It had

no x-ray machine and only the most essential laboratory equipment was provided.7 Like the DC-4, it occupied space in a regular dispensary building.

DC-6 Clinic

The DC-6 clinic, which was a simplified version of the DC-5, was intended

for use in prisoner of war camps. It was authorized a base-type chair but no

cabinet. A mobile dental engine was substituted for the operating unit.8

Cosf of th& Various Clinics

The cost of the aforementioned installations was approximately as follows :

9

Building

Type Equipment approximate Total

DC-1 $33,684 $25,000 $58,684

DC-2 20,535 15,000 35,535

DC-3 - 11,356 10,000 21,356

DC-4 5,717 (') 5,717

DC-5 2,425 (>) 2,425

DC-6 1,192 (0 1,192

1 None provided.

By September 1942,100 DC-1,150 DC-2, and 138 DC-3 clinics were in operation

or nearing completion. 10 11

THE DENTAL SERVICE IN A REPLACEMENT TRAINING CENTER

General Considerations

Major dental rehabilitation for the inductee was not initiated until arrival

at a replacement training center, which was recognized to be the most favorable

place in which to concentrate dental facilities. It was the first installation in

which an inductee spent enough time to permit the completion of extensive

treatment.

The replacement training center was a large, fairly stable establishment

where the dental service could be organized for maximum efficiency. Specially qualified dental officers could be assigned to the more critical positions

' MD Equipment List No. 95059, 6 Dec 44.

8 MD Equipment List No. 95054, 6 Dec 44.

» Cost of equipment listed is taken from the ASP Medical Supply Catalog of 1 Mar 44, on file in

HD. The cost of buildings of course varied greatly in different locations and at different times. The

figures quoted are approximate, obtained from the Fiscal Div, CE, Mr. Jonas Stein. They were given

the author in a telephone conversation, 7 Mar 47.

10 Mills, R. H. : Dentistry in the war. J. Am. Dent. A. 15 Sep 42, p. 1754.

"At the time this history was prepared (1947) information was not available on the clinics

constructed subsequent to 1942.
262 DENTAL SERVICE IN WORLD WAR II

and trained auxiliary personnel and clerical assistants were available to take

over many time-consuming, nonprofessional duties.

Soldiers usually went directly from a replacement training center to duty

with operational units and a high percentage were sent overseas within a short

time. It was therefore desirable that all possible treatment be completed during

the training period, and absolutely essential that men leaving the center should

at least meet minimum dental standards for foreign service.12 From the start

of the war the Director of the Dental Division, SGO, recommended that replacement training center dental clinics meet the main burden of dental rehabilitation.

Operation of the Dental Service in a

Replacement Training Center

Time for the treatment of inductees in a replacement training center was

limited; it was also necessary to avoid as far as possible interruption of normal

activities. The dental service in a replacement training center was therefore

organized to attain three primary objectives:

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

treatment immediately.

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

his departure from the center.

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

scheduled training.

No uniform system was prescribed, and each dental surgeon used the

methods which best conformed to his own ideas and to conditions encountered

in his particular camp. The operation of a typical training center dental

service (Fort Knox, Kentucky) has been described as follows:13

Dental surveys were conducted 3 times during each training cycle of 17 weeks. The

first was made within 48 hours after the arrival of the trainees from the induction

centers. A second was made at the completion of the basic training period, before the

start of specialist training. The third or final dental check was conducted during the

final week of the training cycle, just prior to shipment.

All dental surveys were scheduled by the S-3 officer of the center as a part of training

and the company commander was responsible for the presence of all trainees at every

dental check within his unit. Surveys were conducted in the unit area by the dental

surgeon and one assistant. Clerks for the examination were supplied by the unit.

The company was requested to furnish duplicate copies of a current roster for every

survey. At the time of examination an individual survey form was given to each

trainee, who filled in all data on the form except the dental classification and information concerning his dental condition. This form was collected by the clerk at the

time of examination and entry made of the dental classification and pertinent information regarding prosthetic appliances. Forms and rosters were then taken to the office

12 Memo, Brig Gen E. H. Mills for Exec Off SGO, 27 Apr 42. SG : 322.0531.

13 Incl to Personal Ltr, Dr. H. L. Davidson to Col Walter Love, 2 Dec 46. SG : 703.
DENTAL SERVICE IN ZONE OF INTERIOR 263

of the dental surgeon where individual classifications were entered on both copies of

the roster and a record of prosthetic appliances made on the original copy. This

copy was retained by the dental surgeon and the duplicate sent to the company commander for use in filling appointments allotted his organization.

From the data on the individual survey forms an MD Form 79 [now AG Form 8-116,

Register of Dental Patients] was made out for each trainee in need of dental care and

held in the files of the dental surgeon for use at such time as the man was ordered in

for treatment.

Patients were treated at four widely scattered clinics but all orders for trainees

to appear for treatment were issued from the office of the dental surgeon as an official

memorandum over the signature of the commanding general. The dental surgeon consulted flow charts and training schedules so that patients might be called for treatment

during the least important parts of their training cycle, though dental care held

preference over all training. A carbon copy of the memorandum directing men to

report for treatment, a list of the trainees requiring care, and the previously prepared

MD Forms 79 were forwarded to the clinic named in the memorandum.

Patients were ordered for treatment by classification only, and the unit commander

was charged with the responsibility for selecting men of the indicated classification

from his dental roster, detailing them to the specified clinic. Changes in classification

were reported directly from the clinic to the unit of the patient receiving care and to

the office of the dental surgeon. All completed MD Forms 79 were returned daily to

the files of the dental surgeon.

Should the individual clinic chief find it necessary to make changes in the flow of

patients, or should he be confronted by any delinquency in keeping appointments, he

discussed the matter with the dental surgeon, who took the necessary steps to correct

the situation.

The midtraining survey was necessary because a considerable number of trainees

were transferred to new companies due to sickness, emergency furloughs, etc. These

men did not appear on the dental survey rosters of their new organizations and were

easily lost to the dental service. It was therefore deemed advisable to conduct a new

survey at the end of basic training and carry through a second time as the original

had been handled, except that new MD Forms 79 were made for new patients only.

The dental check made a few days before completion of training gave the dental

surgeon a final chance to correct any defects still existing among the men about to

be shipped out. These patients were given the highest priority.

The aim of the dental service of this replacement training center was to put every

man in Class III or IV prior to completion of his training. This policy was rigidly

followed, especially in respect to men being sent to Army Ground Forces replacement

depots. The dental surgeon had the authority to request the removal of specific

persons from shipping orders for dental reasons.

A check of original dental survey rosters over a period of 42 months revealed the

following average classification of men arriving in the replacement training center

from civilian life:

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

Class I-D 5.0%

Class II 22.5%

Class III 1-5%

Class IV 48.5%

330324 0—55 18
264 DENTAL SERVICE IN WORLD WAR II

Treatment Rendered

The personnel of the larger camp dental clinics included specialists in oral

surgery and prosthetics, and the station hospital was able to give institutional

care when it was required. As a result, very few dental patients had to be sent

off the post for other than highly specialized treatment. However, when such

treatment was necessary for conditions which involved badly comminuted or

displaced fractures, severe infections, the removal of tumors, or plastic reconstruction, the patient was usually transferred to a general hospital. Dental

hygienists provided many soldiers with their first instruction in the individual

care of the teeth and the supporting structures. In general, the centralized

clinics of the replacement training centers and other major installations were

well designed to provide rapid, efficient treatment of routine conditions and at

the same time to give the more complex defects the extra attention they required.

The "production line" organization of the larger clinics, with all surgical

and prosthetic care given by specialists, undoubtedly increased output and improved the quality of the treatment rendered. It was not without disadvantages,

however. In particular, the strain on men in the general operative section was

severe. The placing of even routine fillings is meticulous work, hard on the eyes

and nervous system, and requiring a tiring posture. In his civilian office the

dentist is able to get a "change of pace" by doing surgical, prosthetic, or laboratory work, but in a large Army clinic, the officer works continuously at the

chair "plugging amalgams," with another patient always waiting to take the

place of the one just completed. The monotony and physical strain of performing one task over and over for months at a time was a constant cause of complaint. Further, the dentist had no chance to maintain his skill in other

branches of dentistry. The bitterness of young officers toward the "amalgam

line" was certainly a factor in their lack of interest in a career in the Army

Dental Corps after the war.

Personnel Problems

In determining the number of dental officers to be assigned replacement

training centers it was necessary to compromise between what was theoretically

desirable and what was practical with available resources. The Dental Division,

SGO, recommended a ratio of 1 officer for each 300 men in training and this

figure probably represented both the largest number which could be spared and

the smallest number which could provide effective treatment.14 However, the

number of dentists actually provided varied greatly and cannot accurately be

determined, but figures on the overall assignment of dental officers in the Zone

of Interior give some indication of the working ratio.

On 30 November 1942 there was 1 dentist for each 473 soldiers in the United

States. This ratio decreased steadily until April 1943 when each dental officer

" Memo, Chief, Oprs Serv SGO, for CG ASF, 5 Jun 44, sub : Requirements for Dental Corps

officers. HD: 314.
DENTAL SERVICE IN ZONE OF INTERIOR 265

was responsible for 586 men. Thereafter the proportion of dentists again increased until in November 194415

it reached a fairly stable level of 1 officer for

each 350 men. Some Zone of Interior installations (e. g. hospitals) had more

than the average ratio; others had less (e. g. air fields) ; the proportion of 1

dentist for each 350 men is probably not far from the ratio actually provided

replacement training centers in 1944.

THE DENTAL SERVICE IN A ZONE OF

INTERIOR REPLACEMENT DEPOT

The function of the dental service in Zone of Interior replacement depots

was to detect and provide treatment,16 within a maximum of 15 days, for men

who, when reporting for shipment overseas, still failed to meet minimum dental

standards.

The details of operating the dental service in a replacement depot varied

in different installations, but two fundamental requirements had to be kept in

mind: (1) early detection of the men needing treatment, and (2) a system for

insuring that patients were called to the dental clinic without delay and with

minimum chance that they would be "lost" administratively. At one replacement depot, Camp Reynolds, Pa., new arrivals were first assigned to a casual

battalion where processing was completed. Men reporting to this battalion

were marched directly to the dental survey office where 2 dental officers and 3

clerks were constantly on duty. Those in Class I were placed in a separate

company and carried as "unavailable for shipment" until their essential treatment had been completed. The dental service notified the Classification and

Assignment Section whenever a man was ready for shipment and he was then

taken out of the "dental" company and returned to his unit, or to the regular

processing line if he was a casual.17

Personnel were allotted in about the same proportion as for replacement

training centers, for though the men were passing through the replacement

depot in a much faster flow they had generally received more or less complete

dental care at previous stations, so that the average amount of work per individual was much less than in a replacement training center.

Since only the most essential treatment was rendered at replacement depots it might have been expected that extractions and dentures would have

constituted a high proportion of all operations performed. Apparently, how18 The proportion of dental officers to total strength of the Army was calculated by author from

data in Strength of the Army, 1 Mar 46.

16 This service was also to be rendered at ports of embarkation, redistribution and redeployment

stations, but in actual practice these played a minor role in the process; ports of embarkation were

primarily concerned with the supervision of embarkation, and with the sudden end of the war in Asia

the activities of the redistribution and redeployment stations were curtailed almost before they could

reach stable operation.

11 Annual Rpt, Surg Cp Reynolds, 1944. HD.
Percentage offiver

principal

operations in a

replacement depot

Percentage offive

principal

operations in the

Army as a whole

87. 6 78. 1

6.3 18.0

3.8 2.8

2.2 0. 9

0. 1 0.2

266 DENTAL SERVICE IN WORLD WAR II

ever, these major dental deficiencies had usually been corrected at home stations, and work completed at replacement depots consisted of a higher proportion of permanent fillings. The following tabulation compares the treatment

rendered in a replacement depot (Camp Eeynolds) in 1944 with the treatment

rendered in the total Army in the same period:1810

Operation

Permanent fillings

Extractions

Dentures

Denture repairs

Bridges

THE DENTAL SERVICE IN A SEPARATION CENTER

Prior to 1944 the problem of providing dental treatment for men being

discharged from the Army was overshadowed by requirements for the rehabilitation of inductees. A circular letter of 2 September 194.3 prohibited the

practice of informing separatees that they could have their dental work completed in Veterans Administration facilities after discharge and also stated that

"The status of the soldier with reference to his retention in the service should

be clearly understood before any extensive dental treatment is started. Every

effort will be extended to complete all essential dental treatment for a soldier,

once begun, prior to his discharge." w While this letter encouraged the completion of work which had already been initiated, it also had the probable

unintentional effect of discouraging extensive treatment for men due for early

discharge. It was not the desire of the Dental Division or The Surgeon General

to limit treatment for men leaving the service and on 7 March 1944 the Dental

Division recommended that care be made available for all Class I patients prior

to relief from active duty.21 On 31 March 1944 this recommendation was substantially repeated in a memorandum to the Medical Practices Division, SGO,

but no formal action resulted. In a Physical Standards Division conference

on 27 December 1944 the following points were agreed upon with the concurrence of the Dental Division:22

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

2. Treatment to be optional with the man concerned.

3. Priority for treatment of separatees over other personnel to be given

only at separation centers.

" See footnote 17, p. 265.

18 Data on the Army as a whole taken from Army Medical Bulletin 4 : 632, Dec 1945.

20 ASF Ltr 156, 2 Sep 43.

21 Memo, Act Dir Dental Div for Oprs Serv SGO, 7 Mar 44, sub: Dental treatment for personnel

during demobilization. SG : 703.

22 Memo for Record, 27 Dec 44, sub : Office policy regarding dental treatment at separation centers.

HD: 314.
DENTAL SERVICE IN ZONE OF INTERIOR 267

In spite of informal agreement on general policies for the operation of

separation centers no official directive was issued until 10 September 1945.

Technical Manual (TM) 8-255, published on that date, provided that:23

Individuals having Class I dental defects which are incapacitating or likely to

interfere with performance of duties in military or civilian life, or individuals who have

lost anterior teeth in line of duty, will be provided with appropriate treatment and/or

prosthetic appliances prior to separation if the individual so desires. Routine dental

treatment, such as for Class II's, etc., may be provided for individuals, providing time,

facilities and dental personnel are available, and providing the individual elects to

have such treatment.

It was further directed that dental officers would be provided on examining

teams, in accordance with the number of separatees processed daily, as follows:

Number of daily Number of dental

examinations officers on teams

75-150 1

200-300 2

400 3

500-600 4

800 6

1,000 7

1,800 12

These dental officers were concerned only with examinations; treatment was

given in established clinics. In a memorandum of June 1944 it had already been

recommended that dentists be provided separation centers in the ratio of 1

officer for each 300 separatees,24 though the number actually assigned to each

center was determined by the respective service command.

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

Every effort should be made to use existing dental facilities to the fullest capacity,

and when such facilities are inadequate, additional dental equipment should be installed

in other available quarters to meet the local demands.

Dental personnel, officers and enlisted men, should be shifted within the Service

Command to permit the greatest service.

Under the provisions of AR 40-510, C 1, paragraph 5& (3), 10 September 1942, the

procurement of civilian dental laboratory service may be authorized by the Commanding Generals of Service Commands where adequate dental laboratory facilities are not

available and when there is insufficient time to have the cases completed at Central

Dental Laboratories. . . .

At many stations the Dental Service operated a double shift.

The Dental Division was not in a position to predict how much work would

have to be accomplished at separation centers. The dental classification of the

Army was known, but this classification was based on the urgency of the treatment required rather than upon its amount. A man in Class II, for instance,

23 TM 8-255, Terminal physical examination on separation from military service, 10 Sep 45.

24 See footnote 14, p. 264.

25 Ltr, SG to CG 1st SvC, 6 Sep 45, sub : Dental treatment prior to separation from the Army.

HD : 314.
268 DENTAL SERVICE IN WORLD WAR II

might have 1 cavity or 10, so that information on total classifications was of

little value in estimating future needs. Above all, it was impossible to predict

what percentage of men needing treatment would ask for it. Previous experience had indicated that only a small proportion of separatees would risk delaying their discharge even a few hours, but many factors influenced their decisions. It was found, for instance, that more men applied for dental care during

the period when 45-day furloughs for recuperation and recreation were being

granted than afterthat privilege was discontinued.26

Since the requirements for separatee dental service might change from day

to day faster than personnel could be shifted, the service command dental surgeons could only establish the separation center clinics to meet average expected

demands, thereafter maintaining an even flow of patients by varying the types

of service rendered. When the flow of separations was slow, all kinds of treatment were offered and every effort made to complete routine fillings without

delaying the departure of patients from the center. When the flow of separations was rapid, treatment had to be limited to the urgent cases specified in

TM 8-255.

The organization of the dental service of a separation center offered peculiar problems which were solved in different ways on different posts. Separatees were understandably impatient to be released from the Army, even when

they had asked to be held for dental care. They wanted furloughs and passes

and often failed to return in time for appointments. Keeping in touch with

the men under treatment was in itself a major problem, and constant supervision was needed to insure that service was rendered as speedily as possible

and that patients were released for discharge as soon as their dental work was

completed. Men requiring prolonged treatment were withdrawn from processing, but every effort was made to complete minor care without delaying departure of the patient, although in many cases only a few nighttime hours were

available for such treatment out of the 48 which the separatee spent in the

center.

The system in operation at Fort Monmouth was typical of the elaborate

methods used to control the dental patient in a separation center.27 The salient

points of the Fort Monmouth plan were as follows:

1. Patients were classified into three broad groups according to the type

and amount of treatment needed:

a. Men for whom treatment was urgent, including those requiring replacement of missing teeth, received first priority and at their own request

were withdrawn from processing until treatment was completed. No man in

this group was refused care regardless of the backlog of patients.

26 Incl to ltr, Col Arne P. Sorum to Dental Div SGO, 30 Oct 46, sub : Dental treatment at a separation center. HD: 314.

" Memo, Maj Joseph G. Kosen for OG 1260th SCÜ, 16 Nov 45, sub : Plan of dental treatment at

separation center, Fort Monmouth, N. J. SG : 703 (Ft. Monmouth) N. J.
DENTAL SERVICE IN ZONE OF INTERIOR 269

b. Men needing extensive but routine dental care were also withdrawn

from processing at their own request if the backlog of patients was sufficiently

small to permit starting their work within a reasonable time. But these were

not accepted unless they could be given appointments within 36 hours.

c. Men needing routine care which could be completed at one sitting

were given appointments during free periods of their processing schedule if

such were available. Because these men were often fully occupied during

the few daylight hours they passed in the installation, their work was frequently done at night. If no free time was available for completing their

work during the normal processing period they could be voluntarily withdrawn from the schedule under the same provisions as men in group b.

2. A dental officer was on duty at the Initial Keceiving Point (IRP) at

all times when separatees were being processed. This officer was notified in

advance as to how many appointments of each type he might give out during

the day. The IEP dental officer explained to each group the possibilities of

getting dental treatment. If ample appointments of all types were available

he notified the separatees that those requiring extensive care could be withdrawn from processing for such treatment and that those with minor defects

could have their work completed without delaying their departure from the

separation center. If appointments could not be given during the normal

period of processing, but would be available within 36 hours, it was explained

that all men needing treatment could be given appointments but that it would

be necessary to withdraw them from processing until such treatment was

completed. If the accumulated backlog of patients was such that no appointments could be given within 36 hours it was explained that only urgent

cases would be accepted and that it would be necessary to hold these from

processing. The IRP dentist then examined those separatees who feltthatthey

qualified for treatment and who volunteered to delay their departure if that

was necessary. Those in the first two groups were immediately suspended

from processing by notification to the IRP officer and given colored cards

which they took to the dental clinic as authority for starting treatment (blue

cards for Class I's, pink cards for Class IPs). Men in the third group were

given white appointment cards to the dental clinic for a period when they

were not required for processing.

3. All separatees were given a chance to request dental care at the IRP,

as explained above. Those in Class I were given another opportunity to

request treatment when they were given the dental examination during processing. To avoid withdrawing partially-processed men from the line, those

who did not require urgent care were not accepted later unless they had asked

for treatment when given the opportunity at the IRP.

4. On arrival at the dental clinic men in the first two groups were given

appointments and their names entered on "suspense logs." The IRP dentist

also sent in a list of those placed on suspense during the day and this was
270 DENTAL, SERVICE IN WORLD WAR II

checked against the clinic suspense log to insure that all men withheld had

actually reported to the dental clinic. This log was checked periodically to

detect for investigation any patient who had been on suspense for an unusually

long period. Any Class II patient who failed to keep an appointment was

automatically released from suspense. The colored cards which patients

brought to the dental clinic were clipped to their dental records and, when

treatment was completed, were filled in on the reverse side and placed in a

box which was emptied every hour. Separation center headquarters was in

turn given, by telephone, an hourly list of men whose cases had been closed,

and this list was verified in writing at the end of the day. A patient was

thus released to continue his processing within an hour after his treatment

had been completed. No special check was needed for men given white cards

for minor care since they were not withdrawn from the processing schedule.

The proportion of separatees needing treatment was only a fraction of the

number who had needed care when they entered the service. Of 278,309 separatees processed at Fort Dix between 1 March and 30 September 1946 only 0.86

percent needed extractions or other urgent treatment, only 1.75 percent, replacement of missing teeth, and 10.15 percent, fillings or other routine care.28 Of

those requiring treatment only a small percentage were willing to delay their

discharge even a few days.

The total number of separatees who received dental treatment at the time

of separation is not known since a report was made only of those suspended

from processing, and many thousands had minor work completed while on the

normal separation center schedule. During the demobilization period, from

May 1945 through October 1946, about 111,800 persons were withdrawn from

the examining line because they needed urgent oral treatment requiring a delay

in their separation. Of these, about 104,900 were for dental defects, and about

6,900 for mouth and gum defects. These withdrawals constituted 1.6 percent

of all personnel processed for separation during this period: 1.5 percent for

teeth, and 0.1 percent for mouth and gum defects. While the proportion of

men withdrawn from the line for dental reasons may seem to be relatively small,

the number of persons who received such care is obviously quite important.

In fact, the withdrawals for dental reasons made up about 36 percent of the

withdrawals for all physical reasons. About 2.6 percent of the persons withdrawn for dental reasons required inpatienttreatment.29

Among the soldiers willing to wait for dental treatment, a high proportion

needed extensive prosthetic replacements. Over 65 percent of the men held for

treatment at Fort Dix required replacement of missing teeth. Special prosthetic sections had to be set up in many clinics and civilian laboratories called

»See footnote 26, p. 268.

29 Unpublished data from Medical Statistics Div SGO, based on special reports dealing with the

processing of military personnel at separation centers, points, and bases.
DENTAL SERVICE IN ZONE OF INTERIOR 271

upon to carry some of the unusual load. At Fort Dix, when 4,500 men were

being discharged daily, 1 officer with a staff car was kept busy delivering and

picking up cases from civilian laboratories.30

As a means of saving money the program for dental treatment of separatees

was not too successful. The Veterans Administration soon provided dental

care for "service connected" defects of former military personnel and the many

men who had refused such treatment at a separation center were able to have

their work completed later at Government expense. The program did give

the soldier a last chance to have essential work completed before he returned

to civilian life, however, and those who took advantage of the offer were generally the most urgently in need of care and the most deserving of consideration

by the Army.

Summary, Dental Service in Separation Centers

1. After extensive service in the Army the average separatee needed

relatively little dental care.

2. The majority of the men willing to delay their discharge to receive dental

treatment required extensive replacements, necessitating special prosthetic

facilities and the use of civilian laboratories.

3. To be effective, the dental service of a separation center must have the

facilities and organization adequate to handle as many patients as possible

during the normal separation period. Very few men will take advantage of

the proffered treatment if they must be suspended from processing to receive it.

To reach as many of these as possible it becomes necessary to operate extensive

facilities outside of regular duty hours.

THE DENTAL SERVICE IN ZONE OF

INTERIOR STATION HOSPITALS

Each Zone of Interior post of any importance had its own station hospital

for the institutional medical care of local personnel. These hospitals were not

expected to render highly specialized treatment but were equipped and staffed

to handle all routine medical and surgical conditions. They varied in size

from 25 to 1,000 beds or more. In small hospitals of less than 100 beds the

dental clinic normally occupied a part of the administration building. Intermediate hospitals of from 100 to 200 beds were authorized a separate dental

clinic of 8 chairs (DC-3), while hospitals of 250 beds or larger were provided

a separate clinic building of 15-chair capacity.31 The hospital clinics were

10 See footnote 26, p. 268. 31 Data on the dental clinics provided the smaller station hospitals obtained by the author from

Mr. James J. Souder, Act Chief Hospital Construction Br Hospital Div SGO, on 14 Apr 47. Hospitals

of 250 beds or larger were authorized DC-2's by 3d ind, TAG, 20 NOT 40, on Ltr, SG to TAG, 2 Nov 40,

sub: Dental service in cantonment hospitals—dental laboratory service, divisional areas. AG: 632.
272 DENTAL SERVICE IN WORLD WAR II

authorized base-type chairs, units, cabinets, x-ray machines, and laboratories.

Equipment and instruments were adequate for all routine operations.

Unlike overseas station hospitals, the Zone of Interior station hospitals

had no prescribed allotments of personnel. The number of officers and enlisted

men required in each situation was determined within the service command

on the basis of relative strength, the primary activity of the post, and individual

ideas of the staff officers concerned. Late in the war (October 1945), ASF published a "guide" for the allotment of officers and men to station hospitals. It

suggested that 1 dental officer and iy2 enlisted men be provided for each 200

hospital beds. Since the hospital dental clinics on the smaller posts had to

furnish all dental care for the troop areas as well as for hospital patents, it was

recommended that they be allowed 2 additional dental officers and 3 enlisted

men for each 1,000 troops.32 This directive was only advisory, however, and

not binding on local commanders.

The station hospital dental clinics fulfilled different functions on posts

of different sizes, as follows:

1. On posts of less than 10,000 men the hospital dental clinic normally

furnished all definitive dental treatment for the command, including routine

care for outpatients, laboratory service, and any treatment of hospital patients

which was not of a highly specialized nature. If tactical units were present

on the post their own dental officers conducted surveys, held sick call, and

rendered emergency care to their men, but all other treatment was carried out

in the hospital clinic, sometimes with the aid of the tactical dentists on temporary duty. The hospital clinic constructed prosthetic appliances, placed

permanent restorations, treated infections about the mouth, extracted diseased

or impacted teeth, and rendered emergency treatment to serious facial injuries

pending their transfer to a hospital where specialized care would be given.

2. On posts of more than 10,000 men the hospital dental clinic provided

routine care only for hospital patients. In addition it undertook the more

difficult types of treatment such as the construction of complicated prosthetic

replacements or the extraction of impacted teeth. It provided care for infections or other conditions which could not be treated on a duty status and

rendered emergency treatment for serious facial injuries. Simple fractures

might be handled in the hospital dental clinic but more difficult surgical cases

were normally transferred to a general hospital. Routine fillings, prosthetic

restorations, and extractions for nonhospitalized personnel were taken care

of in the troop-area clinics.

The maximum number of station hospitals in the United States was

reached at the end of 1943 when 611 hospitals provided bed space for 270,499

patients.33

32 ASF Ltr 389, 16 Oct 45.

33 Info from flies of Medical Statistics Div SGO.
DENTAL SERVICE IN ZONE OF INTERIOR 273

THE DENTAL SERVICE IN ZONE OF

INTERIOR GENERAL HOSPITALS

Zone of Interior general hospitals were strategically located to provide

highly specialized medical and surgical care which could not be furnished in

the station hospitals. A circular letter of 1 January 1943, stated that:34

General hospitals are established and maintained to afford better facilities than

ordinarily can be provided in station hospitals for the observation, treatment, and

disposition of complicated or obscure cases ; for the performance of the more formidable

surgical operations; and to provide beds for the evacuation of station hospitals. . . .

No hard and fast rules can be laid down, but in general it will be the policy of the

Medical Department to treat as general hospital cases all patients who require more

than 90 days' hospitalization, as well as all cases requiring specialized treatment which

is not available at station hospitals. . . .

Complicated or severe fractures of the long bones, facial bones, and fractures of the

vertebrae should be transferred to a general hospital as early as possible. . . .

It was soon apparent, however, that not even all of the general hospitals could

provide certain types of treatment. The Adjutant General therefore directed,

in March 1943, that maxillofacial cases would be sent to one of the following

general hospitals:35

Bushnell General Hospital, Brigham, Utah.

O'Reilly General Hospital, Springfield, Mo.

Valley Forge General Hospital, Phoenixville, Pa.

Walter Reed General Hospital, Washington, D. C.

The number of hospitals offering maxillofacial care increased gradually until

the following eight installations were designated as maxillofacial hospitals in

August 1944:36

Baker General Hospital, Martinsburg, W. Va.

Beaumont General Hospital, El Paso, Tex.

Cushing General Hospital, Framingham, Mass.

Dibble General Hospital, Menlo Park, Calif.

Northington General Hospital, Tuscaloosa, Ala.

O'Reilly General Hospital, Springfield, Mo.

Valley Forge General Hospital, Phoenixville, Pa.

Wakeman General Hospital, Camp Atterbury, Ind.

These installations were given specially trained personnel and every item of

equipment needed for performing the most exacting operations on the oral

and facial structures. The other general hospitals had qualified oral surgeons,

prosthodontists and operative personnel, and laboratory and x-ray equipment,

for the treatment of any but the most unusual cases.

As in the case of the station hospitals, allotments of personnel for general

hospital dental clinics were determined within the service commands. Pro34 SG Ltr 1, 1 Jan 43. . 35 WD AG Memo W40-9-43, 6 Mar 43, sub: General hospitals designated for special surgical

treatment. AG : 705.

36 WD Cir 347, 25 Aug 44.
274 DENTAL SERVICE IN WORLD WAR II

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

listed:3T

Number of beds Number of dental officers

1,000 7

1,500 8

1,750 9

2,000 12

2,500 14

3,000 16

3,500 19

4,000 21

The maximum number of general hospitals in the United States was

reached in 1945 when 65 installations provided bed space for 153,595 patients.38

DENTAL SERVICE ON HOSPITAL SHIPS

Since the primary purpose of hospital ships was transportation rather

than definitive treatment, the Dental Service operated on a slightly smaller

scale than in a hospital of corresponding size. Ships of 400-bed capacity or

less had a single exodontist in the grade of captain or lieutenant; with 500

beds an oral surgeon in the grade of major was authorized; with 600 to 800

beds 2 officers were allotted, with the senior in the grade of major; ships with

900 or 1,000 beds had a lieutenant colonel, a major, and a captain or lieutenant;

vessels carrying 1,500 beds had a lieutenant colonel, a major, and 2 captains or

lieutenants.39

Hospital ships carried full base dental equipment, including prosthetic

and x-ray facilities. As mentioned, the smaller vessels were authorized an

exodontist, larger craft an oral surgeon. All types of work were possible and

needs of seriously wounded or ill patients could be met en route.

The Dental Service of hospital ship platoons proved less satisfactory.

These auxiliary units were used to provide medical care for patients returning

to the Zone of Interior on ordinary transports. Each platoon with a capacity of

100 or more patients was authorized a dental officer.40 A large proportion of

all patients with maxillofacial injuries were transported by air, however, and

these small contingents had little need for a dentist. Also, much valuable

time was wasted in long "layovers" between trips. Since specially qualified

exodontists or oral surgeons could not be spared for such minor organizations

it was found that the men assigned were often young and inexperienced.41

In view of these considerations the Dental Division decided that it would be in

37 WD Cir 209, 26 May 44.

88 See footnote 33, p. 272.

39 T/O&E 8-537T, 7 Dec 43 ; T/O&E 8-537, 3 Mar 45.

40 T/O&E 8-534, 21 Oct 43.

« History of the Dental Division, Ho. BTOUSA, 1 Sep-31 Dec 1944. HD.
DENTAL SERVICE IN ZONE OP INTERIOR 275

the best interests of all concerned if the dental officers and their equipment

were removed from hospital ship platoons.

A recommendation to this effect was made to the Operations Service, SGO,

7 March 1944.42 No action being taken, it was repeated 7 December 1944.43 The

new recommendation was approved by the Technical Division, to which it was

first sent, and forwarded on 20 December 1944 to the Hospital Division for

comment. The Hospital Division disapproved the proposed action because (1)

it was felt that the dental officer would be of some use treating patients, (2)

dentists were filling administrative positions which would have to be filled by

Medical Administrative Corps officers if the dental officers were removed, and

(3) it was believed that the dentists with the hospital ship platoons would

serve as a useful pool of officers from which to draw in case of special need.44

Faced with this nonconcurrence the Dental Division dropped the matter, though

it still held that the use of dentists in hospital ship platoons was wasting manpower needed elsewhere.

DENTAL SERVICE ON ARMY TRANSPORTS

In World War I regular dental service on Army transports, as distinguished from incidental treatment rendered by transient dental officers, was not

inaugurated until the latter part of 1919, when most ships on the Atlantic run

were provided dental personnel and equipment. The Surgeon General's annual

report for that year stated that experimental installations had proved so successful that new transports were being built with space for a dental clinic

especially provided.45 In the period of retrenchment following World War I,

however, and with the withdrawal of most troops from overseas areas, this

project was neglected. In the period preceding World War II the transport

surgeon was normally equipped with a few essential dental instruments, and if

no dental officer was on board as a passenger he took what measures he could

to relieve pain until the ship docked. Army regulations authorized the assignment of dentists "if required," but did not specify definite conditions under

which such assignment would be made.46 So long as transports were small the

absence of a dental officer was not serious, but when ships capable of carrying

10,000 men were taken over at the start of the war adequate dental facilities

became a necessity.

On 26 January 1942 the Dental Division recommended to the Finance and

Supply Division, SGO, that a dental field chest be placed on every transport

42 Biweekly Dental Service Reports, 1 Jan 1944-30 Oct 1945. HD : 024.

« Memo, Dir Dental Dlv for Dir Technical Div SGO, 7 Dec 44. HD : 314.

"Memo, Col A. H. Schwiehtenberg, Dep Chief Hosp Dir for Chief Technical Div SGO, 23 Jan

45, sub : Dental officers in medical hospital ship platoons. HD : 314.

«Annual Report of The Surgeon General, U. S. Army, 1920, Washington, Government Printing

Office, 1920, p. 303.

M AR 30-1150, 16 Sep 42.
276 DENTAL SERVICE IN WORLD WAR II

so that emergency treatment could be rendered, presumably by personnel travelling on the ship.47 No specific action was taken, and in August 1942 the Dental

Division resubmitted the recommendation, accompanied by the following extract from a letterreceived from the European theater:4S

One of my greatest headaches, and the source of my greatest complaints, is the dental

service on board transports en route to this theater of operations. As previously stated,

in many cases there is little or no dental equipment on board these transports to relieve

the urgent dental emergencies. Reports come to me of acute conditions going untreated

during the entire voyage.

The Chief of the Finance and Supply Division answered that he knew

of no convoys which had not had an adequate number of field chests assigned

and suggested thatthe trouble lay in coordination at the ports.49 On 16 September 1942 The Surgeon General directed all port surgeons to make maximum use

of the available dental equipment and officers to insure that each transport complement was afforded at least emergency dental care.50 On 23 November 1942

Col. Thomas C. Daniels, DC, was assigned to the New York Port of Embarkation to supervise the transport dental service under the port surgeon, and to take

any action required to provide dental officers and equipment on transports leaving the harbor. These steps were apparently effective, at least so far as the

eastern seaboard was concerned, for the dental surgeon of the European theater

reported in October 1943 that he had had no further trouble due to inadequate

dental treatment on transports bound for England.51 Dental field chests were

still not standard components of the medical equipment of transports, however,

and on 7 March 1944 the Dental Division again recommended to the Operations

Division of the SGO that M. D. Chest No. 60 be routinely authorized for all

ships carrying Army personnel.52 An equipment list published about a month

later listed the dental field chest as a regular item for troop ships.53

When used on the larger transports field equipment left much to be

desired. The amount of treatment to be rendered might equal that of a

small post, and one ship reported that the dental clinic was in constant use

from 8 a. m. to 9 p. m.54 In addition, the light wooden chair of the field set

proved very unstable at sea and the foot engine was difficult to operate on an

undulating platform. On 20 June 1944, after a conference with the Director

of the Dental Division, the surgeon of the San Francisco Port of Embarkation

«Memo, Col Don G. Moore for Finance and Supply Div SGO, 28 Jan 42. SG : 444.4-1 (BB).

« Memo, Col Rex McDowell for SG, 26 Äug 42. SG : 703.1 (BB).

" Memo, Col F. C. Tyng, Finance and Supply Div SGO, for Gen J. C. Magee, 28 Aug 42. SG:

703.1 (BB).

M Ltr, SG to CGs of all ports of embarkation, 16 Sep 42, sub : Dental attendance of troop transports. SG: 703.-1.

«Ltr, Col William D. White to Maj Gen Robert H. Mills, 22 Oct 43. HD: 703 (ETO).

82 See footnote 42, p. 275.

» Incl 4, Equipment List No. 9N809, to Ltr, Chief Oprs Serv to CofT, 3 Jul 44, sub : Dental

equipment for transports. SG : 444.4 (BB).

M Rpt, dental surg of an unnamed transport, 21 Jul 44. HD: 460 (Army Transport).
DENTAL SERVICE IN ZONE OF INTERIOR 277

asked that permanent outfits be authorized for troop transports operating out

of that base55and 4 days later his medical supply officer submitted a requisition for 50 units, chairs, cabinets, air compressors, and operating lights.56 On

the recommendation of the Dental Division this requisition was approved.

On 28 June 1944 the Dental Division recommended to the Technical Division, SGO, that current equipment lists be amended to authorize base-type

dental outfits for Army transports.57 For reasons which remained obscure,

this recommendation was neither adopted nor disapproved. Its status on 14

December 1944 was described in a letter from the Chief of the Technical

Division to the Chief of Operations Service, in which it was stated, in effect,

that all efforts to get a decision from the Chief of Transportation had failed

but that under existing instructions port surgeons could get the necessary

equipment when they wished. It was further stated that "It is informally

understood that the Chief of Transportation prefers this arrangement to any

set requirement which would necessitate the automatic installation of dental

equipment on all transports regardless of the circumstances under which they

operate or the availability of permanent dental personnel."58 By 6 February

1945 the Dental Division had apparently given up any hope of having permanent dental outfits authorized as standard equipment and asked the Technical Division to distribute a list of recommended items to assist port surgeons

in ordering supplies on their own responsibility.59 The Technical Division

concurred in this request since it also had many inquiries from port surgeons

concerning appropriate outfits.60 The Supply Service, SGO, disapproved,

however, for the reason that it would be tantamount to authorizing the issue

of items for which no formal procurement authority existed.61 Meanwhile,

port surgeons had been able to have the desired equipment installed in many

transports without the formal approval of either the Chief of Transportation

or The Surgeon General. By the end of November 1944, 35 ships had been

so equipped62and by March 1945, 63 transports had permanent chairs and

units. Since the most important needs had been met by these conversions the

Dental Division notified the Technical Division on 7 March 1945 that no further efforts would be made to have the base outfits placed on the standard

equipment list.63

K

Ltr, Brig Gen Wallace DeWitt to Col Rex McDowell, 20 -Tun 44. SG : 444.4-1 (BB).

56 Incl 3, ltr, Col F. C. Tyng to Chief of Supply Div SGO, 24 Jun 44, sub : Requisition No. D 4424-44,

to ltr, Chief Oprs Serv to CofT, 3 Jul 44, sub : Dental equipment for transports. SG : 444.4 (BB).

" Incl 1, Memo, Col Rex McDowell for Technical Div SGO, 28 Jun 44, to ltr, Chief Oprs Serv to

CofT, 3 Jul 44, sub : Dental equipment for transports. (SG : 444.4 (BB).

58 Ltr, Chief Technical Div to Chief Oprs Serv SGO, 14 Dec 44, sub : Dental equipment for Army

transports. HD: 314.

59 Memo, Dental Div for Chief Technical Div SGO, 6 Feb 45. HD : 314.

»»Memo, Chief Technical Div for Chief Supply Serv SGO, 21 Feb 45, sub: Dental equipment for

Army transports. HD : 314.

« 1st ind, Chief Supply Serv, 26 Feb 45, to memo cited in footnote 60 above. HD: 314.

«

2 Memo, Col Rex McDowell for Chief Technical Div SGO, 30 Nov 44. HD ; 314.

63 Ibid.
278 DENTAL SERVICE IN WORLD WAR II

PROSTHETIC FACILITIES IN THE ZONE OF INTERIOR

Prior to World War II, prosthetic facilities were concentrated in central

dental laboratories (figs. 22, 23, and 24). For a peacetime Army, or for small

stations scattered over a corps area, these well-equipped laboratories, staffed

with skilled technicians, could complete dentures or appliances with enough

efficiency and economy to outweigh the disadvantages of transporting these

cases considerable distances. However, with a fully mobilized Army, it was

recognized that the facilities of the existing central dental laboratories were

inadequate to meet the demands of the increased prosthetic needs °* and plans

were made to inaugurate laboratory facilities in the larger camps.

From the outset some laboratory space and equipment was provided in all

the larger dental clinics. To reinforce these facilities The Surgeon General

recommended to The Adjutant General on 2 November 194065that a DC-2

clinic be established in each station or general hospital of 250 beds or more.

On 20 November 1940 The Adjutant General approved this action with additional comment as follows:m 67

In camps of less than 10,000 strength the building will provide dental chairs for all

camp personnel, including hospital patients, and laboratory space for necessary making

of prosthetic appliances. In camps of over 10,000 strength the building will provide

dental chairs for hospital patients only, and laboratory space for making prosthetic

appliances. The division of floor space between chairs and laboratory will be made

locally.

Four months later, in March 1941, the Dental Division found it necessary

to ask that laboratory equipment for these station hospitals be increased

slightly, though it was still expected that the hospital laboratories would sufficiently reinforce the small prosthetic facilities in the camp dental clinics.68

By May 1941 the Director of the Dental Division foresaw that larger

laboratories would be required in training camps and other strategic locations

and announced a plan for their construction.69 Responsibility for obtaining

these installations, however, was left largely to local dental surgeons. In fact,

Maj. Gen. Eobert H. Mills, who became Director of the Dental Division early

in 1942, subsequently stated that he had at first attempted to have additional

CDL's authorized, and only after this recommendation had been rejected by

The Surgeon General did he definitely decide to establish laboratories in each

"Final Report for ASF, Logistics in World War II. HO: 319.1-2 (Dental Div).

65 Iitr, SG to TAG, 2 Nov 40, sub : Dental service in cantonment hospitals—dental laboratory

service, divisional areas. AG : 632.

" 3d ind, TAG, 20 Nov 40, to ltr cited in footnote 65.

61 The footnote referred to here is found only on a single copy of the basic communication. AG : 632.

68 Memo, Brig Gen Leigh C. Fairbank for Finance and Supply Div SGO, 13 Mar 41. SG: 444.4-1.

68 Fairbank, L. C.: Prosthetic dental service for the Army in peace and war. J. Am. Dent. A. 28 :

798-802, May 1941.
DENTAL SERVICE IN ZONE OF INTERIOR 279

•*ft

B i

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

Figure 23. Flashing and defiasking unit, Central Dental Laboratory.

330324 0—55 19
280 DENTAL SERVICE IN WORLD WAR II

camp of 10,000 men or more.70 Standard camp laboratory equipment was prescribed in March 1943. In the annual report of the Dental Service for the fiscal

year ending 30 June 1943, it was noted that "An increasing number of the larger

camps have been able to institute their own laboratory service, thereby reducing

the load on the central dental laboratories." 71 From the annual report of the

Dental Service for fiscal year 1944 it was noted "The tremendous requirements

Figure 24- Vitallium unit, Central Dental Laboratory.

for dentures made it necessary to expand the laboratory facilities to include

those camps of 10,000 or over. . . ." 72 It was not until 1946, however, that a

War Department circularstated unequivocally that:

All general hospitals, camps and stations with a military strength of 10,000 or over

will furnish their own laboratory service with the provision that each of those stations

is authorized to forward cases to the central dental laboratory serving its service command when local facilities cannot meet the demands, and cases which require special

fabrication methods available only at central dental laboratories.

Laboratories established in the more important camps were often larger

than the peacetime CDL's. Fort Knox, Ky., for instance, had 2 laboratories

employing a total of about 25 men to provide prosthetic service for a strength

of from 15,000 to 20,000 trainees.74

*> Memo, Brig Gen R. H. Mills for Supply Serv SGO, 15 Feb 43. SG : 322.15-16.

" Annual Rpt, Dental Serv, 1943. HD.

« Annual Rpt, Dental Serv, 1944. HD.

'» WD Cir 21, 22 Jan 46.

" Info given to author by Col Walter D. Love, former dental surg at Ft. Knox.
DENTAL SERVICE IN ZONE OF INTERIOR 281

General approval by the War Department did not in itself insure that adequate facilities would be provided these camp installations, however. Under

the usual system of assigning enlisted men, camp dental surgeons still had to

obtain allotments of personnel in competition with all other branches. Moreover, there was no backlog of trained laboratory men in replacement centers in

1942 and 1943. Often a large proportion of all enlisted men allotted to the

dental clinic had to be put on duty in the laboratory, leaving few assistants for

the operating sections. Later, civilian assistants were hired to replace the

technicians so lost, but at first, when demands were greatest, the activities of

many dental clinics were hampered by the necessity of assigning half or more

of their men to the construction of prosthetic appliances.

The camp laboratories reduced the strain on the CDL's, but prosthetic

service still had to be provided for a large number of stations too small to

operate their own establishments. It was therefore necessary to multiply the

facilities of the five existing CDL's, and their increasing output from 1940

through 1944 is shown in the following tabulation:75 76"

Total cases

Year completed

1940 --

10

-

658

1941 10,658

1942_-

_ ~_ " 48,012

1943 _" 216, 358

1944] 178,034

1945 153,908

But while the total output of the CDL's expanded about 2,000 percent between

1940 and 1943, they completed in 1943 only 22 percent of all prostheses constructed in the United States, as compared with over 50 percent in 1940.

Operation of the Laboratory Service

There can be no doubt that the prosthetic service was severely hampered

by shortages of personnel and equipment at a period when the demand for

dental appliances was increasing many times as rapidly as the strength of the

Army.78 In spite of these difficulties there was surprisingly little delay in the

processing of cases. In July 1943 the Director of the Dental Division stated

that the current time interval from impression to insertion of the finished

appliance was as follows:79

Data on the annual output of the CDL's in 1940 are taken from Annual Report . . . Surgeon

General, 1941.

" Figures for 1941-43 are found in Annual Rpt, Dental Serv, 1944. HD.

" Figures for 1944 are found In Annual Rpt, Dental Serv, 1945. HD.

"For discussion of personnel and supply difficulties see chapters on "Personnel and Training"

and "Equipment and Supply."

'»Memo, Brig Gen R. H. Mills for Chief Prof Serv SGO, 19 Jul 43, sub : Construction of dentures.

SG: 444.4-1.
282 DENTAL SERVICE IN WORLD WAR II

Percentage of

appliances

Elapsed time completed

1-7 days 33

8-10 days 21

11-14 days 18

15-21 days 17

22-28 days 6

over 28 days 5

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

Percentage of

appliances

Elapsed time completed

1-7 days 54

8-10 days 18

11-14 days 11

15-21 days 10

22-28 days 5

over 28 days 2

A comparison of the time required for the completion of cases in CDL's

and station laboratories is given in the following tabulation, based on 21,156

appliances processed in CDL's and 73,416 in station laboratories between 1 June

and 31 August 1943:80

Percentage

completed Percentage

in camp completed

Elapsed time laboratories in CDL's

0-6 days 39.9 67.3

7-10 days 23. 8 17. 7

11-14 days 14. 8 7.2

15-21 days 12.4 4. 8

22-28 days 4.0 1.6

over .28 days 5. 1 1. 4

It is evident that CDL's were able to process cases in considerably less

time than the camp laboratories. This advantage was somewhat reduced, of

course, by loss of time in the mails for cases sent to the CDL's, and 21.8 percent

of all cases completed in c^mp laboratories were actually inserted within 6

days after the impression was taken, compared with only 15.3 percent of the

cases completed in CDL's. But for any laboratory time over 6 days the greater

speed of the CDL more than offset the time required for mailing, so that except

for the 21.8 percent of the camp laboratory cases completed in less than 6

days the actual elapsed time between taking of impressions and insertion of

the finished denture was less for appliances made by the CDL's than for appliances completed at the patient's home station. Actual elapsed time from impressions to insertion of the finished dentures for cases completed in CDL's

and camp laboratories is shown in the following tabulation:81

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

81 Ibid.
DENTAL SERVICE IN ZONE OF INTERIOR 283

Percentage

completed Percentage

in camp completed

Elapsed time laboratories inCDL's

0-6 days 21. 8 15.3

7-10 days 24.8 35.8

11-14 days 17-

6

22. 8

15-21 days 17-

8 15

-

6

22-28 days 8-

6 5

-

7

over 28 days 9-

4 4

-

8

Data on the output per technician are limited to the larger laboratories

because of obvious difficulties in determining how much time was actually

devoted to technical procedures in the smaller units. Figures given for the large

laboratories include all dentures, repairs and bridges, though the latter item

constituted a negligible part of the total. On this basis each technician completed 58.6 cases per month in 1943 and 51.0 cases per month in 1944.82 83 The

decrease in output per technician in 1944 was probably due to a slackening in

the demand for dental appliances, which had made it necessary to operate with

considerable overtime in 1943.

Use of Civilian Laboratories

In some individual centers the situation was more critical than indicated

by the aforementioned figures. In July 1943 Fort Bragg reported that minimum time required for completion of a prosthetic case was 35 days; average

time 56 days, while some patients had had to wait 120 days for their appliances.

Fort Riley reported an average period of 91 days between impression and completion of dentures.84 To meet these emergency situations the Dental Division

was forced to make temporary use of civilian laboratories. In a letter of 26

November 1942 The Surgeon General called the attention of local commanders

to their authority to send cases to civilian installations and requested that they

take necessary action when military facilities were inadequate.85 86 The following day a second letter placed some restrictions on the amounts and types of

service to be obtained from the civilian laboratories, as follows:8T

a. This is an emergency measure to relieve the present critical situation in construction of needed prosthetic appliances only until our dental laboratories are established

and equipped to take care of our needs. It is in no manner to be construed as a

reason for any delay of effort to establish and place in full operation laboratories adequate to care for all local needs in all large camps. The Central Dental Laboratories

will then be able to meet the demands made upon them by smaller stations.

82 Data for 1943 computed from History of the Army Dental Corps, 1941-43. HD.

83 Data for 1944 computed from Annual Report of the Dental Service, .Tan-Dec 1944. HD.

84 M;emo, Lt Col R. S. Nourse, AG Replacement and School Command AGF for CG AGF, 13 Jul 43,

sub : Bye correction and dental restorations. SG : 444.4-1.

» AR 40-510, C 1, 10 Sep 42.

M Ltr, SG to CG 1st SvC, 26 Nov 42, sub: Prosthetic dental appliances. SG: 703.

87 Ltr, SG to CG 1st SvC, 27 Nov 42, sub : Dental appliances constructed by civilian laboratories.

SG: 703.
284 DENTAL SERVICE IN WORLD WAR II

b. When laboratories are established as above, except in isolated cases, there will

be no need for further employment of civilian laboratories for the construction of

dentures.

c. No special appliances, such as all-cast dentures of gold, ticonium, vitallium, or

similar materials, are to be authorized under provisions of this letter.

d. In approving vouchers for payment care will be taken to assure that the prices

charged are reasonable and not above those charged civilian dentists for similar work

in the locality.

After March 1944 payment for civilian laboratory service was made by the

service commands and it is therefore not known how many cases were completed

under this plan. In 5 months, from March through July 1943,16,607 dentures

were constructed by civilian laboratories,88 amounting to 5 percent of the total

of 327,838 appliances constructed for Army personnel in the United States in

the same period. From April 1943 through January 1944 a single medical

depot at Los Angeles paid vouchers for dentures constructed for 8,643 patients,

costing $276,271.35, or an average of $31.96 per patient.89 At this installation

the cost of dentures increased gradually from $23.09 per patient at the start of

the program to well over $30.00 at the end of the period reported upon. (About

40 percent of these patientsreceived 2 appliances.)

Important as the civilian laboratory service was in an emergency, it did

not supply a significant proportion of the total cases completed. By September

1944 the central laboratories were able to handle all cases not completed in

their home stations and a circular letter announced that a station unable to

complete any appliance within 1 week would forward such appliance to a CDL.

It also directed that station laboratories would be discontinued where diminishing activities warranted this step.90

Coordination of the Activities of

Camp and Unit Dental Officers

Tactical units in training in the United States or awaiting shipment overseas were concerned primarily with the instruction of their personnel in the

duties they would have to perform in action. They were unable and unwilling

to assume responsibility for the routine operation of the permanent stations

on which they were temporarily quartered. Nevertheless, many post functions

had to go on whether the units housed there were in barracks or absent on

maneuvers or field exercises. A camp where tactical units were quartered was

therefore authorized a permanent service detachment which provided the necessary utilities and such special facilities as medical and dental service. Since

it was undesirable to change the camp administrative staff with each successive

tactical organization, this service detachment was put under a post commander

and its activities were independent of those of the tactical units.

8

» Memo, Voucher Audit Br AGO, for Col Rex McDowell, 18 May, 3 Jun, 22 Jul, and 11 Aug 43.

SG: 703.

•" Weekly Civ Lab Rpts, LA Med Depot, 24 Apr 43-8 Feb 44. SG : 703.

»• SG Ltr 295, 8 Sep 44.
DENTAL SERVICE IN ZONE OF INTERIOR 285

During the early period of mobilization the fact that tactical unit dentists

were administratively independent of the post dental surgeons led to some

confusion. Unit dental officers had to devote much of their time to training

activities, and were equipped with field dental chests only. They were therefore not expected to meet the routine needs of their organizations. However,

though post dental officers were expected to assist the unit dentists, they were

not authorized in sufficient numbers to enable them to provide full dental care

for both permanent and temporary personnel. Adequate treatment could be

rendered only by using both groups of dentists to the limit of their availability.

Post clinics were planned to provide extra working space for as many tactical

unit dentists as could be spared from their units, but some difficulty was encountered in obtaining their services when needed. Organization commanders disliked to release their dental officers for duty in the camp clinic and often gave

them nonprofessional duties to occupy their time when not engaged in training.

Unit dental surgeons also felt that they should have control of any installation

where their men were receiving dental treatment and sometimes refused to

cooperate when told that the camp dental clinic would remain under the

direction of the camp dental surgeon.

To clear up any misunderstanding concerning respective responsibilities

for dental care on posts having both types of dental personnel, The Adjutant

General directed in January 1941 that:91

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

2. Camp dental facilities would be operated and maintained so that the

using troops would derive the utmost benefits therefrom.

3. Tactical unit dentists would be used in the camp dental clinic whenever

they were not required for essential duties in their own organizations.

4. The use of tactical unit dentists in camp clinics would be arranged by

mutual agreement between the commanding officers concerned. In case of

failure to come to an agreement the matter would be forwarded to the War

Department for decision.

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

. . . under its provisions [the directive mentioned above] the dental clinics will be

activities operated by the personnel assigned or attached to the post, camp, or station

complements and not oy field force personnel, although the dental clinics may be operated in areas occupied by the field force. Under this same authority, the permanent

personnel of the dental clinics (i. e. those assigned to post, camp, or station complements) has been limited to that necessary for the operation and maintenance of

the post when all units of the field forces are absent therefrom. This personnel will

be augmented by members of units of the field forces only when the field forces are

present. When the field forces leave the post for maneuvers or for any other reason,

these men will be relieved from duty with the dental clinic and will rejoin their

units. . . .

«Ltr, TAG to CGs of Armies and Corps Areas, 11 Jan 41, sub: Station complement activities

and agencies. SG : 320.3-1. M The control and operation of central dental clinics. The Dental Bulletin, supp. to the Army

Medical Bulletin 12 : 118, Apr 1941.
286 DENTAL SERVICE IN WORLD WAR II

A second directive of 11 April 1941 provided that:93

a. Dental service at regimental and separate battalion dispensaries and aid stations

will consist of emergency service and dental surveys in the tactical units to which the

dispensaries are attached and will be provided by dental officers attached to the

regiment'or separate battalion.

b. Definitive dental treatment, serious extractions, and treatment which demands

more extensive dental equipment will be provided in camp or hospital dental clinics

and will be under the control of the Corps Area Service Command.

c. Dental officers of the tactical units will receive training in medical tactics as

auxiliary medical officers and in emergency treatment of jaw casualties in their respective units. Technical instruction in more extensive definitive dental treatment

will be provided in the camp or hospital dental clinics. . . .

d. Training activities in medical tactics and functions of the regimental and separate battalions will be under the direction of the division or unit surgeon. Technical

training in camp or hospital dental clinics will be under the direction of the camp or

station surgeon.

In July 1942 still more specific instructions were issued, as follows:9i

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

b. It is desired that all Dental Corps officers under your jurisdiction who are now

engaged in nonprofesslonal duties be relieved of those duties and returned to professional work with the Dental Corps as soon as practicable, and that in the future

no dental officers be assigned to nonprofessional duties. You are authorized to make

exceptions to the foregoing policy only when the immediate release of such officers

will severely interfere with the functions of the medical service. In these exceptional

cases dental officers will be permitted to continue on nonprofessional duties only until

they can be replaced by qualified Medical Administrative Corps officers.

2. a. Instructions are being issued to division and other tactical unit commanders

that up to 50 percent of the dental officers assigned to and present for duty with such

organizations while they are at camps or stations where dental clinics are in operation

are to be made available for duty at such clinics at all times.

b. It is desired that in cases of dental officers from tactical units made available

for duty in clinics under your jurisdiction, mutual arrangements be effected locally

to insure that although the clinics will be fully staffed at all times, no individual

dental officer from a tactical unit will spend more than 50 percent of his time on such

duty and that during the remainder of the time, each officer be returned to his organization for such training as may be directed by the appropriate tactical commander.

The restriction on the nonprofessional use of dental officers curbed the

tendency of some commanders to use dentists for purely administrative functions, and at the same time the provision that 50 percent of the dentists with

tactical units would be on duty in the camp dental clinics whenever their organizations were on the post helped the service detachments complete essential dental treatment for these units before they were sent overseas.

53 Ltr, TAG to CGs of Armies and Corps Areas, 11 Apr 41, sub: Organization, training, and

administration of medical units. SG : 320.2.

84 Ltr, TAG to CGs all SvCs, 31 Jul 42, sub : utilization of dental officers for professional duties.

HD: 314.
CHAPTER VIII

Administration of the Dental Service in a

Theater of Operations

GENERAL CONSIDERATIONS

In the administration of the Dental Service in theaters of operations, it

was at first believed that the flexibility needed to meet rapidly changing situations could be attained only by assigning dentists directly to the small organizations which they were expected to serve, together with equipment which could

be moved on short notice and set up near the actual combat area. Such assignments were made to small units the size of a battalion or regiment, in each of

which 1 or 2 dentists were responsible for the care of from 400 to 3,000 men.

The unit dental officer was normally part of the organization medical

detachment, responsible directly to the unit surgeon and through him to the

unit commander. He was concerned mainly with the care of the men of his

own organization and was involved very little in the problems of the Dental

Service as a whole. His relation to the dental surgeon of a higher headquarters

was often vague; the latter might offer technical advice, but the unit surgeon

actually exercised direct supervision over the dental surgeon's activities. Under

such control, the unit dental service had the advantage of flexibility; without

waiting for specific orders from higher authority the dental officer and his

equipment accompanied the command wherever it might move. Unfortunately,

however, there resulted a system of highly dispersed, loosely supervised dental

installations with certain very serious weaknesses.

Two of the outstanding defects of the unit dental services, the difficulty

of providing uniform dental care in the larger commands and the inefficient

utilization of dental personnel, are discussed in connection with the dental

service of a division. A third difficulty was the practical impossibility of making an equitable assignment of dental officers to separate small organizations.

In much of the period between World Wars I and II dental officers were

provided in an overall ratio of 1 dentist for each 1,000 men. Some officers were

required for hospitals and administrative positions, however, and the number

available for field units was therefore somewhat less than this figure. In the

absence of any formal policy, a ratio of 1 dentist for each 1,200 men in tactical

commands seems to have been generally accepted; this ratio was eventually

made official in 1943.1 But since very few units had a strength of exactly 1,200

men, or a multiple of that figure, the application of any fixed ratio was not

simple. Even if the doubtful assumption that 1 dental officer could care

1 WD AG Memo W310-9-43, 22 Mar 43, sub: Policies governing tables of organization and

tables of equipment. AG : 320.2.
288 DENTAL SERVICE IN WORLD WAR II

for 1,200 soldiers was accepted, what was to be done about the organization

with 600 men, or the one with 1,800 men? In the final analysis each case still

had to be decided on its own merits, and many unsatisfactory compromises

were necessary. Some commands which would have been entitled to a dentist

under the prescribed policy were allowed none if it was felt that they would

be able to get attention from nearby units, while smaller commands were

sometimes given a dental officer when they were expected to function independently.

The Dental Division recognized the need for a more equitable distribution of dental personnel. In 1944, with the approval of The Surgeon General

and the Air Forces, it recommended that 1 dentist be authorized for each

1,000 troops. At that time the proposed increase was disapproved by Ground

Forces and Army Service Forces, and even by the end of the war when it was

clear that fundamental changes were needed in the tables of organization of

tactical units, no further action on this recommendation had been taken.

Figure 25. Dental Clinic of the 61st Coast Artillery Battalion (AA). KaUadames,

Iceland, 1942.
ADMINISTRATION OF THE DENTAL SERVICE 289

Figure 26. Dental Clinic of the 48th Quartermaster Truck Regiment. Queensland,

Australia, 1942.

iffiäSiäi

Figure 27. Dental Clinic of Headquarters Company, 41st Infantry Division,, New Oumea,

1943.
290 DENTAL SERVICE IN WORLD WAR II

I

&*.

W5

)"\ m

Figure 28. Dental Clinic of the 2d Field Hospital. Woodstock, Australia, 1943.

DENTAL SERVICE OF A DIVISION

In the administration of the dental service the division was an important

organization for it was the smallest complete combat team comprised of many

arms and services in which coordination of the activities of individual dental

officers could be attempted. The division dental service, however, was a very

loosely organized activity. It consisted essentially of the separate unit dental

services of its component commands, supervised by a division dental surgeon.

At the start of World War II the dental service of a "square" infantry

division numbered 30 officers under a division dental surgeon in the grade of

colonel. In the "streamlining" of the division to its "triangular" form during

the early part of the war this figure was reduced by approximately one-half,

otherwise the internal organization of the dental service was changed only

in minor details. With something less than 15,000 men the infantry division

was authorized 12 dentists. One, in the grade of major, was assigned to the

medical section of division headquarters as division dental surgeon. Eleven

dentists, captains or lieutenants, were assigned to the larger component tactical

units as follows:2

2

T/O&E 7, 15 Jul 43.
ADMINISTRATION OF THE DENTAL SERVICE 291

3 Infantry regiments (3,256 men each) 6

Division artillery (2,219 men) 1

Engineer battalion (664 men) 1

Special troops (943 men) 1

Medical battalion (469 men) . 2

One of the first responsibilities of the division dental surgeon was to coordinate the activities of seven or more separate dental services to provide

equitable care for the organization as a whole. Under the system officially in

effect during most of the war, this task involved formidable difficulties. Many

smaller units had no assigned dental officers; moreover, the division was commonly reinforced with a number of auxiliary commands which were also without their own dentists. The total strength of these "orphan" units might reach

several thousand men. In theory the personnel of the smaller organizations

were expected to receive dental attention from the officers of nearby regiments

or battalions, but in practice they were often given treatment under protest, if at

all. The dentists of the larger units, who were individually responsible for a

thousand or more men, were naturally reluctant to neglect their own troops to

care for adjoining commands, and in this attitude they usually had the full

support of their commanders and surgeons. The General Board of the European theater found that "personnel of units whose tables of organization did

not authorize dental personnel received as a rule only mediocre dental service.

These units depended upon dispensaries, hospitals, clinics, and other units in

the area for their dental care, and in most instances the emergency cases only

received attention."3Even among units with assigned dental officers there was

no uniformity in the quality of the dental service provided. The dental officer

of the engineer battalion, for instance, was able to render adequate treatment

for all his 664 men, but the dental officer with the division artillery could meet

only a fraction of the needs of his 2,219 soldiers. Even with unlimited authority

the solution of this problem would not have been simple, and the practical

powers of a division dental surgeon were anything but unlimited.

As previously stated, the dental officer of any individual unit was directly

under the surgeon of that unit, who in turn was under the orders of the commanding officer. By tradition and necessity the commander had complete control over all personnel under his supervision, and higher authority was extremely reluctant to disturb internal matters so long as major policies or directives were not violated. The local commander's first responsibility was for his

own men, and any proposal to use a dental officer outside the organization, or

for the benefit of other troops, was almost certain to meet with prompt and

vigorous opposition. As a staff officer, on the other hand, the division dental

surgeon generally had no authority to issue orders. He could make recommendations to dental officers and commanders, but neither was obligated to

accept his counsel. If his advice on an important matter was rejected his only

s

Ept, General Board, ETO, Study 95, Medical service in the communications zone in the European

Theater of Operations. HD: 334 (ETO).
292 DENTAL SERVICE IN WORLD WAR II

recourse was to present his problem to the division commander through the

division surgeon. If approved, an official order could be sent through channels

to the dental officer concerned. Approval of an action opposed by high-ranking

subordinate commanders was very difficult to obtain, however, and the division

dental surgeon, in the grade of major, who attempted to have a dental officer

temporarily released from an infantry regiment commanded by a senior colonel

often faced a fight to the finish. At best the procedure of issuing a division

order was too ponderous to be of much help in making the frequent minor adjustments necessary to meet a rapidly changing situation. The following account is typical of the problem sometimes encountered by dental staff officers:

In 1943 the dental surgeon of the Middle East theater found that the

dental officer of a unit which had been cut to about 400 men was being given

full-time duty in administrative work, principally as court-investigating officer. On the same post three dental officers of other organizations were

vainly trying to meet the needs of several thousand men, including the personnel of the unit in question. The unit commander flatly refused to release

his dental officer for duty in the post clinic, or even to place him on professional work with his own personnel. The next higher commander admitted

the need for corrective action but refused to interfere in what he considered

the internal administration of the subordinate unit. The theater commander,

in turn, did not consider the utilization of a dental officer a sufficiently important matter to warrant reversing the decision of another senior commander.

In this particular case it was eventually possible to have the dentist transferred to another unit on the grounds that the original organization had been

reduced in strength to a point where assignment of a dental officer was no

longer necessary, but even this step was attained with difficulty and at the

expense of the ill-will of the commander concerned.4

Surgeons and line commanders, like dentists, were only human; in some

cases they did not exercise perfect judgment in dealing with dental problems.

Nevertheless, they cannot be blamed for the main defects of the division

dental service. Both were only exercising the established rights of any

commander, and both felt that they were showing only praiseworthy concern

for the welfare of their men when they refused to release a dental officer for

temporary duty where his services were more urgently needed. Only a complete revision of the division dental organization could avoid the difficulties

inherent in an attempt to provide uniform dental care with a number of small,

independent, unit dental services.

Another problem of the division dental surgeon was keeping all unit

dental officers performing professional duties whenever possible. In a reinforced division each dentist might have to care for as many as 1,500 men,

and even the minimum needs of such a population could be met only if each

4 Personal experience of the author who was dental surgeon of the Middle Bast theater at the

time these events took place.
ADMINISTRATION OF THE DENTAL SERVICE 293

dental officer devoted all his time to the duties for which he was trained. Yet

the dentists of units in combat could not operate clinics under fire and for

weeks at a time could render only emergency treatment or act as assistant

battalion surgeons.

As the war progressed it became increasingly evident that a more efficient

use of tactical dental officers was imperative. A unit which entered combat

in good condition could go for some time with emergency dental care only,

plus the sporadic attention that was available between periods of fighting, but

lack of definitive treatment eventually resulted in reduction of combat efficiency due to excessive evacuations for dental causes.5

Almost every World War II division ultimately attempted some modification of its dental service in an effort to improve the efficiency of dental

officers assigned to combat units. The War Department apparently did not

wish to prescribe any rigid reorganization however, until the more promising

suggestions had been tested under field conditions, and no official change was

published until near the end of hostilities. Most improvements were therefore made on the personal initiative of progressive dental officers, with the

help and advice of far-sighted surgeons and line commanders. The final

result, which differed in almost every organization, depended upon the individual ideas of the dental surgeon and the support received from his superiors. In a few divisions where dental surgeons were given complete control of all dental personnel and facilities, a near-ideal type of service was

possible. In one such division the dental service was organized as follows:6

The division dental surgeon kept the dental survey records showing the

condition of the command and supervised the operation of all dental facilities.

One dentist of the medical battalion acted as division prosthodontist and

operated the dental laboratory. The remaining 10 dental officers were assigned

to staff 2 clinics. Each of these clinics had its own electrical generator and

tentage and could be employed alone if necessary. Both clinics might be set

up near the clearing station, or either or both might be moved on short notice

to some location where they were more urgently needed. On the rare occasions

when all combat units were committed to action the clinics worked for service

personnel and for replacements. Treatment for the latter was particularly

important since many hundreds might arrive in a single day and many needed

care before they were assigned to combat organizations. The advantages of

this type of division dental service became most apparent, however, when an

infantry regiment or other combat unit was withdrawn from action. When

the command arrived at its designated rest area it found a clinic staffed by at

least five dental officers. It was equipped with electric engines and lights and

so organized as to use the special skills of all its personnel. With such a

5 History of the Dental Division, Hq, ETO, 1 Sep through 31 Dec 44. HD.

6 The dental service described is that of the 8th Div, 9th Army, ETO. Info furnished by Brig

Gen James M. Epperly, former dental surgeon, 9th Army.
294 DENTAL SERVICE IN WORLD WAR II

concentration of dental facilities it was possible to complete a great amount of

work in a short time and no dental officer wasted his efforts in nonprofessional

duties or tried to operate under hopelessly adverse conditions. If necessary,

single dentists could, of course, be sent to individual units, but the improvement

in dental care for the whole command which resulted from the procedure just

outlined greatly lessened the need for emergency treatment even in the small

organizations. Though the dental service remained under the ultimate control of a medical officer (the division surgeon) this experienced senior medical

officer who was more interested in the dental welfare of the whole command

than was the average regimental surgeon, saw to it that service was impartially

rendered to all elements.

In divisions where similar plans were effected the reaction of both dental

officers and line commanders was uniformly favorable. (One armored division

disapproved the centralized dental service because it was believed that individual officers were given an incentive for better work when they were responsible

for the same troops at all times, but this division had not actually tested the

plan.) It was found that with centralization even the larger organizations

received much better care than had been possible when their own dentists had

tried unaided to meet the needs of their commands in the short intervals between

actions, while the smaller units were able to get treatment on the same basis

as the larger. An effective division prosthetic service was provided and dental

officers worked under conditions which promoted maximum efficiency. Line

commanders were relieved of the unfamiliar responsibility for the Dental

Service of their commands and their traditional rights were not compromised

since the dentist was now assigned directly to a medical unit.

The increased output attained by centralizing the division dental service

and placing it under immediate dental control was surprising even to the

sponsors of such plans. One division in Europe reported that during the first

week of operation 5 dental officers in a central clinic produced 17 times as

much work as they had when working with their individual units.7 During

periods of combat the output of 10 dental officers of this division had previously

fallen to 40 percent of the theater average (combat and noncombat) and to

only 20 percent of their own noncombat average. With inauguration of the

central clinic in a rear area the same officers completed more than four times

the theater average of work even during combat, and during the exceptionally

unfavorable circumstances existing in December 1944 their output still exceeded

the theater average by 70 percent.

By the end of 1944 the Dental Division felt that sufficient experience had

accumulated to justify an effort to have a revision of the division dental service authorized in tables of organization. Three senior officers who had been

dental surgeons of armies or major theaters were requested to submit a joint

'Annual Dental Ept, 8th Div, ETO, 1944. HD.
ADMINISTRATION OF THE DENTAL SERVICE 295

Figure 29. Dental Survey in European Theater, 19/ti.

330324 0—55 20
296 DENTAL SERVICE IN WORLD WAE II

fU$l -A:

' '.I

S

■■it

i'S;

w

ri

HAS».I'?'

Figure i 0. Waiting Room of Dental Clinic, 66th Infantry Division, France, 1945.

Figure 31. Dental Clinic, 9th Evacuation Hospital, France, 1944.
ADMINISTRATION OF THE DENTAL SERVICE 297

study of the dental service in the field. On 8 February 1945 they reported

to the surgeon of the Army Ground Forces as follows:8

Under the present method of assignment of dental officers to various units within

the division the control and disposition of the division dental service by the division

dental surgeon is greatly hampered. He may desire to utilize certain dental officers

in other than their assigned units, and if the regimental or unit surgeon objects the

dental surgeon is often overruled since the regimental or unit commander accepts the

advice of his surgeon. . . . The unit surgeon's view is often selfish, being concerned

only with his organization. For maximum efficiency the dental service of a division

must be flexible, and if flexibility is obtained the dental officers can be busily engaged in constructive operational procedures under practically all conditions. . . .

The dental needs of a division require the full and most efficient utilization of its

dental personnel in dental capacities at all times. To secure this the following outline

of a divisional dental service is offered :

a. The division dental service to consist of a division dental detachment directly

under the division dental surgeon, who in turn functions directly under the division

surgeon.

b. Detachment to consist of:

Division dental surgeon 1

Prosthodontist 1

General operators 10

Total officers 12

Clerk (for divisional dental surgeon) 1

Technicians (067) 2

Technicians (855) 11

Total enlisted men 14

With this centralization of control the division dental surgeon can utilize personnel

to maximum advantage by attaching officers or establishing clinics with units or in locations where the greatest amount of work can be accomplished. Normally five officers should be attached to forward units to provide emergency treatment and at the

same time to accomplish as much definitive work as possible. These five would normally be distributed as follows: Each infantry regiment (1), division artillery (1),

and engineer battalion (1). The remaining six officers (exclusive of the division dental

surgeon) to be held in service areas where dental work can constantly be performed

upon rear echelon troops and combat troops in reserve and in rest areas. These six

may be utilized as one large clinic if the situation warrants, divided into two groups

of three each, or three groups of two each. The division laboratory would normally

be in conjunction with one of these rearward clinics. . . .

The important and fundamental features to be stressed for a division dental service

are: (1) Centralized control; (2) Maximum motorization possible.

Based on these recommendations, new tables of organization and equipment for the headquarters and headquarters company, medical battalion, were

published on 1 June 1945." This reorganization concentrated the entire division dental service in a "division dental section" in the medical battalion,

consisting of a division dental surgeon in the grade of major, a division prosthodontist, and 10 general operators in the grades of lieutenant or captain.

8 Memo, Maj Gen R. H. Mills for Gen F. A. Blesse, 8 Feb 45. SG : 444.4.

» T/O&E 8-16, 1 Jun 45.
298 DENTAL SERVICE IN WORLD WAR II

Thirteen enlisted assistants were authorized as follows: 1 sergeant (855) for

supply and administration, 10 technicians grade 5 (855) as dental assistants, 1

technician grade 3 (067) in charge of the laboratory, and 1 technician grade 4

(067) as laboratory assistant and truck driver. The division dental section

was also authorized a dental laboratory truck; one 21/^-ton cargo truck with a

1-ton, 2-wheel trailer; six i^-ton trucks ("jeeps") with %-ton, 2-wheel trailers;

a 3-KVA generator; 11 Chests No. 60; a field kit for each officer; and enlisted

man's kits for 11 of the dental technicians. It was provided that "normally 1

dental officer (general operator), and 1 technician, dental, (855), will be attached to the following units when in actual combat: each infantry regiment;

engineer combat battalion."

World War II ended before the reorganization prescribed in T/O&E 8-16

could be put into effect, but previous experience with similar unofficial plans

in individual divisions justified the belief that it would result in more adequate

dental service for all personnel of unitslargerthan regiments.

Even with the new centralized dental service there would undoubtedly be

occasions when dental officers could not function in a professional capacity. In

an invasion, for instance, dentists could be of most service as assistant surgeons

during the period when the landing was being consolidated. Under such

circumstances there was nothing to prevent the division surgeon, who had the

dental detachment at his disposal, from using all or part of the dental personnel

for nondental duties. But as soon as conditions permitted, the dental detachment could be reassembled to resume its primary function of preserving the

dental health of the command.

DENTAL SERVICE OF A FIELD ARMY

Since the composition of a field army was determined by its mission rather

than by fixed tables of organization, the number of dental officers assigned

might vary within wide limits—from a minimum of about 100 to a maximum

of many hundreds. (The Ninth Army had 650 officers at one time.)10Something less than half of the dentists of an army were assigned to the component

divisions operating under the general supervision of division dental surgeons.

The larger proportion, however, were assigned to hospitals and army units

other than divisions, and the army dental surgeon was directly responsible for

their activities, as well as for the general guidance of the division dental

services.

Medical units assigned to an army were concerned primarily with the

evacuation and care of casualties, and except for the provision of extremely

limited prosthetic facilities their dentists could not be counted upon to render

routine treatment for army personnel. Army medical units varied as widely

1

Info furnished by Brig Gen James M. Epperly, former dental surgeon, 9th Army.
ADMINISTRATION OF THE DENTAL SERVICE 299

as did other elements, but a typical allotment (units with dental officers only)

for an army of nine divisions would have been:u

Dental

Units Numbers officers

Medical clearing companies 9 18

400-bed evacuation hospital 9 18

750-bed evacuation hospital 1 3

Auxiliary surgical group (Before April 1944) 1 7

Gas treatment battalion 1 3

Convalescent hospital 1 4

Field hospital 5 15

Medical depot company (After March 1944) 1 2

Total 70

In addition to the dentists assigned to army medical units, a large number of

dental officers were on duty with the many service and combat elements allotted

the command for the reinforcement of the basic infantry and armored divisions. The number of dentists so available was not constant, but generally

exceeded the total of all dental officers with the combat divisions.

The problems of an army dental surgeon were essentially those of a division

dental surgeon, on a larger scale. However, the difficulties of providing adequate dental care for the organization as a whole were increased in an army,

partly because a larger number of troops were involved, but mainly because a

much larger proportion of the army troops had no regularly assigned dentists.

The principle of allotting dental officers directly to individual units had been

based on the assumption that such distribution would provide for the majority

of the troops in an area and that the relatively unimportant remainder could be

taken care of by means of minor adjustments in the overall dental service. This

assumption was partly justified in a division where the assignment of 7 dental

officers to the 3 infantry regiments and the division artillery provided at least

minimum dental care for four-fifths of the total strength of the command. But

in an army the situation was reversed, and dentists assigned to individual army

units provided dental care for only a very small proportion of the total strength.

The nature and magnitude of this problem was more clearly revealed in a study

carried out by the dental surgeon of the Ninth Army in Europe. His analysis

of the dental service of a "type army" (3 corps of 2 infantry divisions and 1

armored division each) disclosed the following situation:12

Number of nondivisional troops with a type army 157,493

Number of dental officers assigned to nondivisional troops (including

medical units) 205

Average number of troops per dental officer 768

Number of units with assigned dental officers 141 (23.3%)

Number of units without dental officers 463 (76.7%)

11 T/O&E's for the organizations listed varied somewhat from time to time.

1! See footnote 10, p. 298.
300 DENTAL SERVICE IN WORLD WAR II

Number of troops with assigned dental officers 48,225 (30.6%)

Number of troops without dental officers 109,268 (69.4%)

It will be noted from this summary that the problem of an army dental

surgeon resulted principally from inequities of distribution rather than

from shortages of facilities. The overall ratio of 1 dentist for each 768 men

was higher than in combat divisions, yet only 48,225 troops were cared for

by their own assigned dentists. The remaining 109,268 had to receive dental

attention from officers assigned to other units. In addition to the usual difficulties of persuading dentists to provide adequate treatment for the personnel

of other units, the army dental surgeon was thus faced with the necessity

of making, with every important change in the general tactical situation,

new arrangements for the treatment of 100,000 or more men in 463 units.

The dental surgeon, Ninth Army, also emphasized another fact often

overlooked; namely that the dental service of nondivision troops of an

army far overshadowed that of the divisions themselves. There was a strong

tendency to regard the divisions as the "core" of an army and to depreciate

the importance of the "auxiliary" army troops, but the type army considered

in the aforementioned summary required only 108 dental officers for the treatment of division troops while 205 were assigned to army units. Improvements

in the Dental Services of divisions, important as they were, failed therefore

to solve many of the overall problems of army dental services.

The striking advantages which resulted from concentrating all dental

facilities of a division into a central detachment under the division dental

surgeon suggested to some senior dental officers the possibility of applying

the same principles to the problems of army dental services. Among the more

interesting proposals along these lines was a plan submitted by the dental

surgeon of the Mediterranean Theater of Operations.13 This plan, which

was designed to insure greater efficiency and a more equal distribution of

dental service to all military personnel in theaters of operations, presented

the following changes for eliminating the weaknesses of the system then in

effect:

1. Removal of all dental officers from present individual assignments, except for

those with hospitals, general dispensaries, and administrative headquarters.

2. Organization of dental detachments of 15 dental officers, 1 Medical Administrative

Corps officer, and 24 enlisted assistants and technicians. Each detachment to have its

own essential transportation and tentage and a mobile dental laboratory. The dental

detachment to be organized and equipped so that it could function as one large clinic or

as a number of smaller installations.

3. Each major force to be authorized dental detachments in the ratio of 1 detachment

for each 15,000 men. Each detachment would be assigned to an appropriate area and

the dental surgeon in charge would be responsible for utilizing his resources in the

most efficient manner for the benefit of all troops in the area.

13 Col Lynn H. Tingay, dental surg, MTO, Suggested plan for Dental Service In a theater of

operations, 15 May 45. SG : 703.
ADMINISTRATION OF THE DENTAL SERVICE 301

During the war no such sweeping reorganization of an army dental service was attempted, however, and the coordinating activities of army dental

surgeons were generally limited to relatively minor shifts of local facilities to

meet changing situations.

Another persistent problem of the army dental surgeon, especially during

the first years of the war, was the provision of an adequate prosthetic service.

This was partly solved by the addition to combat divisions of prosthetic facilities, but it still did not provide the army dental surgeon with adequate facilities

to care for special army troops. Of the army medical units, the 400-bed evacuation hospitals and the field hospitals had no laboratories; the larger evacuation hospitals were often not supplied in armies; and the convalescent hospitals,

limited in number, were usually fully occupied with treating their own patients.

The army dental surgeon might thus have only the three prosthetic teams of

an auxiliary surgical group and a small number of prosthetic field chests from

army medical battalions and clearing companies to render laboratory service

for nondivision troops totalling more than 150,000 men. Though this situation

was greatly improved by the arrival in quantity of the prosthetic trucks, it was

still necessary to operate improvised (and unauthorized) laboratories in subordinate units (e. g. corps) and in such strategic locations as army replacement

depots.

There is evidence in fact that even if the authorized ratio of 1 mobile prosthetic team for each 30,000 men had been attained in World War II, the full

laboratory needs of armies and other major units would not have been met.

From figures on the monthly requirements for replacements in the Fifth Army

and from production records of the prosthetic teams, Colonel Lynn H. Tingay,

former dental surgeon of the Mediterranean Theater of Operations, calculated

that a single team with a division would meet about 75 percent of the prosthetic needs of the (approximately) 15,000 men of that unit." This left a

residue of 25 percent of all prosthetic service for divisions to be met by other

means. On a similar basis, a single truck assigned to 30,000 army troops would

be able to complete only about 35 percent of all needed dental prostheses, leaving

65 percent to be constructed by other installations. Colonel Tingay estimated

that a "type" army (nine divisions) would need laboratory facilities for handling about 1,000 cases a month in excess of the combined capacity of the authorized prosthetic teams and army hospital laboratories. To meet this situation

he recommended that "BI" teams ("dental prosthetic detachment, fixed," with

2 officers and 6 technicians) of the medical service organization be authorized

for armies in the ratio of 1 team for each 100,000 men. Under favorable circumstances two or more teams could be grouped to afford the advantages of

"production line" operation. Though it cannot be determined without further

experimentation whether this or a mobile type of installation would be more

" Personal Ltr, Col Lynn H. Tingay to author, 13 Feb 47.
302 DENTAL SERVICE IN WORLD WAR II

effective in meeting the prosthetic requirements of an army, most dental surgeons

were agreed that some reinforcement was urgently needed.15

DENTAL SERVICE IN THE COMMUNICATIONS ZONE

The organization of a communication zone varied so widely according to

the size and geography of the theater, and the nature of the principal mission

to be accomplished, that its dental service could have no uniform structure.

In particular, the dental surgeon might be directly responsible for all dental

activities in the area, or he might act through two or more dental surgeons of

subordinate "base commands." In general, however, communications zone

dental facilities could be grouped under the following broad classifications:

1. Dental officers assigned directly to tactical commands. (In a communication zone, as in a combat zone, it was difficult to provide a uniform

dental service with hundreds of individual officers concerned only with their

own units. A detailed discussion of this problem has already been presented

in connection with the dental services of the divisions and armies.)

2. Dental clinics and detachments established in connection with standard table of organization medical units.

3. Special dental facilities set up to meet unusual situations.

In the communications zone auxiliary dental care was provided by a number of medical organizations. In addition to those discussed in connection with

an army dental service, the communications zone might have available any

or all of the following, in numbers depending upon the strength of the theater:16

Dental personnel

Units Officer Enlisted

1,000-2,000-bed general hospitals 5-10 9-13

25-900-bed station hospitals 1-4 1-7

Convalescent centers (3,000-bed) 5 9

Convalescent camps (1,000-bed) 3 6

Medical supply depots 1

Medical dispensaries, aviation 1 1

Dental prosthetic detachments, mobile (1 for each 30,000 men) 1 3

Dental prosthetic detachments, fixed 2 6

Dental operating detachments, mobile (1 for each 25,000 men) 1 1

General dispensaries (serving 2,000-10,000 troops) 1-3 2-4

Dispensaries (serving 1,500-3,000 troops) 1 1

Medical detachments (assigned separate battalions) 1 1

Hospital centers (headquarters only) 1

Maxillofacial detachments 1 1

The hospitals provided all types of dental care for their own patients; also

treated the more serious oral surgical conditions of troops in nearby units.

They had small laboratories and during the first part of the war it was

15 (1) Personal interviews by author with senior dental surgeons. (2) See footnote 3, p. 291.

18 The last eight installations listed were part of the Medical Service Organization, T/O&E

8-500, 18 Jan 45.
ADMINISTRATION OF THE DENTAL SERVICE 303

expected that these would provide an important part of the prosthetic service

in theaters of operations. It will be pointed out, however, in the discussion

of the overseas prosthetic service, that the demand for dental appliances soon

became too large to be met by the hospital laboratories. Planned primarily to

care for the sick and wounded, the hospitals did not have enough reserve

capacity to supply dental service for large bodies of troops.

Of the smaller detachments, the "medical dispensary, aviation," and the

"medical detachment" were assigned to separate bodies of troops having no

regular dental officers, providing a service similar to that furnished by unit

dentists. Before hostilities ended dental prosthetic detachments and dental

operating detachments were available only in very small quantities and were

generally used where more critically needed—in the combat zone. General

dispensaries were employed only in connection with the more important headquarters, but with only three assigned dental officers the amount of dental care

provided was woefully inadequate.17 The dental officer with a hospital center

was engaged in purely administrative duties. The functioning of the maxillofacial detachment will be discussed in connection with the evacuation of

dental casualties. These smaller dental units met critical needs but they were

specialized organizations designed to meet specific requirements for mobility

or to provide care for definite bodies of troops who otherwise would be neglected. Even had they been available in the numbers authorized, the bulk of

the communications zone dental service would still have been rendered by unit

dentists and hospital clinics.

Standard dental facilities sometimes failed completely to meet the needs

of large concentrations of troops in the communications zone. The fixed prosthetic team of 2 officers and 6 technicians, for instance, was not designed to

supply large scale laboratory service for hundreds of thousands of men, and a

100-man laboratory had to be established in England. Similarly, the largest

general dispensary had only 3 dental officers, yet 35 dentists were required just

to care for military personnel in and around Paris.18 Large clinics had to be

supplied such installations as the replacement depot near Naples where 5,200

men arrived in one day.19 Consequently the communications zone dental surgeon, who was also the theater dental surgeon in most instances, was required

to improvise a considerable number of large clinics and laboratories not contemplated in tables of organization.

The theater dental surgeon had no reserve pool of dental personnel with

which to establish these essential but nonstandard installations. Depending

upon the urgency of the situation he had possible recourse to two alternatives:

1. If the need for the special facility could be adequately foreseen, the

dental surgeon could submit for it a tentative table of organization. If

17 See footnote 3, p. 291.

" Ibid.

M Rpt, Peninsular Base Sec, supp. to the Dental History, MTO. HD.
304 DENTAL SERVICE IN WORLD WAR II

approved by the theater commander and the War Department, this table of

organization became the authority for requisitioning necessary personnel from

the Zone of Interior. The principal defect of this method was the time

element for even under the most favorable circumstances several months were

required to get the approval of all concerned and to complete the shipment

of personnel to the theater. On the other hand, staff officers were slow to be

convinced that a unit not contemplated in existing tables was actually necessary.

The whole process of having a special table of organization authorized was so

cumbersome that only one dental installation, a central dental laboratory, was

so procured in the European theater during hostilities.

2. The theater dental surgeon might, with the consent of the theater commander, establish the needed installation with personnel already in the area.

This procedure did not increase the total number of officers allotted to the

theater, however, and it could be accomplished only by "robbing Peter to pay

Paul"; men had to be "borrowed" from other organizations from which they

could ill be spared.20 Dental surgeons used devious methods to obtain the

officers to staff such facilities with a minimum of disruption of the dental

service. Most of the dentists drafted for such duty could be used for only a

few weeks and the turnover of personnel was high. Constant supervision was

needed to insure a steady flow of replacements and to provide qualified officers

for the oral surgical and prosthetic services. Very little organization for

efficiency was possible when key men might be lost at any time. Personnel from

the smaller dental detachments were sometimes juggled to provide a reasonable

approximation of the desired unit. In Europe, for instance, 6 fixed prosthetic

detachments were used to establish a 36-man laboratory in Frankfurt.21 Since

only 2 of the 12 officers obtained were needed in the laboratory the other 10 were

used to reinforce the badly overworked dental dispensary in the same city.

Such subterfuges were countenanced because the results justified the means and

no one was willing to inquire too closely into how they were obtained. The

formation of these nonstandard, improvised units was necessary in the absence

of any better plan, but the difficulties encountered emphasized the need for

establishing approved tables of organization for all important installations

which may be required in an overseas campaign.

Even more than an army dental surgeon, the theater dental surgeon was

heavily burdened with the never-ending task of maneuvering minor, widely

scattered, dental facilities to provide care for units with no dental officers and

to make available the personnel needed to staff the large nonstandard clinics

and laboratories. World War II experience indicated that the problems of a

theater dental surgeon could be materially reduced, and the dental service

improved, by two steps:

Make available to the theater dental surgeon a small pool of reserve per20 See footnote 3, p. 291. 21 Personal knowledge of author who was stationed in Frankfurt at the time.
ADMINISTRATION OP THE DENTAL SERVICE 305

sonnel to meet emergencies and add flexibility to the dental service. The dental

surgeon of the European theater stated that "the one recommendation which

this division cannot stress too strongly is that some provision be made for a

pool of dental officers in theaters of operations."22

Remove dental officers from individual tactical units and assign them to

dental detachments of 15 or more dentists, similar to those already discussed

in connection with the dental service of an army. Each dental detachment,

under an experienced officer, would, regardless of parent organization, be responsible for the care of all troops in its area. Detachments would be allotted

throughout the communications zone on the basis of 1 unit for approximately

15,000 troops and according to the disposition of personnel each detachment

would establish a dental laboratory and 1 to 4 or 5 clinics. The theater dental

surgeon would make an equitable distribution of the detachments to meet

overall needs but minor local adjustments would be made on the spot by the

detachment commander who would also supervise the detailed functioning

of his men. Such a reorganized dental service would have the following

advantages:M

1. The provision of uniform treatment for large and small units would

be simplified.

2. Dental officers would function under the immediate observation of an

experienced officer rather than under the loose supervision of a line commander

or a surgeon unfamiliar with the requirements for a good dental service. Line

commanders would be relieved of the responsibility for the detailed operation of

a highly technical activity having no relation to the primary mission of the

organization.

3. To handle difficult conditions specially qualified men could be provided.

4. Dental officers would be relieved of individual responsibility for supplies, records, and other miscellaneous overhead, allowing them to devote more

time to their proper duties.

5. Local adjustments of dental service could be made at once, on the spot,

without the necessity for prolonged consultations with numerous individual

commanders and dental officers.

It would also appear that the dental surgeon of a major theater would be

able to discharge more effectively his responsibility for the quality of the dental

treatment if given the assistance of one or more dental consultants. The

22 History of the Dental Division, Hq, ETOUSA, from inception to 1 Sep 44. HD.

33 This plan for the organization of the Dental Service has been proposed by several senior dental

officers who occupied positions of responsibility during the war, particularly by Maj Gen Thomas L.

Smith, Chief of the Dental Service, and by Brig Gen James M. Epperly, former dental surgeon, 9th

Army, Europe. General Smith, however, has also suggested certain disadvantages of such a policy.

In the invasion of France, purely dental units were given such a low priority for shipment that some

would not hare arrived in less than 3 months. It was found that dental installations could be moved

to France in time to accomplish their mission only if attached to a combat command. One laboratory

received a warning order for its move several weeks after it had already set up on the continent

subsequent to having been informally attached to a line unit for the channel crossing. Application

of the "cellular" type of dental organization would also necessitate some revision of plans for dental

surveys, but satisfactory alternate schemes have already been worked out in some divisions and armies.
306 DENTAL SERVICE IN WORLD WAR II

European theater had the services of an oral surgery consultant during the war

but no full time consultant was on duty in any other theater headquarters. The

administrative duties of a theater dental surgeon were sufficient to occupy most

of his time, and in any event it would seem to be expecting too much of any

one man to ask him to pass on the quality of the care given by specialists in three

or more fields.

DENTAL SERVICE IN AN INVASION

Dental preparations for an invasion began long before the event with an

intensified effort to put all men in the best possible condition. The dental officers of individual units brought surveys up to date, eliminated conditions

which might cause men to become noneffective, and speeded up the tempo of

routine treatment. At the same time dental surgeons of major commands reinforced unit dental officers with all available prosthetic and operative resources,

and a special effort was made to complete essential replacements.

With the assembly of the invasion force in the vicinity of the ports of

embarkation it was no longer possible to continue dental service on a large scale

and emphasis shifted to the care of last minute emergencies. Since by this time

the equipment of unit dentists had been packed, the bulk of dental care in the

marshalling areas had to be furnished by installations not involved in the

movement.

In the actual invasion and during the initial assault phase, the activities

of dental officers differed with the type of action and resistance encountered

but in general they served as assistant battalion surgeons or performed other

nondental duties. In subsequent periods they usually continued in such

capacity until dental equipment could be assembled for the resumption of normal dental activities. In the meantime, though the incidence of emergency

dental cases was low, dental kits were utilized to care for those which did occur.

Lag in commencement of dental operations, as such, varied from several

days to several weeks, and in some combat units fully 50 percent of the dental

officers continued to be employed in a medical status for a number of months.

In one such combat unit a dental officer remarked "I gave more plasma than I

inserted fillings."24

The prolonged use of dental officers as auxiliary medical officers was

widely condemned by most senior dental officers, but it cannot be denied that

due to the exigencies of the first phases of an invasion, dental officers must be

prepared to assume other duties until the situation has become partially

stabilized. However, experience has shown that unless dental officers resume

their normal functions at the earliest possible date any advantages gained by

their emergency assistance will be offset by increased evacuations for dental

" Rpt, 7th Army Sec, supp. to the Dental History, MTO. HD.

* See footnote 5, p. 293.
ADMINISTRATION OF THE DENTAL SERVICE 307

DENTAL SERVICE FOR REDEPLOYING TROOPS

With the end of hostilities in Europe the Dental Service was suddenly

charged with the responsibility for surveying and completing essential dental

treatment for thousands of men being redeployed to other combat areas.

Due to the following circumstances this task involved unusual difficulties:

1. Personnel being processed in redeployment centers were available for

a very short time only, and often arrived in waves which taxed the facilities

provided for normal operation.

2. Eedeployment centers were often established in areas where existing

dental facilities were limited or nonexistent, so that clinics had to be built,

equipment obtained, and personnel assembled before treatment could be

started.

3. The general reshuffling of officers and men incidental to making up

units for redeployment to the Far East affected dental personnel as well as

combat troops and the confusion of the period multiplied the difficulty of

obtaining sufficient dentists and technicians for operation of the necessary

clinics and laboratories. No tables of organization were drawn up for these

interim installations and personnel had to be borrowed from hospitals or

other organizations, usually on a temporary duty status.

So that he could plan the clinics and supervise their construction or

conversion the dental surgeon assigned to a redeployment center usually arrived about a week or two before operations were to begin. He then submitted

requisitions for equipment and personally followed their progress through

intermediate offices to insure rapid action. Dental personnel, supplies, and

patients usually came in at about the same time. About half of the staff were

obtained from the redeployment center complement and the remainder borrowed from organizations currently being processed. Basic equipment was

normally the M. D. Chest No. 60 plus such civilian items as could be procured

locally. Lights, cuspidors, and other improvised supplies were constructed

and installed by engineer or ordnance detachments. Since prosthetic treatment made up a high proportion of all dental care rendered in redeployment

centers a laboratory was essential, and in the absence of other trained personnel it was often staffed in part by qualified prisoners of war.

At the Florence Eedeployment Center,26 which had a maximum capacity

of 25,000 men, provision for a 21-chair clinic was made. A single oral surgeon was able to handle all extractions but three officers were placed on

prosthetic duty. One chair was devoted to examinations and one was used

by the x-ray service—the remainder for routine operative procedures. The

permanent staff numbered 16 officers and 36 enlisted men; the rest of the

personnel required to operate the installations were obtained from transient

units.

20 History, Dental Clinic, Florence Redeployment Center, 10 Aug 45, inclosure to Supp. to Dental

History, MTO. HD.
308 DENTAL SERVICE IN WORLD WAR II

Dental officers on loan from other organizations had to be replaced at

short intervals and dentists of the station complement had to be released for

redeployment or return to the United States. Thus the turnover of personnel

was constant and heavy. One of the principal duties of the dental surgeon

was to estimate future requirements for his staff and arrange for necessary

replacements.

When a unit arrived in a redeployment center the dental surgeon immediately contacted the organization commander and arranged for a dental survey

if one was necessary. If the unit had an assigned dental officer he was directed

to report to the central clinic for duty as long as he was in the camp. Men

in Class I or ID were called for early treatment, followed by as many less

urgent cases as could be handled in the time available. All urgent treatment

was completed and, except in periods of peak operation, a large proportion

of minor defects were corrected as well, so that a high ratio of the men

departing from a redeployment center were in Class IV. Since from 20,000

to 30,000 men might be processed in less than 2 months such a result could be

achieved only with the most efficient organization and supervision.

The dental condition of men going through the redeployment centers

varied widely according to whether or not they had been in extended combat

and whether or not their units had had assigned dentists. In general, however,

dental defects were not excessive. The following comparison of the classification of men redeployed through a center in Italy and men inducted at

Camp Eobinson (Arkansas) in 1942 shows that the dental condition of most

men had been greatly improved during their Army service, even while in

combat:27 28

Redeployment Training Center

Center Florence Camp Robinson

Class Percentage Percentage

j 0.9 I__) 27 26 5

JJ 19.5 29.3

in Mdiv;;:::::::::::::::: - 9 44 2

THE EVACUATION OF MAXILLOFACIAL CASUALTIES

Since maxillofacial casualties went immediately into the general chain

of evacuation the dental service had no special responsibility for their management beyond cooperating in their treatment at medical installations en

route. Methods of handling wounded men varied with geography, combat

conditions, and transportation facilities, but a typical system might be described as follows:

1. Within a few minutes after receiving his wound the injured man was

usually picked up by a "company aid man" of his own organization. This

" See footnote 26, p. 307.

38 Health of the Army, vol. I, Report 1, 31 Jul 46, p. 8.
ADMINISTRATION OF THE DENTAL SERVICE 309

Medical Department soldier was trained in first aid and could stop bleeding

or take other steps immediately necessary to save life but his principal

function was to get the casualty into the hands of a supporting medical unit

which would remove him from the combat area. The aid man stopped hemorrhage, applied a bandage, and directed the wounded man to the battalion aid

station several hundred yards to the rear. If the patient could not walk he

was carried by litter bearers sent forward from the same installation.

2. The battalion aid station was set up with field chests in the first available cover behind the "front line." Here the casualty was seen by a medical

officer and possibly a dental officer as well, though the latter was more often

located at the regimental aid station. Since the battalion aid station had

meager facilities and poor protection from enemy fire the wounded man was

held there only long enough to prepare him for further evacuation and to

arrange his transportation to the rear. His bandages might be adjusted, he

might be given plasma or a sedative if required, and an open airway was assured, but as soon as possible he was turned over to litter bearers sent forward

from a collecting station which had been established by medical troops of the

division medical battalion. The regimental aid station was usually bypassed

at this point.

3. Division collecting stations were normally established within littercarry distance of the battalion aid stations they served and, if possible, on a

motor road passable to the rear. Two medical officers were available and with

slightly more elaborate equipment they could attempt emergency procedures

which were not practical at the battalion aid stations. However, the collecting

station was still within easy range of hostile artillery and mortar fife and

its primary mission was the assembly and evacuation of patients rather than

treatment. In the absence of a dental officer at the collecting station the

maxillofacial patient usually received only such general care as would minimize the danger of further transportation by ambulance to the clearing

station.

4. Clearing stations were division medical installations which were

normally established several miles behind the lines for the further assembly

and treatment of patients from the collecting stations. Four medical officers

and at least one dentist were in attendance and equipment included a small

operating room and ward tents for the temporary care of patients who could

not immediately be removed to a hospital. A clearing station had to be

ready to move on short notice, however, and only the most urgent operational

procedures were undertaken. A maxillofacial injury normally received little

care at this point beyond the control of bleeding, treatment of shock, and

possibly the temporary immobilization of fractured jaws with some type of

bandage. As soon as possible the patient was removed by ambulance to an

evacuation hospital.
310 DENTAL SERVICE IN WORLD WAR II

5. Evacuation hospitals of 400 or 750 beds were army installations established beyond the range of ordinary artillery fire and within reach of reliable

transportation to a major hospital in the communications zone. Though they

were mobile and often operated under tentage they were true hospitals and had

the equipment and personnel to institute general definitive treatment for casualties who had received emergency care in the installations already discussed.

They possessed medical, surgical, and x-ray facilities, and the dental officers

sometimes, though not always, had prosthetic chests in addition to the authorized dental operating chests. "When casualties were heavy a special maxillofacial team might be attached. If such a team was available, the maxillofacial injury received conservative debridement, foreign bodies and unattached bone fragments were removed and fractured jaws immobilized with

more permanent fixation than was afforded by bandages. Drainage was provided and prophylactic doses of penicillin or sulfa drugs administered, if indicated. In the hands of specially trained personnel this treatment added to

the comfort of the patient and minimized disfigurement. In the absence of

a maxillofacial team, however, extensive intervention at this point might do

more harm than good, and evacuation hospitals were frequently instructed

to limit their maxillofacial treatment under such circumstances to conservative

measures to prevent infection and the application of new bandages and temporary fixation.29

6. As soon as it was safe for a patient with a maxillofacial injury to leave

an evacuation hospital, he was usually transferred by train, plane, ambulance,

or ship to a general hospital in the communications zone. Here he was put in

the care of a team which included a plastic surgeon, an oral surgeon, an anesthetist, and specially trained assistants. His wound was thoroughly cleaned

and nonviable tissue and bone removed; permanent fixation was applied; drainage was provided and infection, if any, controlled; eventually the wound was

closed in a way which would best facilitate future plastic repair. If the injury

was not too serious the patient might be retained at this point until he could be

returned to duty. In most instances, however, the severe nature of maxillofacial wounds and the probable need for future plastic operations made it

advisable to return the patient to the Zone of Interior when he could be transported without danger. Maxillofacial patients were given a high priority for

air evacuation, and in a single 5-month period in 1945, 4,907 casualties with

head and neck injuries were returned by air from overseas areas.30

Circumstances often made it necessary to modify the "type" procedure

described. In the invasion of a Pacific island, for instance, a wounded man

might be taken directly from the beach to a ship having medical facilities on

board and transported to a general hospital in a rear area without passing

through any of the installations mentioned. Patients from a battalion aid

»See footnote 10, p. 298.

*• Leibowitz, S.: Air evacuation of sick and wounded. Mil. Surgeon 99 : 7, Jul 1946.
ADMINISTRATION OF THE DENTAL SERVICE 311

station were sometimes taken directly to an evacuation hospital if there was

sufficient cover for ambulances to reach the aid station without being fired

upon, while if there was no cover at all patients might have to be treated in a

battalion aid station or a collecting station until nightfall or until the enemy

was driven from the immediate area. In general, however, the following

cardinal principles were observed: the patient was removed from the combat

area with all practical speed with only the most urgent treatment given en

route, and definitive care, especially that which involved removal of tissue or

bone, was delayed until he could be put in the hands of qualified plastic and

oral surgeons.

THE MOBILE DENTAL OPERATING TRUCK OVERSEAS31

The need for a mobile operating truck overseas was based on the following

general considerations:

Any practical means of bringing convenient base equipment into the combat zone could be expected to increase materially the efficiency of dentists with

tactical units.

Many small units had no regular dental officers and depended upon itinerant facilities for their dental care. Officers assigned to such duty required

equipment which was both efficient in operation and readily transportable, with

time lost for packing and unpacking supplies reduced to a minimum.

Requests for mobile operating trucks were received from overseas units

early in World War II, but development was exceedingly slow and delivery in

quantity did not start until the spring of 1945.

Since the official model of the operating truck did not arrive overseas until

shortly before the end of hostilities, reports on its functioning were meager,

though uniformly favorable.32 However, more elaborate reports are available

on the many improvised operating trucks placed in operation before the arrival

of the standard vehicle.

In the absence of an official model, almost every theater managed to

assemble a considerable number of improvised dental operating trucks of

widely varying characteristics. In many cases these were built by small organizations with captured and makeshift equipment, but in Italy the Fifth Army

went so far as to authorize the construction of dental trailers on standard

bodies in the ratio of five trailers for each infantry division.33 The following

reports are typical of a large number received:

Fifth Army. As in the case of the mobile prosthetic trucks, the mobile

operating trucks could function under any conditions, and by seeking out the

31 For a description of the mobile operating truck see chapter V. The history of the development

of this item has been told in Johnson, J. B., and Wilson, G. H.: History of wartime research and

development of medical field equipment. HD.

»

2

Ibid.

a Rpt, 5th Army Sec, supp. to Dental History, MTO. HD.

330324 0—55 21
312 DENTAL SERVICE IN WORLD WAR II

patient saved an inestimable number of man-hours which would otherwise have

been consumed by patients travelling to a point where their needs could be

met.8*

Twelfth Air Force. In May 1943 it became increasingly evident that a

great deal of operating efficiency at the chair was being lost due to the time

required to set up and tear down the dental equipment before and after an

organizational move. At this time efforts were directed toward construction

of a number of complete dental offices in covered trucks or trailers which were

to remain in operative condition during an overland move.

One such unit was constructed at the direction of the surgeon of the Twelfth Air

Force in the 809th Engineer Aviation Battalion. At the same time another mobile

unit was being manufactured by . . . the 560th Signal Air Warning Battalion. These

two units proved so successful in giving dental attention to outlying stations and

facilitating the service as a whole that coordinated efforts were continued along this

line. . . . Through the individual efforts of the organization dental officers and with

the cooperation of the Ordnance Section of both the Twelfth Air Force and the Twelfth

Air Force Service Command, nine mobile dental units were in operation 1 February

1944.36

There could be no doubt of the superior convenience of the mobile operating

truck over the dental facilities available in the M. D. Chest No. 60, and there

was every reason to believe that similar vehicles would henceforth be considered

essential to the dental service overseas and in maneuver areas in the United

States. However, in determining the extent to which mobile units would eventually supplant dental field chests several other factors had to be considered.

In the first place, the operating trucks were not a substitute for large, conveniently equipped clinics, wherever the latter were practical. Further, the mobile

units cost about $9,000 each, while the Chest 60 cost only a little over $300.

Obviously it would be necessary to determine whether or not manpower and

materials would be available for the construction of several thousand operating

trucks in a time of national emergency before this item could be adopted as

standard equipment for any large proportion of the dentists with the field

forces. Also, the mobile units were not adapted for use in jungle areas or on

small Pacific islands where a chest which could be carried by hand might

actually be more mobile than a truck.

It is highly probable that future experimentation with mobile units will

find means to reduce materially both the cost and the weight of the dental

operating truck, possibly by installing lighter equipment in a trailer or in

a smaller self-propelled vehicle. In 1945 the Director of the Dental Division

recommended further study along these lines.36

34 See footnote 33, p. 311.

x

Rpt, 12th AF Sec, supp. to Dental History, MTO. HD.

M

Final Rpt for ASF, Logistics In World War II. HD.
ADMINISTRATION OF THE DENTAL SERVICE 313

THE PROSTHETIC SERVICE OVERSEAS

World War I

The more rigid physical requirements which were in effect during most of

the First World War prevented the induction of such large numbers of dental

cripples as were accepted for full military duty in World War II. Also, the

early end of World War I brought demobilization of the Armed Forces before

the full effect of meager overseas prosthetic facilities could be felt. As a result,

the provision of prosthetic dental appliances for the personnel of the American

Expeditionary Forces in 1918 and 1919 was a comparatively minor problem.

Only 13,140 new dentures and repairs were completed in France from July

1917 through May 1919. Of these only 2 percent were full dentures.37 Only 1

soldier out of each 150 men in the AEF was provided any denture service

overseas.

In World War I, laboratory equipment was initially furnished abroad only

in base hospitals, evacuation hospitals, and in certain large clinics in the principal centers of population. Installations which were called central dental

laboratories were established in base sections and depot division areas but these

laboratories functioned mainly for the camps in which they were operating,

usually taking impressions as well as completing the fabrication of cases. No

official laboratories were set up specifically to process appliances from impressions taken within the smaller organizations. No prosthetic facilities were

provided in the combat divisions and men in those commands who needed dental

replacements had to be sent to a hospital or to one of the large clinics in the

communications zone.

It was soon apparent that there was urgent need for prosthetic equipment

within combat units to avoid unnecessary evacuation of personnel. A man sent

to a base hospital for construction of dentures might be lost to his organization

for as long as a man hospitalized with a moderately serious wound, and the mere

fact that a soldier had to leave the combat zone for any type of prosthetic treatment encouraged the willful destruction of dental appliances and increased the

demand for replacements which could not be considered essential. The experience of one division dental surgeon graphically illustrates the situation

which sometimes arose. This officer was called to investigate a report that due

to absences for construction of dental appliances the strength of one company

of an infantry regiment was being dangerously reduced. He found that the

trouble had started several days before when a single officer had been authorized

to go to Paris for construction of a needed replacement. The following day

several persons with more or less legitimate requirements had requested the

same privilege. On the third day approximately a dozen had reported for this

purpose, and on the fourth 20 men, many of whom were merely hopeful, asked

" The Medical Department of the United States Army in the World War. Washington, Government

Printing Office, 1927, vol II, p. 121.
314 DENTAL SERVICE IN WORLD WAR II

to be sent to Paris. It was necessary to limit further evacuations from that

company to cases approved by the division dental surgeon.38 As a result of

such experiences, which were repeated in less exaggerated form in many

divisions of the AEF, a special prosthetic chest weighing about 200 pounds was

assembled and issued to each division as it entered the final phase of combat

training.39 This chest was used to establish a laboratory in the division field

hospital where it effectually prevented the evacuation of troops for dental care.

Other changes in the overseas prosthetic service during World War I were of

minor importance.

World War II

With the experience of World War I in mind the Dental Division was

careful to make what was considered ample provision for prosthetic facilities

in theaters of operations. Tables of organization in effect at the start of

World War II authorized dental laboratories in many convenient installations in the communications zone and as far forward into the combat zone

as they could safely be operated.

In rear areas small permanent laboratories were provided in all general

hospitals and in all station hospitals of more than 50-bed capacity; later

they were also supplied in convalescent camps and convalescent centers.

Though central dental laboratories were not specifically prescribed for overseas use, it was anticipated that they could be obtained on special tables of

organization when required.

In the eombat zone, fixed or semifixed laboratories were of course impractical, but the portable equipment contained in the M. D. Chests Nos. 61 and

62 was provided all convalescent hospitals, evacuation hospitals, and field hospitals. Portable laboratory equipment was also carried by the medical battalion assigned to each division. The field sets, with their hand-operated lathes

and lack of protection from the elements, were not suitable for large scale production but they brought laboratory facilities within easy reach of the fighting

man. The Dental Division also expected to obtain modern laboratory trucks

for the use of prosthetic teams in the combat zone,40 and after July 1942 three

mobile units were authorized, in theory at least, for each of the auxiliary

Surgical groups supposed to be assigned to field armies. In spite of these

facilities, however, the provision of prosthetic replacements overseas proved

to be one of the major problems of the Dental Service during the first years

of the war.

Difficulties in providing adequate prosthetic care overseas resulted mainly

from the fact that demands for dental appliances greatly exceeded all calcu88 Personal experience of Maj Gen Thomas L. Smith who was dental surgeon of the 80th Infantry

Division, AEF.

8

» See footnote 37, p. 313.

40 Fairbank, L. C.: Prosthetic dental service for the Army In peace and war. J. Am. Dent.

A. 28 : 801, May 1941.
ADMINISTRATION OF THE DENTAL SERVICE 315

lations. In contrast with the total of 13,140 dentures constructed in France

during the First World War, 845,000 prosthetic cases were completed for military personnel outside the United States in the 4 years from 1942 through

1945; an additional 20,000 appliances were constructed for civilians and prisoners of war.41 The following prosthetic operations of various types were

completed for each 1,000 men overseas during the 3-year period 1943-45: *

2

Full Partial

Year dentures dentures Repairs Total

1943 10.0 28.1 19.9 58.0

1944 12.3 37.9 29.4 79.6

1945 9.2 40.3 33.6 83.1

Yearly average 10.5 37.2 29.6 77.4

Theater reports in 1944 placed the proportion of overseas personnel wearing

dentures at about 10 percent.43 44 ** **

In every area the dental laboratories were pushed to the limit of their

capacity. The Dental Division reported that 7.2 prosthetic operations were

completed for each 1,000 men overseas in the single month of August 1944.47

The Fifth Army in Italy found that 9 men per 1,000 required prosthetic treatment every month.48 The First Army in France reported that "the construction, reconstruction, and repair of dental prostheses is the main dental problem

that we have had to contend with."4t> A single prosthetic team on a Pacific

island (Saipan) constructed 300 dentures a month,50 and on the Anzio beachhead, where 1 dental officer was killed, 5 wounded, and 1 captured, laboratories

in tents protected by sand bags completed 373 cases under constant shelling

and bombing during March 1944.51

The unexpectedly large requirements for prosthetic treatment overseas

may be attributed to a number of factors. Early in the war it was necessary

to ship personnel to foreign areas before essential dental care could be completed, and these men often needed replacements on arrival in the theater.

Many cases were started in the United States but not completed before departure of the patient, and nearly all of the dentures made under these circumstances were either lost in shipment or reached the individual after so many

months that they were useless. In the rush to get troops ready for duty abroad

prosthetic appliances were unavoidably placed too soon after extraction and

the dental surgeon of the European theater reported in 1943 that 10 percent of

"Data compiled by author from reports in the files of the Dental Division, SGO, 1947.

« Ibid.

«ETMD Rpt, SWPA, 6 Jul 44. HD: 350.05.

"Quarterly Rpt of Dental Activities, Hq Base Section No 3, SWPA, 20 Apr 44. HD.

«Medical History 1312th Engineer General Service Regiment, SWPA, May-Jul 1944 (4 Jul

44). HD.

"Quarterly Dental History, Hq Base E, SWPA, 23 Jul 44. HD.

« Memo, Maj Gen R. H. Mills for Technical Div, SGO, 18 Nov 44. SG: 400.34.

48 See footnote 33, p. 311.

4

» Dental History, 1st Army, 18 Oet 43 to 30 Jun 44. HD!

»Annual Rpt, 148th GH (Saipan), 1945, p. 24. HD.

H

Cowan, E. V. W.: North African Theater. Mil. Surgeon 96: 142, Feb 1945.
316 DENTAL SERVICE IN WORLD WAR II

the men who received prosthetic treatment shortly before shipment were unable

to wear their appliances on arrival in England.52 The lack of prosthetic

facilities in forward units early in the war also encouraged carelessness in the

handling of dentures since loss or willful destruction of an appliance might lead

to evacuation from a combat area.

All of these factors were secondary, however, to the simple fact that an

unexpectedly large number of men who required dental appliances had been

taken into the Army, thus increasing the demand for both initial and maintenance treatment far beyond what had been anticipated. Many of these dental

cripples had already been supplied replacements when they arrived overseas,

but dentures are necessarily fragile and require occasional reconstruction to

compensate for gradual changes in the oral structures. Others, borderline

cases, needed appliances after the loss of only one or two additional teeth. The

Fifth Army reported:53

It is of interest to note how quickly prosthetic needs appear in newly arrived divisions (85th, 88th, and 91st) even though these divisions' troops embarked for overseas

duty with all dental requirements fulfilled. Also of significance is the rate of new

dentures and the rate of denture repairs within veteran divisions (1st Armored, 34th,

36th, and 45th).

When nearly 500,000 men overseas were wearing one or more dentures it is not

surprising that over 800,000 cases were completed during 4 years of field operations. Prosthetic requirements overseas, though not as great as in the large

camps receiving recent inductees in the United States, were somewhat greater

than for noncombat troops living under relatively stable conditions, but the

bulk of the prosthetic treatment rendered overseas was routine in nature and

would have been necessary wherever an equal number of men had been on duty.

The situation resulting from the unexpected demand for prosthetic service

overseas was further complicated by the removal, early in the war, of all portable laboratory equipment from medical battalions and regiments, from the

400-bed evacuation hospitals, and the field hospitals. Very little correspondence

has been found to explain this important action, and it was apparently based

largely on informal agreements. As nearly as can be determined the Army

Ground Forces and the Dental Division, the two agencies most concerned, were

actuated by entirely different motives. The AGF had streamlined the division

and was anxious to keep noncombatant personnel and equipment in the combat

zone to a minimum. The Dental Division, on the other hand, certainly had no

intention of leaving the forward areas without prosthetic service, but it was

equally anxious to substitute laboratory trucks for the less efficient portable

outfits and it appears to have concurred in the proposed action in the belief

that the trucks would be able to provide an even better service by the time the

field chests were removed.54 This optimism was later proved premature since

«Personal Ltr, Col William D. White to Maj Gen R. H. Mills, 22 Oct 43. HD: 703 (BTO).

"See footnote 33, p. 311.

" Memo, Col Rex McK. McDowell for Insp Br, Plans Div, SGO, 15 Jan 44. S(*: 70d.
ADMINISTRATION OF THE DENTAL SERVICE 317

development of the trucks lagged and delivery did not start until the summer

of 1944.

In any event, the Dental Division recommended in November 1942 that the

field laboratory chests be removed from all medical battalions.65 No further

correspondence has been found on this recommendation but it is apparent that

oral approval was granted and the portable sets were removed not only from

the medical battalions but also from the smaller evacuation hospitals. Changes

in equipment lists were made very informally at this time, often by undated

pencilled notations; it is therefore not clear exactly when the field chests were

eliminated, but by 7 September 1943 the Dental Division noted that "with the

exception of the 750-bed evacuation hospitals and the convalescent hospitals

the prosthetic service in an army area is provided only by the prosthetic

teams, of which there are three in the auxiliary surgical group." 56

Removal of Chests 61 and 62 from the medical battalions and small

combat zone hospitals left the divisions with no prosthetic service whatever

and drastically reduced the facilities of the armies. Even with the 3 prosthetic teams which had been added to the auxiliary surgical group, an army

of 10 divisions, with 3 evacuation hospitals and 1 field hospital, suffered a net

loss of 11 field laboratories. The mobile laboratories of the auxiliary surgical

group were expected to function with more efficiency than the equipment

carried in chests, but the trucks were not available until well into 1944, a year

after the field chests were eliminated.

The hospitals of the communications zone were already busy providing

prosthetic treatment for their areas and they could increase their output only

to a limited extent. Also, since patients had to be sent from many miles away,

hospitals had to devote beds needed for the care of the wounded to men who

required only a place to sleep and eat while their appliances were being constructed. At one time in 1943, 250 prosthetic patients occupied beds in

general hospitals of the Mediterranean Base Section.57 In March 1943 the

dental surgeon of the North African theater reported:58

At present there are thirty-five patients occupying beds in the 21st General Hospital, awaiting denture prostheses as part of their medical treatment. The 64th

Station Hospital is servicing an engineer regiment of the 6th Corps. This regiment

is soon to move east and has over 50 denture cases awaiting treatment. . . . The

7th Station Hospital is constantly being asked by organizations within a radius of

80 miles to hospitalize men for full or partial denture work, and at present is dated

up to the first day of May, 1943.

The necessity for evacuating prosthetic patients from combat areas also

resulted in great loss of manpower. The dental surgeon of the China-BurmaIndia theater reported that it often took a month for a man to be shipped to a

55 Memo, Col Rex McK. McDowell for Supply Serv, SGO, 3 Nov 42. SG : 400.34-1.

56 Memo. Brig Gen R. H. Mills for Oprs Serv, SGO, 7 Sep 43. SG : 322.15-16.

' See footnote 51, p. 315.

«* Ltr, Col E. W. Cowan to Surg. NATOUSA, 13 Mar 43, sub: Dental needs in the theater of operations, incl to personal ltr, Col William D. White to Brig Gen R. H. Mills, 7 Apr 43. HD: 703 (ETO).
318 DENTAL SERVICE IN WORLD WAR II

hospital, have his work completed, and return to his unit.59 The dental surgeon

of the North African theater stated that one of his biggest problems was to

prevent the evacuation of men from combat areas for prosthetic treatment.60

When hospitals were flooded with wounded any patients not requiring immediate care to save life were sent to the rear as rapidly as possible to make

room for the more seriously injured, and under these circumstances the

evacuation of a prosthetic case might go to fantastic lengths. One man who

reported for repair of a denture in Sicily eventually arrived in North Africa

after passing through four hospitals with such speed that he was never seen

by a dentist.61 Even when prosthetic cases could be handled on an outpatient

basis results were not too good since either the patient or the hospital might

be moved before the denture could be completed.

The situation resulting from the drastic reduction in prosthetic capacity

in forward units soon led the theaters to take independent and unofficial action

to restore at least part of the lost facilities. The European and North African theaters issued field chests to evacuation hospitals and medical battalions

on their Own responsibility.6263 The Southwest Pacific theater issued them

to field hospitals as well.64 In general, in every important theater the portable

laboratories were restored at least to the medical battalions with divisions.

Most theaters went further and anticipated the arrival of approved laboratory trucks by improvising models of their own.

The Dental Division did not modify its original stand on removal of

field laboratories from the divisions and combat zone hospitals but it did give

tacit approval to the action of the theaters as an emergency measure by

approving requisitions for enough Chests 61 and 62 to allow issue of the

equipment in excess of the quantities authorized by tables of organization.

In February 1944 the Dental Division briefly considered restoration of the

portable laboratories to the medical battalions,65 but in May of the same year

stated "it is the opinion of the Dental Division that sufficient dental laboratory facilities will be available when the mobile dental laboratories are supplied to the units in the number called for by T/O's."66 Since the mobile

units were slow in arriving, Army Ground Forces suggested in November

1944 that the portable chests be returned to evacuation hospitals.67 By this

time, however, laboratory trucks were finally en route to the theaters and the

Dental Division disapproved the recommendation of Army Ground Forces

• Ltr, Col Dell S. Gray to CofS, Hq, USAF. CBI, 30 Jan 44, sub : Report of theater dental

surgeon on trip to Calcutta, 8-22 Jun 44. On file as Incl to ltr, Dell S. Gray to Col Hex McK. McDowell, 1 Jul 44. HD : 333 (Dental) CBI.

60 Interv, author with Col Lynn H. Tingay. Report of dental activities in the North African

Theater of Operations, 29 Dec 44. HD : 00.71 (NATOUSA).

«»History of the Army Dental Corps (MTO) 1943-44. HD.

K

See footnote 5, p. 293.

83 Chief Surg, NATO, Ltr 1, 6 Jan 44. HD : 314. (NATO).

" Annual Rpt, Chief Surg, SWPA, 1944. HD.

65 Memo, Col Rex McK. McDowell for Col J. B. Mason, 4 Feb 44. SG : 444.4-1.

68 Memo, Maj Gen R. H. Mills for Oprs Serr, SGO, 18 May 44. SG : 444.4-1.

« Memo, Maj Gen R. H. Mills for Insp Br, Oprs Serv, SGO, 4 Nov 44. SG : 400.34.
ADMINISTRATION OF THE DENTAL SERVICE 319

and restated its position that the laboratory trucks were the real answer to

the prosthetic problem in the combat zone.68 By the end of 1944 the improvised laboratory trucks and the field chests which had been issued in

excess of tables of organization, plus the newly arrived mobile units, had the

prosthetic situation well in hand. Further recommendations of the Dental

Division were concerned principally with utilization of the laboratory trucks.

It cannot be said how many of the 865,000 prosthetic cases completed

overseas were constructed with the portable sets or improvised laboratory trucks

but the number was certainly important. The First Infantry Division, alone,

completed 1,945 appliances in 1 year.69 During 1944 a total of 15,288 cases

was constructed by units of the Fifth Army, and 3,503 new dentures and 2,081

repairs were completed within combat divisions of that Army in the same

period.70 The unhappy results of removal of the divisional prosthetic service,

and the amount of work which was accomplished after some facilities had

been restored, left no doubt that dental laboratories were essential in the

forward areas.

The importance of an adequate prosthetic service as a morale factor was

unexpectedly demonstrated by an embarrassing experience in the North African theater in 1943. This theater was established at a time when earlier physical standards had been drastically lowered, men were still being shipped

m& ?4

•*$» {?&%$

m

t * ji *fi|

\.7 :. ^n *

!« "%.!

Si

m

/ \ 1 \ v

Figure 32. Dental Laboratory, 602d Clearing Company. Italy, 1944-

ffi See footnote 47, p. 315.

«»Annual Dental Kpt (1944), 1st Division, 25 Jan 45. HD.

70 See footnote 33, p. 311.
320 DENTAL SEEVIOE IN WORLD WAR II

i-,**i~;

* W

r%

\ i

W

- A

V iÜ

Figure 33. Small Prosthetic Laboratory in the Field. France, 1944.

ft

Figure 34. Improvised Prosthetic Truck icith the Fifth Army. Italy, 1944-
DEMOBILIZATION OF DENTAL CORPS PERSONNEL 321

Figure 35. Gold and Clasp Room, Central Dental Laboratory No. 1. London, lQIfi.

overseas before completion of their dental work, and the portable laboratories

had just been removed from a large number of combat zone medical organizations. Consequently the prosthetic service in North Africa was at a low

ebb in 1943. General Eisenhower had asked that mail censors tabulate the

complaints noted in soldiers' letters, and to the astonishment of all concerned

the Dental Service took first prize with "gripes" relative to the inability

of getting dental replacements.71 The fact that troops getting their first taste

of action were more voluble about difficulties in getting dentures than about

defects of food or the discomforts of combat showed that the prosthetic

service was almost as important to morale as to health.

Utilization of the Mobile Prosthetic Trucks

Long before the first laboratory trucks (described in Chapter V) were

delivered overseas considerable difficulty had been encountered in finding organizations to which the prosthetic teams could conveniently be assigned. Since

the mobile laboratories had to move from unit to unit and from area to area on

short notice they could not be assigned permanently to the small individual

commands which they served. They were initially too few in number to be

assigned even to divisions. They could have been given to field armies in the

combat zone, but large headquarters frequently protested at having their

staff personnel involved in the detailed administration of minor units. It was

1 See footnote 51, p. 315.
322 DENTAL SERVICE IN WORLD WAR II

Figure 36. Dental Laboratory of the 181st General Hospital. India, 19Ufelt in the Dental Division that until the value of the trucks had been proved

the Army Ground Forces, which had to approve any change in the organization of combat units, would vigorously oppose any proposal to add them to the

tables of organization of any large line unit. To avoid controversy with Army

Ground Forces the Dental Division therefore recommended that the mobile

laboratories be added to a medical unit, the organization of which was a responsibility of the Medical Department.72

Obviously the prosthetic teams, whose functions were unrelated to most

medical activities, could not conveniently be added to hospitals or most other

large medical units. The auxiliary surgical group, however, was itself a

catchall, composite, organization of just such semi-independent, highly specialized, medical units, and the prosthetic teams could be incorporated in its

tables of organization without materially disrupting its operations. In July

1942, therefore, almost 2 years before the trucks became available in quantity,

3 prosthetic teams and laboratory trucks were added to a new table of organ-

" Personal interview between author and Colonel Beverly Epps who was on duty in the Dental

Division, SGO, during most ot the war.
ADMINISTRATION OF THE DENTAL SERVICE 323

ization for this unit.73 M. D. Chests Nos. 61 and 62 were substituted for the

trucks pending arrival of the latter. It had been planned originally that one

auxiliary surgical group would be assigned to each army, but no specific allotment had been authorized. By 7 September 1943 estimates of the number of

auxiliary surgical groups to be organized had been reduced to a total of 5, and

in addition The Surgeon General was recommending that only 2 prosthetic

teams be included in each group. The total of 10 prosthetic teams which would

have been provided overseas by 5 auxiliary groups was only a fraction of the

number urgently needed and the Dental Division recommended that the teams

be deleted from the surgical groups and added to the general headquarters of

a theater in the ratio of one for each division or equivalent number of troops.74

The Surgeon General disapproved this recommendation on the grounds that

since the tables of organization of a general headquarters was the concern of

Army Ground Forces, the latter should be requested to initiate the change.

The Surgeon General also recommended that the Dental Division plan on

supplying prosthetic trucks overseas in the ratio of 2 for each 3 divisions, but

added the ambiguous statement that they should be shipped only on request

of the theaters concerned in a ratio not to exceed one per division.75 The Dental

Division then asked the surgeon, Army Ground Forces, to approve a table of

organization embodying the recommended modifications, but no action was

taken on this request.76 Itis known that general headquarters of the European

theater opposed the assignment of incidental units to its overhead and it is

probable that this attitude was reflected in Army Ground Forces headquarters

in Washington.77

Early in 1944 the proposed reorganization of two medical installations

made it possible to continue the assignment of the prosthetic teams, as before, to

medical units. On 17 March 1944 a new T/O 8-667, Medical Depot Company, provided for 2 prosthetic teams in that organization, which was expected

to serve about 75,000 troops.78 On 23 April 1944, the auxiliary surgical group

was absorbed into a new "medical service organization" which included prosthetic trucks "as needed."79

In a memorandum to the Operations Service,

SGO, on 4 February 1944, the Dental Division stated that the prosthetic teams

in the medical service organization would be able to provide mobile prosthetic

service in the communications zone and that the teams with the medical depot

companies would do the same for the combat zone.80

Neither assignment worked out as planned, however. A change in the

tables of organization for the medical depot company in August 1944 provided

ra T/O 8-571, 13 Jul 42.

» See footnote 56, p. 317.

15 Memo, Col Arthur B. Welsh for Dental Dlv, SGO, 11 Sep 43. SG: 322.3-1.

'• Memo, Brig Gen K. H. Mills for Surg, AGF, 13 Sep 43. SG : 322.3-1.

" Info from Maj Gen Thomas L. Smith, former dental surgeon, ETO.

re T/O 8-667, 17 Mar 44.

T/O&E 8-500, 23 Apr 44.

»See footnote 65, p. 318.
324 DENTAL SERVICE IN WORLD WAR II

that 1 unit would serve 125,000 troops instead of Y5,000, leaving only 1 prosthetic team for each 62,500 personnel.81 The authorization of prosthetic teams

in the medical service organization "as needed" also proved too vague and was

generally not interpreted to provide an adequate number of trucks in the communications zone. Because of the prospective reduction in the number of prosthetic teams in the combat zone, incident to the change in the medical depot company, the Dental Division recommended in November 1944 that the trucks be

made available directly to armies in the ratio of 1 mobile unit for each 30,000

men.82 Though this proposal was not put into effect, approximately the same

result was attained on 18 January 1945 when the number of teams assigned to

the medical service organization was increased to "one for each 30,000 troops,"

apparently anticipating that the needs of both the combat zone and the communications zone would henceforth be met from this unit.83 Finally, when the

division dental service was reorganized in June 1945, one prosthetic team was

authorized for direct assignment to the dental detachment of each division.84

The previous allotment of trucks to the medical service organization was not

rescinded at this time, however, and at the end of hostilities the prosthetic

teams were authorized, in theory at least, both in the ratio of 1 for each division,

in the dental detachment, and 1 for each 30,000 total strength of a theater, in the

medical service organizations. It is probable that correction of this duplication was delay pending expected changes in the organization of the Army

following the war.

The actual utilization of the prosthetic teams overseas was highly complex

and followed no definite pattern. Flexibility of operation, which was essential

to meet unexpected situations, often necessitated wide and unorthodox variations from the plan contemplated in tables of organization. In the European

theater, for instance, three teams were assigned to a central dental laboratory

where they were available on short notice for use in any area. These three

teams were given blanket orders every month to proceed to any part of the

theater "to carry out the orders of the theater commander." The theater dental

surgeon, in turn, could move the teams at any time by a telephonic order, giving him a small reserve pool of prosthetic personnel and equipment to meet

emergency situations. Other teams were assigned to the base sections where

they operated under the base section dental surgeons. Several teams were assigned to the communications zone for replacement of units which might be

lost to combat organizations, but these teams were temporarily loaned to army

replacement depots which were overburdened with work for new men; eventually they were turned over to the armies. Other teams were assigned to the

combat armies, either directly or as part of medical depot companies. The

army units in the European theater were utilized in various ways. Some were

81 T/O&E 8-667, C 1, 11 Äug 44.

83 See footnote 47, p. 315.

M

T/O&E 8-500, 18 Jan 45.

"See footnote 9, p. 297.
ADMINISTRATION OF THE DENTAL SERVICE 325

kept under army control; others were in turn attached directly to divisions.

Some had their overhead functions carried out by a parent organization; others

were nearly independent, relying on the units to which they were attached for

little more than rations and housing. About the only generalizations which

can be drawn are that the teams were seldom assigned to the auxiliary surgical

groups or the medical depot companies of which they were ostensibly a part,

and control was generally retained in one of the higher headquarters where

the dental surgeon could utilize the limited number of teams in the best interests

of the whole command. The official assignment of laboratory trucks to individual divisions, under T/O 8-16, was not directed until June 1945, near the end

of hostilities.85

Evaluation of the Mobile Prosthetic Trucks. Keports from every theater

confirmed the value of the prosthetic trucks. During the fighting in France

the First Infantry Division, for instance, had made it a practice to set up the

Chests 61 and 62 only when it appeared that no move would be necessary within

3 days. When the division reached Belgium it obtained a mobile laboratory

and thereafter the prosthetic clinic operated whenever it could count on a single

day in any given location.80 The Ninth Infantry Division reported "prosthetic

dental chests cannot be used efficiently in bivouacs of short duration. A mobile

dental laboratory is essential to meet the prosthetic needs of a division."87 A

general board which made a study of medical activities in Europe at the end

of the war found that:8S

A large number of mobile laboratories and operating units are required in warfare

involving rapid movement, and when attached to divisions provide uninterrupted

dental care and eliminate the evacuation of troops from divisional areas. It has

been found that mobile dental units can offer the maximum service to forward units.

The extreme value of the mobile type of prosthetic unit was proved beyond all question

once the lines had become extended beyond the point at which semifixed installations

were effective.

The Director of the Dental Division stated in 1945:89

The mobile dental laboratory is a most useful, efflcient and economical mechanism for

the rendering of prosthetic laboratory work in Army areas, in the communications

zone, on maneuvers in the continental United States, and in certain isolated stations

in the United States.

In spite of the success of the mobile dental laboratories, however, it would

be a mistake to regard them as the final, universal answer to all prosthetic

problems, even in the field. They brought modern equipment to the combat

zone where it was badly needed, but in other areas, where mobility was of less

importance, the prosthetic trucks could not equal the efficiency of larger, fixed

85 Data on the use of the dental prosthetic trucks were seldom a matter of record. Information

given here has been assembled by the author by means of interviews with senior dental surgeons.

86 See footnote 69, p. 319.

87 Annual Rpt, 9th Division, ETO, 1943, 21 Jan 44. HD.

88 Interviews, The General Board, ÜSFET Medical Section, ETO, vol IV. HD : 334.

8D See footnote 36, p. 312.
326 DENTAL SERVICE IN WORLD WAR II

or semifixed installations operating day after day under relatively stable conditions. It is difficult to obtain figures on the output of the prosthetic teams,

but 5 mobile units of the First Army completed an average of about 1.5 cases

per technician per working day during 5 months in 1944 and 1945, compared

with an average for large laboratories of about 2.5 cases per technician per

working day.90 The mobile units were admittedly crowded, and since the equipment was tied to its means of transportation, operations had to be suspended

when the truck was used to carry water or supplies, or when normal maintenance was required. Time was lost in moves and several days might elapse

after a change of location before all troops in the vicinity could be notified that

prosthetic services were available.

In divisions the need for mobility outweighed all other considerations.

The prosthetic laboratory had to be ready to move on short notice and to

function when no more than 24 hours could be spent in any given location.

Time lost in packing and unpacking equipment with every move would have

offset any advantage of setting up in more spacious quarters even if permanent

buildings had been available. Dental surgeons were therefore generally agreed

that only a completely mobile unit, with built-in equipment, could meet the

prosthetic needs of a division with reasonable efficiency. For similar reasons it

was necessary that armies, and even higher headquarters, should have at least

a few prosthetic teams which could be used to meet emergencies or for assignment with small commands which for any reason could not use the central

dental laboratories. But while the mobile dental laboratories probably did

more to improve the prosthetic service than any other wartime development,

they were not a substitute for the larger fixed laboratories wherever the latter

could be used.

The prosthetic trucks also had certain limitations under special conditions.

On small island areas, for instance, usefulness of the mobile units was limited

by lack of roads, and in addition the trucks were usually given a low priority

in an invasion. For some time after a beachhead was established prosthetic

service had to be rendered from field chests.91

The mobile units themselves might be expected to undergo modification

from time to time, though at the end of the war the line which future development would take was not clear. One important defect, the fact that operations

had to be suspended whenever the truck was moved, could of course be eliminated by mounting the equipment in a trailer, but it was feared that this change

would make it easier for commanders of units to which the laboratories were

attached to appropriate the trucks, leaving the prosthetic teams worse off than

before. A truck and trailer combination would also be less able to negotiate

unfavorable terrain. It was further noted that whenever a prosthetic team

could expect to be in a given location for any considerable length of time, as

much of the equipment as possible was usually unloaded from the truck and

90 See footnote 10, p. 298.

91 See footnote 36, p. 312.
ADMINISTRATION OF THE DENTAL SERVICE 327

set up in any available permanent shelter. It was therefore suggested that

prosthetic teams assigned in the rear of the combat zone or in other areas where

frequent movement was less essential, should be supplied cargo trucks and

equipment designed for use in a building or tentage. The necessity for supplying a highly mobile prosthetic service well forward in the combat zone was

proved beyond all doubt, but the means by which it would be rendered would

probably need to be reexamined periodically in the light of changing conditions

of warfare.

Central Dental Laboratories

It has been seen that the prosthetic needs of divisions and comparable combat units could be met only by small, mobile laboratories functioning in the

immediate vicinity of the troops they served. Only a relatively small proportion of the personnel in a theater were assigned to combat commands, however;

the remainder obtained replacements from some more permanent type of installation. Hospitals of the communications zone were authorized small dental laboratories but these were inadequate to meet the demands of large surrounding areas. The largest general hospital was allotted only two technicians

and the largest station hospital had but one. Further, these dispersed installations could not be organized for maximum efficiency. This could be attained

only when large numbers of skilled technicians repeated over and over the

limited operations in which they were most proficient. As a result the hospital

laboratories were unable to meet the enormous demands for prosthetic service

in a theater of operations.92

In the continental United States the bulk of routine dental laboratory

service was provided by large central dental laboratories organized to function

on a "production line" basis, but this type of installation had not been specifically authorized in tables of organization for overseas use. Failure to provide

for central dental laboratories outside the United States was probably due in

part to the fact that the magnitude of the prosthetic problem had been underestimated but there is reason to believe that other factors were also taken into

consideration. First, the requirements of different theaters would obviously

vary greatly and no single organization could meet the needs of every area.

Also, a central dental laboratory must have rapid, dependable communications

with all parts of the area it serves, and in the more backward regions, where

United States troops first saw service, existing transportation facilities were

often meager. The question of establishing central dental laboratories was

therefore left to the individual theaters which could recommend special tables

of organization to meet their own needs.

Central dental laboratories eventually proved practical and necessary in

most of the major theaters. Considerable delay was encountered in getting

»See footnote 3, p. 291.

330324 O—55 22
328 DENTAL SERVICE IN WORLD WAR II

them in operation, however. Until a theater had been at least partially organized and the direction of its future development determined, the dental surgeon

could not know how many troops would have to be served nor where he would

have to concentrate his facilities. After these questions had been answered, he

still had to get his tentative table of organization approved in his own headquarters and by the War Department, then wait for many months while personnel and equipment were assembled and shipped. As a result most central

dental laboratories were staffed with men taken from hospitals or other dental

installations. By this means a limited number of technicians were utilized with

the greatest efficiency and laboratory service was provided for all on an equal

basis, though hospital laboratories were robbed of needed personnel. The experience of the dental surgeon of the European theater, which was fairly typical,

was described as follows :

93

It is to be noted that no provisions were ever made as far as I can find out for Tables

of Organization for central dental laboratories in any theater of war. During the

past few months I have often wondered why. My first official act on arriving in this

theater was to have a cable sent to the Chief Surgeon requesting one central dental

laboratory complete, for which there was both a T/O and a T/BA at the time. My reply

was to requisition both personnel and equipment from here. This occurred on or about

1 July 1942, and those instructions were promptly carried out. Last week, after a delay

of 15 months a few of these items requisitioned at that time arrived at one of our

depots, but at this time have not yet arrived at the laboratories. In mentioning this it

brings out a point which I wish to emphasize, that is the great delays which occur in

wartime. I am wondering if it would be better to organize these units at home and

send them forward with equipment and trained personnel like any other unit, rather

than try to put them together in a new theater piece by piece. . . . The equipment

which we now have in these laboratories has all been diverted from the hospitals

for which it was intended.

An adequate central dental laboratory system, with nearly 150 technicians,

was eventually established in England, but the factthatthese facilities were not

available for many months seriously hampered the prosthetic service and delayed the treatment of men being prepared for the invasion of France.

The General Board, United States Forces, European theater, also

reported:94

There were sufficient dental personnel in units operating under approved tables of

organization in the communications zone, European Theater of Operations, to perform

the mission of the separate units. However, the dental personnel in these units were

not able to provide for an adequate overall communications zone dental service, particularly at the larger headquarters and in cities such as London and Paris. Fairly

adequate dental service was eventually provided by organizing non-tables of organization laboratories and clinics. There was a definite shortage of dental officers to provide this additional service and it was only accomplished at the expense of taking

dental officers and technicians out of general hospitals, dispensaries and other medical

units under communications zone control . . . thereby reducing the efficiency of the

83 See footnote 52, p. 316.

«See footnote 3, p. 291.
ADMINISTRATION OF THE DENTAL SERVICE 329

dental service of these units. A great amount of improvisation was required as a

result of failure to provide for adequate personnel and equipment in sufficient time to

make the indicated service possible.

It would seem that considerable difficulty and delay would be eliminated

if central dental laboratories for overseas use were established by tables of

organization. Laboratories of the sizes required could then be requisitioned as

units and shipped from the United States complete, ready to function on arrival.

Hospital Laboratories

During the war very few official changes were made in the authorized

personnel or equipment of hospital laboratories. Unofficially, both personnel

and equipment often had to be augmented to meet special situations. General

hospitals of 1,000 beds or over were authorized two dental laboratory technicians; hospitals of less than 1,000 beds were authorized only a single technician

or none at all. Since a single officer can keep approximately 5 technicians

occupied it is obvious thatthe 1 or 2 men assigned to a hospital laboratory could

not complete all the cases started by even one officer on full time prosthetic

duty. When, as frequently happened, a hospital in an isolated location had

to provide prosthetic service for all surrounding commands, its efforts to keep

ahead of the flood of cases were doomed from the start even when it neglected

the care of its own patients. Under these circumstances the theater dental

surgeon had to attach up to a dozen men to the hospital laboratory which then

acted as a subcentral laboratory for the area. Since, initially, the theater

dental surgeon had no reservoir of personnel for such duties, they were usually

taken from other units which needed them only slightly less urgently. Later

in the war fixed prosthetic teams of a medical service organization were sometimes used for this purpose.

In the combat zone the 750-bed evacuation hospitals which were at one time

responsible for almost all the prosthetic service in army areas, were particularly

ill-equipped to handle such a task. When the installation was functioning in

combat the 3 dentists and 3 assistants were fully occupied with other duties, so

that the dental laboratory chests were sometimes unopened for long periods of

time. Almost all the dental officers interviewed by the European General

Board recommended the addition of laboratory personnel to the tables of

organization for the 750-bed evacuation hospital and restoration of the Chests

61 and 62 to the 400-bed hospital.95 It is believed, however, that the opinions

of most of these officers were based on their experiences during the period when

the evacuation hospitals were vainly trying to provide all combat zone prosthetic service; the assignment of mobile prosthetic teams to divisions late in

the war materially reduced the need for extensive laboratory facilities within

evacuation hospitals and both the mission and organization of these units

*> See footnote 88, p. 325.
330 DENTAL SERVICE IN WORLD WAR II

seemed to indicate that they should not be expected to render any great volume

of routine prosthetic treatment.

The experience of World War II demonstrated conclusively that: the

laboratory personnel of the larger communications zone hospitals must be increased slightly if the dental service for hospital patients is to be adequately

maintained, and hospital laboratories cannot provide prosthetic service for

surrounding commands without extensive reinforcement of wartime tables of

organization.

Summary

In the continental United States, with its rapid communications and large

concentrations of troops, there was no question of the superior efficiency of

large central dental laboratories staffed by experts and outfitted with the most

modern equipment. In many overseas areas, however, a compromise had to be

made between the efficiency of the large establishments and the convenience

of the smaller, dispersed installations. The mobile prosthetic teams provided

an acceptable solution of the laboratory problems of divisions and similar

organizations though some dental surgeons felt that the teams could function

better if their equipment were carried in a weapons carrier or light truck.

In the rear areas of the communications zone, at least in those theaters where

communications were not a major problem, it was generally agreed that the

bulk of the prosthetic service should be rendered by central laboratories operating under stable conditions. Hospital laboratories could complete cases for

their own patients and render occasional emergency care for other personnel

and, if effectively reinforced, might act as subcentral laboratories in isolated

locations, but they should not be expected to provide "mass production" facilities for the routine treatment of large commands. The need for approved

tables of organization for overseas central dental laboratories was evident.

There was less agreement on the most effective prosthetic service for army

areas in the rear of the combat zone where neither the mobile teams nor the

central laboratories seemed to meet all requirements. Some army dental surgeons felt that extreme mobility was still essential even in regions where contact with the enemy was relatively improbable and recommended that field

armies be provided enough of the prosthetic trucks and teams to care for all

army troops. Others felt that while some mobility was essential it was not

necessary to use built-in equipment with consequent limitation on space, and

that communications in an army area were sufficient to allow some concentration

of laboratory facilities into more efficient units. After a study of his prosthetic

organization96one army dental surgeon expressed the following views:

1. While the prosthetic teams (preferably with demountable equipment mounted in

light trucks) may be able to meet most of the laboratory needs of divisions, provision

must also be made for the care of army troops, which in a type army have approxim

See footnote 10, p. 298.
ADMINISTRATION OF THE DENTAL SERVICE 331

mately the same total strength as the troops in the divisions and corps. About nine

prosthetic teams are required to provide prosthetic care for the divisions of a type

army and approximately equal facilities would be needed for army troops.

2. Instead of using nine separate prosthetic teams for army troops a more efficient

service would result if the 27 technicians of these teams were grouped into a single

"prosthetic detachment." This prosthetic detachment would have for the army

prosthetic service the same advantages of centralization and control that the new

division dental detachment offered for the division Dental Service. The detachment

would have to be organized along cellular lines so that it could operate either as a

large laboratory or as two or more smaller laboratories of not less than six men each.

Equipment would be demountable and sufficiently mobile to be moved by trucks when

required, but the army laboratories would be located so as to require changes of position as infrequently as possible. Transportation needs would be reduced since only

rarely would the whole laboratory have to be moved at one time. Since equipment

would not be mounted in the trucks, these would be available for carrying supplies,

picking up and delivering cases, or other necessary routine duties.

None of the many opinions quoted on the army prosthetic service was

expected to offer the final solution of the problem, and it may be that no single

plan would be uniformly applicable. It is possible, for instance, that the

scheme for an army prosthetic detachment and a centralized army laboratory

would have worked effectively in Europe where the road net was extensive, but

it might have proved less satisfactory in the Pacific jungles. The significant

point at this time is that while the needs of the divisions and the base areas

were being satisfactorily met at the end of the war there was a fairly general

feeling that the prosthetic service of the field army should be given further

attention.
CHAPTER IX

Demobilization of Dental Corps Personnel

WORLD WAR I

Following World War I, demobilization of Dental Corps personnel was

rapid and relatively uncomplicated. Those overseas had to be returned to the

United States, and some dentists were retained to care for the 120,000 casualties

under treatment in general hospitals when the armistice was signed,12 but reduction of the Army to a skeleton force soon after hostilities ended greatly simplified planning for the postwar period. Since no dental officer had to serve very

long after the end of the war each man could be discharged as his unit was disbanded or as he became surplus to its needs. No elaborate plans for interchanging dentists between organizations or even between geographical areas

on the basis of length of service, dependency, et cetera, were necessary. Under

the policy of "down the gangplank and out," dental officers in units with a low

priority for disbandment had to serve a little longer than those in more fortunate commands, but since all nonvolunteers could be ordered released by 1

October 1919, no man had to serve as much as a year beyond the armistice

against his will.3From 11 November 1918 through June 1920 the Dental

Corps was reduced as follows: *

Strength of

the Dental Regular Temporary

Date Corps Army officers

11 November 1918 4,510 227 4,283

1 July 1919 2,219 218 2,001

30 September 1919 773 209 564

1 January 1920 369 202 i 167

30 June 1920 322 196 > 126

1 All volunteers.

WORLD WAR II

Demobilization From V-E Day to V-J Day

The early losses of physicians and dentists at the close of World War I

had, at times, seriously hampered the medical service. With this in mind, The

1 Annual Report of The Surgeon General, U. S. Army, 19-19. Washington, Government Printing

Office, 1919.

* The Medical Department of the United States Army in the World War. Washington, Government

Printing Office, 1923, vol. I, p. 159.

3 Annual Report of The Surgeon General, U. S. Army, 1920. Washington, Government Printing

Office, 1920.

* Ibid.
DEMOBILIZATION OF DENTAL CORPS PERSONNEL 333

Surgeon General pointed out as early as August 1943 5and later in April 1944 a

that demobilization of Medical Department officers would not only fail to

precede that of other branches, but would lag behind if the needs of the sick

were to be met and separation examinations carried out.

With the end of- the war in Europe, pressure for the release of medical

and dental officers increased rapidly. Within 1 month after V-E Day a Senate

resolution was submitted calling for an investigation of "hoarding of physicians and dentists" by the Army,7

and this action was just one symptom of the

general expectation that Medical Department personnel would be discharged

in large numbers as soon as Germany was defeated. The Surgeon General,

however, consistently discouraged this attitude for the following reasons:

1. The war was not ended; it was to a great extent merely transferred to

the Pacific area. Many units in Europe would be held for occupation duties;

others would be sent to the Pacific either directly or after furloughs and retraining in the United States.

2. Except in Europe The Surgeon General had no excess of Medical Department personnel. On the other hand, shipping priority went to units being

transferred to combat areas, and other categories had to wait. In July 1945

it was reported that there were 6,000 surplus medical officers in Europe, but that

current shipping schedules would return only 30 percent of them to the United

States before the end of October.8 As early as September 1944 The Surgeon

General had asked for the early shipment of Medical Department personnel

after the end of hostilities in Europe,9and in June 1945 the War Department

had directed such return,10 but a force which had been building up for 3 years

could not be moved in a few weeks. Also, some time was required to screen

Medical Department personnel on duty in Europe to determine which should

be sent to the Pacific, which held for occupation duties, and which returned to

the United States. Meanwhile, units awaiting return had to be supplied

medical care.

3. Shipping shortages had precluded the regular rotation of personnel between overseas theaters and the Zone of Interior. Now that units were passing

through the United States en route to the Pacific it was necessary to replace

men with the most overseas service with Zone of Interior personnel who had not

had foreign duty. But each such exchange required 2 extra officers for a period

of 2 months or more. The officer returning to the Zone of Interior had to be

given leave and travel time before he reported to his new post; the officer

»Memo, Col E. W. Bliss for Dir Spec Planning Dlv, WDGS, 16 Aug 43, sub : Demobilization planning. SG : 370.01-2.

« Memo, Brig Gen R. W. Bliss for Dir Spec Planning Div, WDGS, 27 Apr 44, sub: Demobilization

planning. SG: 370.01-2.

i S. Res. 134, 79th Cong, 12 Jun 45.

" Memo, Ell Glnzberg, Dir Resources Anal Div SGO, for SG, 5 Jul 45, sub: Redeployment policy.

SG: 370.01. 8 Memo, Ma] Gen LeRoy Lutes for SG, 19 Jan 45, sub: Priority return of medical personnel from

inactive theaters after V-E Day. SG : 370.01.

Radiogram 16876, 14 Jun 45 ; cited in footnote 8, above.
334 DENTAL SERVICE IN WOELD WAR II

replacing him had to be granted leave and travel time before he left for overseas; a third officer had to be assigned to provide care in the absence of the

other two. The Surgeon General estimated that the necessity for reshuffling

personnel to meet the needs of the Pacific theater would delay the separation

of surplus European theater officers by nearly 5 months.11 From 20 June

through 15 August 1945, 4,000 medical officers were exchanged between units.12

4. Casualties in Army hospitals had to be provided attention, and separation and redeployment centers had to be staffed, regardless of the end of the

war in Europe.

Based on these considerations, General Kirk predicted in July 1945 that

there would be no large scale separation of Medical Department personnel

before the end of the year.13

During this period the situation was further complicated by the necessity

for a general reconsideration of all personnel assignments. The fact that a

man with 18 months' service was surplus in Europe did not justify his release

from active duty if men with 36 months' service were still being held in the

Pacific, and it was essential that there be established a basis for the equitable

discharge or reassignment of all Medical Department personnel regardless

of current place of duty. This was accomplished by an "adjusted service rating" (ASE) scored on the following credits:14

Each month of service since 1 September 1940 1 point

Each month of overseas service (in addition to points for total service) 1 point

Each combat decoration 5 points

Each child under 18 (maximum of 3) 12 points

(ASR scores were first calculated as of 12 May 1945; they were later adjusted

as of 2 September 1945.)

On the basis of the ASR, personnel overseas were divided into the following categories:15

1. Men with the fewest points were put in units bound directly for the

Pacific.

2. Men with slightly more points were put in units bound for the Pacific

after a stopover for furloughs and training in the United States.

3. Men in the median ASR categories were returned to the United States

for assignment to a strategic reserve for duty in the Pacific when and if needed.

4. Men in the moderately high point categories were held in Europe for

occupation duties until eligible for release from the Army.

11 Official announcement on redeployment and separation of Medical Department officers. J. Am.

Dent. A. 32 : 1177-1182, Sep 1945.

13 Memo, Maj George L. Gleeson, Chief Oprs Br Pers Serv SGO, for SG, sub : Quarterly report of

activities, Operations Branch, Personnel Service, for period 10 Jun 45 through 30 Sep 45. HD : 319.1-2

(F/Y 1946).

13 No large release of dental officers before end of 1945. J. Am. Dent. A. 32 : 908, Jul 1945.

14 RR 1-1, 25 Jan 46.

15 Medical Department Redeployment and Separation Policy as revised 6 Aug 45. HD : 314.
DEMOBILIZATION OF DENTAL COEPS PERSONNEL 335

5. Highest point men were to be returned to the United States for

immediate discharge.

On arrival from overseas any dental officer who was either over 50 years

of age, or had an ASR over 100, was discharged.16 Officers on duty in the

United States were supposed to be discharged on the same basis, but ASF had

to hold temporarily dentists with less than 110 points and refused to release

any for age. A dental officer who: (1) was 40 years of age, (2) had 75 points,

or (3) had 6 months of overseas service, was withdrawn from any unit on the

way to the Pacific and replaced by one currently on duty in the United States.

This "withdrawal score" was slightly lower than that for medical officers which

required either age 45 or 12 months of overseas service. Officers who desired to

remain on duty and who were wanted by the Army could voluntarily forego

the privilege of separation. The fact that few dentists were expected to be

discharged immediately is indicated by the estimate of the Resources Analysis

Division of the Surgeon General's Office that under the criteria discussed only

31 men would be released in the United States and about 250 or 300 in Europe.

Separation of men over 50 in the Zone of Interior was not recommended to

start until September or October.17

Beginning on V-E Day, a special effort was made to have certain instructors released to resume their positions in dental colleges. The Procurement and Assignment Service notified the deans to name any five key men on

their faculties whom they particularly needed. Names submitted were forwarded to The Surgeon General who in turn asked the theaters to return

these men for discharge as soon as possible.18 This program continued from

V-E Day until the end of 1945 but was overtaken by the general demobilization

following V-J Day. The total separated under it is not known; 18 dental

officers were discharged as essential to national health or interest, and 20 more

were discharged as key men in government or industry. Instructors might

have fallen in either group as well as in other administrative categories. It is

probable that many instructors were released in the normal, accelerated demobilization which followed V-J Day before their discharges could be accomplished under The Surgeon General's program. As late as 11 September 1945,

for instance, overseas commanders were asked to release 19 dental instructors,19

and most of these must have been nearly eligible for release on other criteria by

the time these requests could be carried out.

18 See footnote 15, p. 334.

" " Memo, Eli Ginzberg for Dir Dental Div SGO, 17 Jul 45, sub : Separation of Dental Corps officers.

HD : 314.

w Info given Dr. John McMinn, HD, by Lt Col William Piper, Mil Pers Div SGO. No documentary

evidence on this point has been discovered.

u

Ltr, Col Robert J. Carpenter, Exec Off SGO, to CGs of various overseas theaters, 11 Sep 45, sub:

Separation of Medical Department personnel essential to medical and dental schools. SG : 210.8,
336 DENTAL SERVICE IN WORLD WAR II

It will be noted in Table 16 that during the months of May, June, July,

and August 1945, 610 dental officers were discharged from the Army.20

TABLE 16. DEMOBILIZATION OF DENTAL CORPS OFFICERS BY MONTHS, MAT 1945-

JUNE 1947

1946

May

June

July

August

September

October

November

December

1946

January

February

March

April

May

Number separated

Each

month

Cumulative

total

50 50

105 155

295 450

160 610

415 1,025

1,505 2,530

1,430 3,960

1,225 5,185

2,190 7,375

1,575 8,950

800 9,750

540 10, 290

535 10, 825

Date

1946—Continued

June

July

August

September

October

November

December

1947

January

February

March

April

May

June

Number separated

Cumulative total

11,500

12, 100

12, 540

13, 175

13, 450

13, 850

14, 200

14, 400

14, 525

14, 600

14, 725

1 14, 850

1 15, 000

' Estimated.

The release of any large number of dental laboratory technicians immediately following V-E Day also proved impractical. In September 1944 The

Surgeon General, foreseeing a moderate shortage of such personnel, had recommended that they be retained by Zone of Interior service commands until

declared surplus by the surgeon.21 At first it was not expected that the shortage

would be sufficiently severe to warrant transferring technicians from commands

where they were surplus to others where they might be needed, but on 7 June

1945 the War Department directed that certain enlisted men, including dental

technicians, be transferred to new commands when declared surplus in their

own units. However, organizations receiving these men were to use them only

in their special duties, and they were to be released as soon as replacements

could be obtained; assignment overseas of technicians otherwise eligible for

20 Table 16 assembled from data given the author on 13 Feb 48 by the Strength Accounting Br,

AGO. It should be noted that the AGO did not process separations until the end of terminal leave

which was often several months after the last day of active duty. However, in the demobilization of

Dental Corps officers, as shown in Table 16, the date indicates the actual month in which the officers

were lost to the effective, administrative strength of the SGO.

» Memo, Col J. E. Hudnall, Chief Pers Serv SGO, for Col G. M. Powell, Dir Spec Planning Div

SGO, 5 Sep 44, sub : Demobilization of enlisted personnel. SG : 370.01.
DEMOBILIZATION OF DENTAL CORPS PERSONNEL 337

discharge was prohibited.22 By 31 August 1945 it was possible to direct that no

dental technician would be transferred to another command when he became

surplus in his own.23

Demobilization after V-J Day

(See Table 16 for separations by months)

The composition of the Dental Corps on V-J Day in respect to priority for

discharge is not known. On V-E Day, however, there were approximately

14,700 dentists on duty, distributed as follows:24

Regular Army ^50

Volunteers for extended service , 750

ASTP graduates !>900

AUS officers desiring early separation 11. 800

Most of the ASTP graduates listed were ineligible for separation until long

after V-J Day so it can be assumed that the majority of the 610 dental officers

discharged between V-E Day and V-J Day came from the category of AUS

officers desiring early separation, leaving about 11,190 men in this group at the

end of hostilities. Procurement from civil practice had practically ceased in

December 1943, and over 9,000 dentists had come on active duty before the end

of 1942, so that by V-J Day almost all non-ASTP AUS officers had had over 1V2

years of service and a large proportion of them had been in the Army more than

2y2 years. The release of such a number of high point men in the proper

priority, according to length of service and dependents, and without jeopardizing the provision of essential care for an Army which at the end of 1945 still

numbered over 4 million men, was certain to involve knotty problems.

It has been seen that prior to V-J Day dentists returning from overseas

were separated only if they had 100 points or were over 50 years of age; in the

United States they could be released only if they had 110 points. On 8 September 1945 new separation criteria for both the Medical and Dental Corps

provided that field grade officers (colonels, lieutenant colonels, majors) with 100

points, and company grade officers (captains, lieutenants) with 85 points, could

be released. On the same day the Eesources Analysis Division, SGO, recommended that the criteria for medical and dental officers be further reduced to 80

points, and that additionally, any man 48 years of age or over, or who had been

in the Army on 7 December 1941, should be released. On 12 September 1945

this recommendation was approved and published.25 Medical and dental officers thus enjoyed, temporarily, more favorable separation criteria than those

of most other branches who were still required to have ASK's of 100 points for

officers of field grade, and 85 points for men of company grade.

sä WD Memo 615-45, 7 Jun 45.

a« WD Memo 615-45, 31 Äug 45.

a Memo, Isaac Cogan, Chief, Resources Anal Div SGO for Chief, Dental Consultants Div SGO, 8

Oct 46, sub : Basic data for Dental Corps. SG : 322.0531.

" Teletype, SG to CGs all SvCs, 12 Sep 45. SG: 210.8.
338 DENTAL SERVICE IN WORLD WAR II

On 14 September 1945 The Surgeon General promised to release 10,000

dental officers by the end of June 1946.26 A few days later it was stated that

3,500 dentists would be separated by 25 December 1945. An additional number

of dental officers became eligible for separation when ASE scores were recomputed on 2 September to include credit for service subsequent to V-E Day. On

17 September 1945 it was announced that no dentist would be sent overseas if

he was 40 years of age or had 45 points.27

Oh 22 September War Department Circular 290 emphasized and liberalized

somewhat the provisions of WD Circular 485, 29 December 1944, concerning

release of officers not eligible for separation on point scores.28 Specifically,

it authorized separation of the following:

1. Officers who were surplus to the needs of the Army, and who could not

be economically trained in new positions, if they had served a reasonable period.

2. Individuals presenting documentary evidence that they would be more

useful to the nation in a civilian capacity.

3. Individuals who had suffered undue hardship by reason of military

service.

4. Officers over 50 years of age, at their own request.

On 1 October 1945 separation criteria for male officers of most branches

were reduced to a straight 75 points but medical and dental criteria remained

unchanged, thus for the first time placing this group at a slight disadvantage.

On 6 October the War Department notified all commands that civilian needs

for Medical Department personnel were critical and directed them to be alert

for the uneconomical use of physicians, dentists, and nurses. Persons found

surplus were to be released without delay; overseas personnel were to be returned

by the fastest transportation, and Medical Department officers processed

expeditiously through separation centers.29 On 16 October, The Adjutant

General asked Zone of Interior commands to release physicians and dentists

with at least 2 years' service at any time they became surplus, regardless of

points.30 Such cases were to be referred to The Surgeon General for final

decision, but telephone communication was authorized. On 18 October The

Surgeon General complained that Medical Department officers eligible for

release were still being held as essential, and emphasized that such action was

permissible only in very exceptional cases.31

On 20 October separation criteria for medical and dental officers were

again dropped below those of the lim branches when either an ASE of 70

points, or 45 months of total service, were specified.32 On 1 December 1945

separation criteria for line branches were dropped to 73 points and the maxi26 Army to release more medical officers. J. Am. Dent. A. 32 : 1321, Oct 1945.

27 Limited number of dental officers to go overseas. J. Am. Dent. A. 32 : 1474, Nov-Dec 1945.

28 WD Cir 290, 22 Sep 45.

28 WD Cir 307, 6 Oct 45.

3

» Teletype, TAG to CGs all SvCs, 16 Oct 45. SG : 210.8.

« Teletype, Brig Gen R. W. Bliss to CGs all SvCs, 18 Oct 45. SG : 210.8.

32 Teletype, TAG to CGs all SvCs, 19 Oct 45. SG : 210.8.
DEMOBILIZATION OF DENTAL CORPS PERSONNEL 339

mum service requirement for medical and dental officers simultaneously reduced

to 42 months, though the ASR remained at 70 points. Former ASTP students

received credit only for time served after receiving their commissions and

were required to put in at least 36 months regardless of points.

On 7 December 1945 all previous agreements to volunteer for additional

periods of service were cancelled. By that time it was possible to give temporary officers more complete information on the possibility of entering the

Eegular Army, the length of time they could expect to serve on foreign service,

et cetera, and it was felt that they should be given an opportunity to revise

their earlier commitments and plan their future on a more stable basis than

had been practical immediately following the war. All officers were at this

time required to sign statements placing them in one of the following

categories:33

Category I—Elect to remain on active duty for an unlimited period.

Category II—Elect to remain on active duty until 30 June 1947.

Category III—Elect to remain on active duty until 31 December 1946.

Category IV—Elect to remain on active duty for a specified period agreed upon

between the officer and his commanding officer, but not less than 60 days after tue date

of signing.

Category V—Desire separation as soon as possible.

On 31 December 1945 new criteria became effective under which physicians

and dentists could be separated if they were 45 years of age, had 42 months of

service, or an ASR of 65 points. Line officers were required to have either 70

points or 48 months total service. Somewhat more than 5,000 dental officers

were separated between V-E Day and 31 December 1945 (see Table 16).

During the period from V-E Day to the end of 1945 the demobilization

program of the Army in general and of the Medical Department in particular

was the target of considerable criticism from Congress, the medical professions,

and from laymen.34 Such criticism will be covered in detail in other sections

of the Medical Department history, and will be discussed here only in relation

to the Dental Corps.

On 1 October 1945 the American Dental Association reported that it had

received many complaints on the slow release of dental officers.35 At that time

this organization stated that it was not in a position to say whether the Armed

Forces were justified in their separation policies, and limited its comments to

pointing out the need for the earliest possible release of medical personnel. On

21 November 1945 the Secretary of War notified the Chief of Staff that he had

received criticism of delays in releasing medical and dental officers, and that a

threatened senatorial investigation had been called off only on his promise to

investigate and take necessary corrective measures.36 He directed The Surgeon

ra WD Clr 366, 7 Dec 45.

» S. 134, 79th Cong., introduced 12 Jun 45 ; S. 1355, 79th Cong., introduced 6 Sep 45 ; S. J. Res. 97,

79th Cong., Introduced 24 Sep 45 ; H. E. 4425, 79th Cong., introduced 18 Oct 45.

38 Release of dental officers from the armed services. J. Am. Dent. A. 32 : 1292-1293, Oct 1945.

»Memo, SecWar for CofS, 21 Nov 45. SG : 210.8.
340 DENTAL SERVICE IN WORLD WAR II

General and the General Staff to conduct a study to determine how many officers

could be released and how they could be separated with the least delay. A mission of senior officers was to be sent to the overseas theaters and Medical Department personnel were to be shipped to the Zone of Interior as soon as declared

surplus, even ahead of other, higher point officers.

On 1 January 1946 the ADA published a bitter editorial criticism of dental

demobilization claiming that the Army and Navy had, at the very least, been

"ultraconservative and discriminatory," that hundreds of dentists were standing

idle while their professional skills rusted, and that there had been no apparent

effortto discharge dentists in the same ratio as enlisted men.37

There is some statistical justification for claims that dental demobilization

lagged behind that of the Army as a whole. The ratio of dental officers to total

strength went from 1.74 per 1,000 troops on V-E Day to a maximum of 2.23 per

1,000 in December 1945, and did not return to the V-E Day average until the

middle of 1946.38 However, other factors must be considered in this connection.

Procurement had been allowed to lag for several months before the end of the

war in Europe and the number of dentists on duty in May 1945 was about 500

less than the authorized figure. If dentists had been discharged in the same

ratio as enlisted men, it would have been impossible to maintain a ratio of at

least 2 per 1,000; dental officers would be the first to insist that such a ratio was

necessary to render effective care. Dentists were needed to provide treatment

for patients remaining in Army hospitals, and to examine and treat men being

processed in separation centers. Further, the loss of time of dental officers

during demobilization was high. Thus, although delayed demobilization of

dental officers from V-E Day to the middle of 1946 did result in the ratio exceeding the normal proportion over a period of 6 months, in only 2 months did it

exceed the 2 per 1,000 ratio by as much as 5 percent.

The Army as a whole had set for itself a demobilization program which

no senior officer would guarantee could be met. In the face of that situation

The Surgeon General had two choices: He might delay the separation of Medical Department personnel slightly until it was clear that the Army would

actually be reduced as planned, or he might gamble on the demobilization

program being carried out according to schedule and release every officer who

could be spared. In the first case he risked criticism for holding officers a

month or two longer than necessary; in the second he risked a breakdown of the

medical service if shipping shortages or other circumstances delayed general

demobilization. If a gamble had to be taken The Surgeon General apparently

preferred to be sure thatthe troops would receive adequate medical care.39 The

37The right to gripe: the fifth freedom. J. Am. Dent. A. 33 : 118-122, Jan 1946.

» Ratios calculated by the author from data on the effective, administrative strength of the Dental

Corps. This information, furnished by the Resources Anal Div, SGO, does not include officers on a

terminal leave status. See footnote 20 for explanation of effective, administrative strength.

x

Info given to author by Mr. John D. Rice, Resources Anal Div SGO, 19 Feb 48.
DEMOBILIZATION OF DENTAL CORPS PERSONNEL 341

fact that the Army demobilization schedule was not only met but exceeded did

notimpair the wisdom of that decision.

Claims that dental officers were not always fully employed probably arose

most often from the fact thatthe flow of troops through separation centers could

not be constant. At times there was more work than could be handled; at

others there was little to do. But personnel in these centers could not be

juggled from day to day to meet changing demands.

The slight extent to which the separation of dental officers was delayed

in 1945 as compared with the Army as a whole, is shown by an analysis of the

situation existing in December 1945 when the excess of dentists was at its

maximum. In that month there were 2.23 dental officers for each 1,000 men,

but if those who were separated just a month later had been discharged in

December the ratio of dentists would have fallen to 1.7 per 1,000, or considerably

less than the number actually needed. It is thus apparent that even when the

situation was most unfavorable, dental officers could not have been separated

more than a few weeks earlier without causing a shortage of personnel to staff

essential dental installations.

It is significant in this connection that after repeated hearings on the

"hoarding" of Medical Department personnel, in which the matter was thoroughly discussed before congressional committees, none of the proposed legislation to force faster demobilization was passed.

By the first of January 1946, the Dental Service was faced with a rapidly

developing shortage of officers. On 21 January a representative of the Military Personnel Division, SGO, pointed out that procurement to meet postwar

needs was very uncertain and that unless replacements could be obtained it

would soon be necessary to hold the remaining dentists to provide essential care

for the troops.40 He advised The Adjutant General that a new objective of

750 men would have to be established without delay if a "serious public relations problem" was to be avoided. This recommendation was approved,41 but

in the absence of the ASTP and without the stimulus of patriotism in time of

combat, only 15 dentists were obtained by the first of May. Nevertheless, a

new change in criteria, effective 1 February, reduced the separation requirements for both medical and dental officers to age 45, 60 points, or 39 months

total service.42 On 15 February, it was further announced that physicians and

dentists who were declared surplus in any Zone of Interior command and who

were within 4 months of being eligible for discharge would be released immediately.43 On 23 April The Surgeon General recommended that the separation

criteria, for medical officers only, be reduced to 30 months total service (other

«Iitr, Col Kobert J. Carpenter to TAG, 21 Jan 46, sub : Procurement objective for appointment

in the Army of the United States (Dental Corps). SG : 210.8.

« See Chapter III.

« WD radiogram 42485, 30 Jan 46.

« ASF Cir 40, 15 Feb 46.
342 DENTAL SERVICE IN WORLD WAR II

requirements remaining unchanged).44 This request was approved and the

new standards were published effective 1 May. 45 Probably no action of the

War Department caused greater unrest among dental officers than this

maintenance of separate criteria for the Dental Corps, especially since it had

been announced in March that male officers of the nonmedical branches would

be released with 24 months' service after the end of August. However, it has

since been shown in the discussion of medicodental relations in chapter I that

no discrimination was intended, and that the termination of the dental ASTP,

which precipitated this action, had been based on what were considered good

and sufficient reasons.

In May and June 1946 arrangements were made to obtain 800 dental officers

from the Navy, and another 1,500 through Selective Service (see chapter III,

p. 74), and on 27 May it was announced that dentists would be released after

36 months of service.46 On 1 September it was directed that dentists, including former ASTP students, would be separated after 30 months of service and

finally, on 1 November 1946, dental officers were ordered released after 24 months

of service under the same criteria as applied to male officers of most other

branches.47

By October 1946 all of the 11,800 V-E Day nonvolunteers (excluding ASTP

graduates) and 1,200 of the ASTP graduates had been separated.48 At the

end of 1946, 14,200 dental officers, of 14,700 on duty at the end of the war in

Europe, had returned to private practice, and it appeared that the last nonvolunteer officer who had been in the Army on V-E Day would be released by the

end of February 1947.49 After February 1947 the active duty Dental Corps

consisted only of the Kegular Army, former ASTP students, officers on loan

from the Navy, and those who had signed voluntary agreements to serve after

they became eligible for discharge.

After 11 January 1946 any temporary officer who had served in the grade

of first lieutenant for 18 months, in that of captain or major for 24 months,

or lieutenant colonel for 30 months, with 50 percent additional credit for overseas service, was eligible for a promotion of one grade on separation if he had

an efficiency index of 40 or above. This regulation also applied to any temporary officer with an efficiency index of 40 or over who had served at least 24

months without any promotion.50

Eegulations in effect on V-J Day provided that until they could be replaced or declared surplus dental laboratory technicians could be retained

within their current commands after becoming eligible for discharge on points.

«Memo, Brig Gen R. W. Bliss for ACofS G-l, 23 Apr 46, sub: Demobilization of Medical Corps

officers. SG : 210.8.

« WD radiogram 37758, 1 May 46.

« WD radiogram 44675, 27 May 46.

«WD radiogram 21743, 15 Oct 46.

48 See footnote 24, p. 337.

» Ibid.

50 WD Cir 10, 11 Jan 46.
DEMOBILIZATION OF DENTAL CORPS PERSONNEL 343

There was no change in this policy until the end of 1945 when it was directed

that no dental technician would be held for more than 6 months after he was

eligible for release under existing criteria.51 In February 1946 dental technicians were removed from the "scarce" category and it was directed that all

men with 45 points or 30 months of service would be discharged by 30 April,

and that all technicians with 40 points or 24 months of service would be

separated, or en route to the United States for release, by 30 June 1946.52

Summary

The principal conclusions to be drawn from Army experience during the

demobilization period are the following:

Pressure from civilian communities for the return of dentists after the

fighting stops will generally be strong. The Armed Forces will be able to hold

dental officers beyond the end of a war only when it can be shown that a clear

and urgent need exists for their services.

Gradual replacement of dental personnel during a long conflict is highly

desirable to permit the release of older men with the longest service and men

who are less efficient than the average. Unless some "turnover" is maintained

the Dental Corps will approach the end of hostilities with a high proportion

of officers with such extensive service that public opinion will force their

release regardless of the need for their services.

Voluntary procurement cannot be relied upon to furnish replacements for

officers being demobilized after a war has ended if any sizeable force is to be

maintained.

51 WD Cir 382, 21 Dec 45.

62 WD Cir 51, 20 Feb 46.

::30324 O—55 28
Index

AAF. See Army Air Forces.

ADA. See American Dental Association.

Adjusted service rating: 334, 337, 338, 339.

See also Demobilization.

Adjutant General, The: 88, 89, 90, 94, 133,

135, 154, 155, 211

applications for original appointment in

Dental Corps, instructions concerning:

54

charge for destroyed dental appliances,

comment on: 234

DC-2 clinic in general hospitals of 250

beds or more, approval of: 278

DC-3 clinic for camps of 3,000 to 6,000

men, approval of: 260

dental officers, evaluation of professional

qualifications: 107

limitation on dental attendance for temporary personnel, disapproval of: 211

mandatory tables of organization for ZI

dental services, disapproval of: 45-46

maxillofacial hospitals, designation of:

273

maximum utilization of Dental Corps

officers, instructions concerning: 286

Medical Officer Recruiting Boards, addition of dental officers, instructions for:

54

on legislation for Dental Corps, transmittal of SecWar's views to The

Surgeon General: 4

procurement for Dental Corps

discontinuance of: 61

objectives, suggested review of: 60

release of physicians and dentists in ZI,

request for: 338

use of tactical unit dentists in ZI camp

clinics, instructions concerning: 285

Adjutant General's Office, the: 155, 211

Administration of the Dental Service

in a theater of operations: 34. See also

Communications Zone dental service;

Division dental service; Field Army

dental service; Redeployment center

dental service; Tactical units dental

service,

in Armv Ground Forces: 33

Administration of the Dental Service—Con.

in camps and stations, ZI: 32. See also

Replacement depot dental service;

Replacement training center dental

service; Separation center dental service; General hospital dental service;

Station hospital dental service,

in Corps Areas (later service commands):

30

in The Surgeon General's Office: 27-28

reorganization of the Army, 1942,

effect on: 28

AEF. See American Expeditionary Forces.

AGF. See Army Ground Forces.

AGO. See Adjutant General's Office, the.

Air Surgeon's Office, Dental Section

establishment: 31

function: 32

Alaska: 215

"Amalgam line." See Morale.

"Amalgam mills." See Morale.

American Dental Association

ASTP, comment on: 141

Committee on Dental Education: 7

Committee on Dental Preparedness: 227

Committee on Legislation: 17, 18

demobilization program, views on: 11,

340

dental treatment, comment on: 214

ethical status, role in determination of:

85, 95-96

induction of dentists and dental students

as enlisted men, objection to: 86

Military Preparedness Committee: 70

National Health Program Committee:

227

objectives for improvement of the Dental

Service: 15-20

advanced rank for Director of Dental

Division: 15-16

"autonomy" for Dental Service: 17-18

PAS, views on: 82

personnel survey, findings of; 41, 78

procurement, role in: 83-86

procurement program, views on: 104

professional status, role in determination of: 85

345

330324 O—55- -24
346 INDEX

American Dental Association—Continued

promotion policies, comment on: 113

rehabilitation prior to induction, comment on: 227. See also Dental rehabilitation prior to induction.

Selective Service deferment restriction

(1944), protest of: 132

American Dental Trade Association: 169

American Expeditionary Forces: 174, 193,

313, 314

American Medical Association: 228

Ames, John R.

appointment to Dental Corps after act

of 1911: 3

Anzio beachhead: 315

Armed Forces Institute of Pathology. See

Schools.

Armies

Fifth: 311, 315, 316, 319

First: 315, 326

Ninth: 293, 298, 299, 300

Seventh: 233, 306

Army Air Forces: 10, 32, 33, 34, 64, 90,

100, 106, 107, 112, 184, 196, 288.

»See also Air Surgeon's Office, Dental

Section.

Army and Navy Munitions Board: 168

Army Dental Corps. See Dental Corps,

Army.

Army Dental School: 119, 120, 125, 126,

128, 156, 157, 160

Army Ground Forces: 33, 90, 288, 297,

316, 318, 322, 323

Army Ground Forces Replacement Depot

No. 1, Fort George G. Meade, Md.:

234

Army Medical Bulletin: 212

Army Medical Center: See Schools.

Army Medical School: See Schools.

Army-Navy General Hospital: 121, 159

Army-Navy Medical Procurement Office:

173

Army of the United States: 62

as temporary emergency force: 64

new appointments in, need for: 54

officers called to active duty: 48-51

Army Regulations

changes in: 19

40-15, Dental Service, provisions for

administration of: 10, 16, 20, 21, 22,

31, 151, 152

40-510, treatment rendered, provisions

for: 9n, 33n, 205n, 231, 232n, 283n

Army Service Forces: 23, 28, 45, 56, 58,

88, 94, 107, 154, 172. 288

Army Service Forces Replacement Depot,

Camp Reynolds, Pennsylvania: 234

Army Specialized Training Program: 55,

56, 57, 58, 59, 61, 66, 67, 74, 86, 87,

88, 89, 91, 104, 116, 136-145, 149, 151,

342

activation: 138

cost: 140

curriculum, preprofessional: 137

curtailment: 138-140

demobilization criteria affected by termination: 11-12, 342

discontinuation of, factors involved:

11-12, 56-58, 342

discussion of: 141-151

enrollment in: 138

enrollment in dental schools, effect on:

142

graduates

commissioned by Navy: 58

lack of vacancies for: 47, 56, 58

release of to private practice, 1944:

57, 66, 144

morale of other military personnel, effect

of: 143-144

procurement: 55

results: 140

schools participating: 138

students release of: 61

termination: 11, 88, 140

undergraduates: 136

Army transports, dental service on: 275-

277

base outfits recommended for: 277

M. D. chest 60,

provided for: 276

unsuitability of: 276

necessity for: 275

Artificial eye, acrylic, role of the Dental

Service in the development of: 235-237

ASR. See Adjusted service rating.

Association of Dental Manufacturers of

America: 168

Association of Military Dental Surgeons: 4

journal of: 6

ASTP. See Army Specialized Training

Program.

Attrition. See also Combat casualties;

Demobilization; Release from active

duty:

acceleration of, 1944: 47
INDEX 347

Attrition—Continued

December 1941-June 1945: 86

estimated: 45

low rate: 56, 110

AUS. »See Army of the United States.

Australia: 175, 230, 289, 290

Authorized dental treatment. See Treatment, dental aspects of.

Auxiliary dental personnel. See also Hygienists, civilian.

allotment authorized by tables of organization: 302

allotment recommended for

camps, ZI: 46

dental clinics, ZI: 46-47

station hospitals: 46

assignment of: 151-152

assistants, chair: 158. »See also Occupational classification.

authorization for: 151

care of equipment, instructions on: 162,

176

civilians, utilization of: 159-160

discussion of: 162-164

grades, compared with medical service

personnel: 152

laboratory technicians. See also Occupational classification,

demobilization of: 336, 342-343

effective utilization of: 155

shortage of: 153-155

morale: 152

on-the-job training: 162

prosthetic supply clerks: 158, 171

training program: 156-158

curriculum: 156

duration of course: 156

enrollment per month: 157

results of: 157

WAC personnel

for duty as dental assistants

disadvantages of: 159

recommendation for: 158-159

training of: 159

Awards: 117

Beaumont General Hospital: 121, 159

Bernheim, Julien R.

appointment to Dental Corps after act

of 1911: 3

assignment in Dental Division, SGO: 22

Blesse, Gen. F. A.: 297n

Bliss, Brig. Gen. R. W.: 45, 58, 60, 183,

184, 333, 338, 342. »See also Surgeon

General, The.

Boak, Siebert D.

appointment to Dental Corps after act

of 1911: 3

Borden General Hospital: 238

Brauer, Col. John C: vii, 136, 153, 219

British Army: 167, 175

Brooke Army Medical Center. »See

Schools.

Brooke General Hospital: 159

Bronze Star: 117

Brown, Dr. Homer C.

chairman, Legislative Committee, National Dental Association: 4, 6

Brown, Col. Pearson W.: vii, 97

Buhler, Dr. John E.: 142

Secretary-Treasurer of the American

Assoc. of Dental Schools: 141-142

Bureau of Standards: 170

Burs. »See Supplies.

Camalier, C. W.

chairman of War Service Committee,

ADA: 70n, 76, 101, 130

Camp Crowder, Missouri: 236

Camp Greenleaf, Fort Oglethorpe, Georgia:

118

Camp Pickett, Virginia: 158

Camp Reynolds, Pennsylvania: 234. »See

also Replacement depot dental service.

Camp Robinson, Ark.: 206. »See also Redeployment center dental service.

Canadian Dental Service: 18-19

Carpenter, Alden

appointment to Dental Corps after act

of 1911: 3

Carpenter, Col. Robert J.: 10, 57, 335, 341

Casaday, George H.

appointment to Dental Corps after act

of 1911: 3

CBI. »See China-Burma-India theater.

Central dental laboratories (CDL). »See

also Laboratories.

Army Medical Center, Walter Reed General Hospital: 217

Beaumont General Hospital: 217

Corozal, Panama Canal Zone: 217

Fitzsimons General Hospital: 217

Fort Clayton, Panama Canal Zone: 217

Letterman General Hospital: 217
348 INDEX

Central dental laboratories (CDL)—Con.

Station Hospital, Fort Sam Houston,

Texas: 217

Chair assistants. See Auxiliary dental personnel.

Chambers, William H.

appointment to Dental Corps after act of

1911: 3

Chiefs of Dental Division, SGO: 22

China-Burma-India theater: 99, 177, 192,

194, 317, 318

Civilian Conservation Corps: 64

Civilian dentists, authorization for use of

to procure emergency dental care: 232

Civilian professional men, tentative plan

for draft of: 53

Classification, dental. See Treatment,

dental, aspects of.

Clay, Maj. Gen. Lucius D.: 172n

Clinic facilities, ZI. See also Prosthetic

facilities, Zone of Interior,

cost of: 261

description of

DC-1: 257

DC-2: 257

DC-3: 260

DC-4: 260

DC-5: 261

DC-6: 261

Combat activities: 117

Combat casualties: 86, 117

Command and General Staff School. See

Schools.

Commission on Physical Rehabilitation.

See Dental rehabilitation prior to induction.

Commissions. See Dental Corps, Army.

Committee to Study the Medical Department: 165

Communications Zone dental service. See

also Tables of organization medical

units,

dental surgeon, responsibility of: 302

facilities: 303

improvements, recommended for: 304-

306

organization: 302

personnel: 303-304

Confederate Army: 1

Conscription

of dentists

Confederate Army: 1

proposed, World War II: 74

Conscription—Continued

of physicians: 56, 73

Consultants: 127, 214, 222, 306

Contract dental surgeons

assignment: 2

authorization for employment: 2

number authorized for employment: 2

number employed, 1901-1911: 3

Corozal, Panama Canal Zone: 217

Cowan, Col. E. V. W.: 166, 317

Craven, Col. Robert C: 44

Criteria, dental, for overseas service:

229-232. See also Standards for military service, dental,

definite standards established: 230, 232

lack of definite standards for, 1942-43:

230

report on personnel arriving overseas:

230, 232

Daniels, Col. Thomas C: 276

Dargusch, Brig. Gen. Carlton S.: 228

Demobilization

criteria

changes in: 337, 338, 339, 341

criticism of: 11, 61, 339, 342. See

also Army Specialized Training

Program; Release from active duty,

establishment of: 334

following V-J Day: 337-343

following World War I: 332

Medical Department personnel, policy

for: 333-335

"hoarding": 333, 341

pressure for release of: 61, 333, 343

period from V-E to V-J Day: 332-337

statistics, May 1945-June 1947: 336

Denit, Brig. Gen. Guy B.: 11

Dental Advisory Committee. See Selective Service.

Dental Bulletin: 285

Dental Corps, Army. See also Legislation

pertaining to Dental Corps,

age distribution, V-E Day: 94

appointments in, after act of 1911: 3

commissioned 1944: 59

components, strength of, V-E Day: 62

composition of, 1945, by

age: 105

component: 105

race: 105

specialty: 106
^^————

INDEX 349

Dental Corps, Army—Continued Dental rehabilitation prior to induction

development, progress of to World War ADA

II. See Legislation pertaining to comment on: 227

Dental Corps. cooperation of: 226

enrollment, 1938: 48 recommendations for: 227

establishment of: 2 Commission on Physical Rehabilitation

grades (FSA), plans for: 226-227

distribution of: 10, 35-36 Dental Advisory Committee, Selective

general officer: 11, 16, 112, 115 Service: 226

initial appointment: 97, 109 Selective Service System, test program

procurement objectives. See Procure- inauguration of: 228

ment, officer personnel. results of: 229

standards for commission in Wartime Health and Education, Senate

ethical: 94-96 Subcommittee, report on: 229

physical: 92-94 World War I: 225

professional: 94-96 Dental Service, formation and organization

status, during World War II: 16-21 of: 2

strength Dental service in Confederate armies: 1

at the time of the Armistice, World Dentistry, military status of

War I: 35 during Revolutionary War period: 1

expansion, during World War II: v in Confederate Army: 1

increased ratio: 340 Dentures, excessive loss or destruction of:

in 1940: 52 232-235, 313

maximum, World War II: 56, 59, 106 Army Ground Forces, report on: 233

reduction in, 1918-1920: 332 North African theater, report on: 233

vacancies, lack of in 1944: 56, 58 property accountability, recommendaDental Corps ratio to Army strength tion for: 235

Director of Dental Division, SGO, com- record of dental appliances in individual

ment on: 37 service records, recommendations for:

goal of Chief of Dental Division, SGO: 233

43-44 Seventh Army, Mediterranean Area, regoal of The Surgeon General: 43-44 port on: 233

increase of for tactical units, recom- War Department directives for listing of

mendation for: 27, 288 dentures'. 233

in replacement training centers, 1944: when lost through carelessness or intent

265 charge for, question concerning: 234

in ZI, 1942-44: 264-65 courtmartial action, recommendation

need for evaluation of: 41 for: 234

period between World War I and II: 35, legality of, opinion of Legal Division:

36, 37, 287 235

V-E Day: 60 Deshon General Hospital: 238

World War I: 35 DeWitt, Brig. Gen. Wallace: 277

World War II: 43-47 Dietz, Maj. Victor: 236

Dental Division, SGO Diseases, dental, incidence of. See Statismaximum strength: 28 tics.

organization during World War II: Distinguished Service Medal: 117

22-30 Director of the Dental Division, SGO: 13,

organization prior to World War II: 22 16, 31, 33, 37, 46, 71, 113, 114, 167,

redesignation of: 29 175, 200, 210, 213, 225, 231, 257, 262,

Dental field chests. See Field equipment. 280, 281, 325

Dental journals, status of Dental Corps, advice against termination of ASTP:

comment on. See Medicodental rela- 139, 144

tions. authority, extent of: 23, 27
350 INDEX

Director of the Dental Division, SGO—Con.

dental laboratory technicians, insure assignment to Medical Department, request for: 154

dental representation in other divisions

of SGO, recommendations for: 29-30

duties: 22-23

effectiveness of ASTP, comment on:

142-143, 151

lack of a permanent corps of enlisted

men, comment on: 15

occupational classification, comment on:

108

PAS, comment on: 82

Dental Laboratory Institute of America,

survey of laboratory manpower: 154

Directors of Dental Division, SGO: 22

Divisions

1st Armored: 316

34th Armored: 316

36th Armored: 316

45th Armored: 316

1st Infantry: 319, 325

9th Infantry: 325

41st Infantry: 289

66th Infantry: 296

Division dental service

dental surgeon, responsibilities of: 291-

293

organization: 290

personnel authorized: 290-291

reorganization

comment: 294-297

prescribed by TO&E: 297-298

recommended: 293

Eanes, Richard H.

Assistant Executive Officer, Selective

Service: 81

Education. See also Schools,

dental students

deferment directives: 130-131

deferment legislation for: 129

deferment through reserve commissions: See Medical Administrative

Corps, Reserve.

military status of: 129

predental students, limited deferment

of: 132

Efficiency reports: 9, 14, 20

Eisenhower, Gen. Dwight D.: 321

England: 165, 175, 215, 276, 328

Epperly, Brig. Gen. James M.: 74, 102,

293, 298, 305

Epps, Col. Beverly: 322

Equipment and Supplies. See Equipment; Field equipment; Supplies.

Equipment. See also Field equipment;

Supplies,

cart, ward, dental: 197

experience gained, World War II:

197-198

for communications zone

fixed installations: 178

semifixed installations: 178

for Zone of Interior installations: 178,

179

handpieces, shortages of: 167

heavy clinical, requirement for: 166

nonstandard impression chests: 196

procurement

overseas, World War I: 174

overseas, World War II: 175, 178

repair of: 176

shipment overseas

removal of restrictions: 179

restrictions on: 178

without authorized field chests: 166,

171, 276

shortages of: 165-168

substitution of: 177

used, program for purchase of: 171-174

Erpf, Capt. Stanley F.: 236, 237

Ethical standards for commission: 94

ETO. See European Theater of Operations.

Europe: 117, 165, 167, 175, 233n, 294, 299,

304, 307, 325, 331, 333, 334, 342

European Theater of Operations: 165, 167,

179, 192, 194, 236, 291, 293, 295, 305,

315, 318, 324, 328, 334

Evacuation

dental causes: 99, 293, 317

maxillofacial casualties, "type" procedure for: 308-311

modification of: 310-311

principles observed: 311

treatment provided in the chain of

at battalion aid station: 309

at clearing station: 309

at collecting station: 309

at evacuation hospital: 310

initial: 309
INDEX 351

Fairbank, Leigh C: 23, 24, 27, 32, 37, 44,

69, 70, 123, 165, 170, 190, 200, 207,

257, 280, 314. See also Director of

Dental Division,

assignment, Dental Division, SGO: 22

Far East: 307. See also Pacific.

Federal Security Agency (FSA): 133, 226

Fedor, Maj. Ernest J.: 44, 57, 58, 59, 68,

73, 75, 81, 88, 136, 178

Female dentists: 102

Female civilian assistants. See Auxiliary

dental personnel.

Field Army dental service. See also Table

of organization medical units.

dental surgeon, responsibility of: 299

personnel allotment: 298-300

prosthetic service, problems concerning:

301-302

reorganization of, proposal submitted by

dental surgeon, MTO: 300

study of, ETO: 299-300

Field equipment. See also Mobile dental

laboratory; Mobile dental operating

truck.

Army Air Forces operating chest: 184

field chest, prosthetic

M.D. 61: 184-185

M.D. 62: 184-185

World War I: 184

kit

assistant's: 186

maxillofacial: 188

officer's: 186

utilization of: 306

operating, M. D. chest No. 60

addition to

electric dental engine: 182

miscellaneous: 183-184

operating lamp: 183

reduction in weight: 183

World War I: 180

World War II: 180

pack chests "A" and "B": 186

prosthetic, M. D. chest Nos. 61, 62

change in: 185

defects of: 190

medical organizations

issued to: 185, 314

removed from: 317

World War I: 184

World War II: 184

Fifth Army: 311, 315, 316, 319, 320

First Army: 315, 326

Fitts, Lt. Col. Francis M.: 54, 93, 136, 144

Fitzsimons General Hospital: 121, 156,

159, 217

Florence Redeployment Center, MTO.

See Redeployment center dental

service.

Fort Bragg: 283

Fort Clayton: 217

Fort Dix, N. J.: 206n, 270, 271

Fort Huachuca, Ariz.: 159

Fort Knox, Ky.: 280. See also Replacement training center dental service.

Fort George G. Meade, Md.: 206, 234

Fort Monmouth, N. J. See Separation

center dental service.

Fort Riley, Kans.: 283

Fort Sill, Okla.: 206

France: 296, 313, 315, 320, 325

Frankfurt: 304

Freeman, Dr. Charles W., Dean, Northwestern Univ. Dental School: 12, 66

Futterman, Dr. M. J., Chairman, National

Victory Committee, Allied Dental

Council, N. Y.: 95

General Board, U. S. Forces, European

Theater of Operations

mobile dental laboratory, comment on:

325

personnel for prosthetic service, comment on: 328

quality of dental service, comment on:

291

General hospital dental service, ZI:

273-274

Graham, George D.

appointment to Dental Corps after act

of 1911: 3

Grant, Brig. Gen. David N. W.: 32, 165

Gray, Col. DellS.: 318

Greece: 117

Gulf Coast Air Corps Training Center. See

Schools, military.

Gunckel, George I.

appointment to Dental Corps after act

of 1911: 3

Hall, Lt. Col. Durward G.: 45, 58, 60,

138, 139

Handpieces. See Equipment.

Harper, Col. Neal: 120

Hawley, Brig. Gen. Paul R.: 175
352 INDEX

Health and Medical Committee: 226

Hearing-aid adapter, acrylic, role of the

Dental Service in the development

of: 237-238

Heavy clinical equipment. See Equipment.

Hemberger, Lt. Col. Arthur J.: 238

Hershey, Gen. Lewis B.: 228

Hess, John H.

appointment to Dental Corps after act

of 1911: 3

Hillman, Brig. Gen. C. C: 172

Hoff General Hospital. See Hospitals.

Hospital laboratories. See Laboratories.

Hospital ships, dental service on

equipment: 274

facilities: 274

personnel: 274

Hospitals

named

Army-Navy General: 121, 159

Beaumont General: 121, 159, 217

Brooke General: 159

Darnall General: 126

Fitzsimons General: 121, 156, 159, 217

Fort Sam Houston, Station: 121,

125, 217

Hoff General: 238

Letterman General: 121, 217

Thomas M. England General: 236

Valley Forge General: 236

Wakeman General: 159

Walter Reed General: 120, 121, 125,

217, 238

numbered

2d Field: 290

7th Station: 317

9th Evacuation: 296

21st General: 317

30th General: 236

64th Station: 317

181st General: 322

Hospitals designated as specialized maxillofacial centers: 273

Hudnall, Lt. Col. J. R.: 90, 93, 139, 336

Huebner, Brig. Gen., AGF: 175

Hygienists, civilian

commissions, recommendations for: 161

conditions outlined for employment of:

160

difficulties of procurement: 161-162

pay of: 160

status: 161

status in Navv: 162

Iceland: 288

Ingalls, Raymond E.

appointment to Dental Corps after act

of 1911: 3

Instructors

deferment of: 145

program for release of: 335

Japan: 61

Johnson, Lt. J. B., co-author, "History of

wartime research and development of

medical field equipment": 188, 193,

194, 311

Judge Advocate General, The

destroyed dental appliances, ruling on:

235

promotion, ruling on: 113

Kennebeck, Col. George R.:31, 162,165,184

Kirk, Maj. Gen. Norman T.: 14, 74, 161,

334. See also Surgeon General, The.

Laboratories

camp: 280-281

central dental laboratories

overseas: 327-329

Zone of Interior: 217, 281

civilian, use of: 283

hospital: 329

output: 281, 282, 283

Laflamme, Frank L. K.

appointment to Dental Corps after act

of 1911: 3

assignment, Dental Division, SGO: 22

Lauderdale, Clarence E.

appointment to Dental Corps after act

of 1911: 3

Lend—lease: 167

Legion of Merit: 117, 237

Legislation pertaining to Dental Corps

act of 1911, command restriction, removal of, 1945: 21

Adjutant General, views on: 4

brigadier general, authorization for rank

of, 1938: 22n

enacted prior to World War I

1901:2

1908:2

1911:2

grades and percentages of grades allowed

for. 1917: 6n

peacetime promotion schedule, establishment of, 1920: 6n
INDEX 353

Legislation pertaining to Dental Corps—

Continued

retirement credits, establishment of,

1938:6

strength authorized, 192.0: 6, 37

strength increases, 1936, 1938, 1939: 6

strength, reduction of, 1921, 1922: 6

Leslie, Samuel H.

appointment to Dental Corps after act of

1911:3

Letterman General Hospital: 121, 217

Liaison

ADA: 55, 85, 95

PAS: 79

Logan, Col. William H. G.: 118

assignment, Dental Division, SGO: 22

Long, Charles J.

appointment to Dental Corps after act of

1911:3

Lott, F. M.: 18

Love, Col. Albert G.: 36, 67

Love, Col. Walter D.: 262, 280

Lull, Brig. Gen. George F.: 44, 61, 81, 114,

169.

Magee, Maj. Gen. James C: 84, 113, 133,

134, 135

Manpower requirements, methods for determination,

civilian experience: 36

estimated need for dental treatment:

37-41.

for tactical units: 45

for Zone of Interior: 45-47

pre-World War II military experience:

36-37.

theoretical versus actual: 41

impracticability of meeting theoretical

needs: 38-40.

mobilization rate, effect on: 38

Marshall, Gen. George C: 134

Marshall, Dr. John S.

appointment to Dental Corps after act of

1911:3.

contribution to military dental service: 2

enlisted assistants, comment on: 151

Mason, George L.

appointment to Dental Corps after act of

1911: 3.

Mason, Col. J. B.: 318

Maxillofacial and plastic training. See

Training.

Maxillofacial care, hospitals designated for:

273

Maxillofacial casualties. See Evacuation.

McAfee, Gen. Larry B.: 45, 52, 68, 159,

161, 211

McAlister, John A.

appointment to Dental Corps after act

of 1911: 3

McCracken, Col. G. A.: 238

McCurdy, Howard A.

first dental casualty to lose his life: 117

McDowell, Brig. Gen. Rex McK.: 99, 115,

162, 183, 192, 208, 222, 233, 276, 277,

316, 317

McNutt, Paul V.: 133, 135

economical use of limited medical personnel, recommendations for: 53

M. D. Chests 60, 61, 62. See Field equipment.

Medical Administrative Corps: 21

Medical Administrative Corps Reserve

commission in, to insure deferment: 133

commissions in

granting of new, discontinuance of: 136

granting of new, request for: 61

procurement source: 67

students holding inactive commissions in

available for active duty: 55, 56

number placed on active duty: 136

transfer to, of medical, dental or veterinary students holding a reserve commission in another branch: 133

Medical Corps: 6, 10, 11, 12, 16, 18, 20,

21, 66, 72, 109, 112, 113, 114

Medical Department: 2, 11, 16, 18, 23, 28,

30, 53, 55, 68, 69, 72, 82, 84, 92, 100,

108, 112, 115, 339

Medical Department Equipment Laboratory: 194

Medical Department Redeployment and

Separation Policy. See Demobilization.

Medical Field Service School. See Schools.

Medical Officer Recruiting Boards: 77, 79,

80, 92

dental applications for original appointments, instructions concerning: 54, 55,

82, 93, 94

dental representatives

added to: 54, 82

removed from: 55

establishment: 54, 96

purpose: 54, 82
354 INDEX

Medicodental relations

ADA, Committee on Dental Education,

views of: 7

Director of the Dental Division, views of:

13

discrimination: 7, 11, 12

failure to consult dental surgeons on

matters affecting dental service: 13

lack of effective control of dental personnel: 14

medical interference in dental administration, extent of: 15

professional interference: 15

professional journals, comments in

Journal of American Dental Association: 7, 8, 11, 12, 14

Oral Hygiene: 7, 9, 12

promotion opportunities as compared

with Medical Corps: 10, 112

Surgeon General, views of: 9, 10, 13-14

Mediterranean Base Section: 317

Mediterranean Theater of Operations:

117, 233, 300, 301

Merritt, Dr. Arthur H., President, ADA:

84

Middle East Theater: 113, 165, 167, 175,

292

Military District of Washington: 90

Military Personnel Division: 30, 54, 57, 58,

59, 60, 75, 91, 98

Miller, Rep. Louis E.: 132

Mills, Robert H.: 13, 14, 15, 20, 25, 58,

60, 61, 68, 75, 90, 95, 99, 102, 115, 117,

123, 162, 165, 166, 167, 174, 175, 177,

178, 179, 211, 219, 224, 225, 230, 231,

261, 262, 280, 281, 297, 315, 317, 318,

323. See also Director of Dental

Division.

appointment to Dental Corps after act

of 1911: 3

assignment Dental Division, SGO: 23, 44

Mission and capabilities of the Dental

Service: 204-207

dental health

maintenance of: v

restoration of: v

Mobile dental laboratory: 188-193

allotment authorized for overseas theaters: 192

description of: 190

evaluation of: 325-327

improvised models, overseas: 190-192

Mobile dental laboratory—Continued

number ordered for distribution overseas:

192

report on: 190-192

utilization of: 321-325

Mobile dental operating truck

accepted as standard item: 194

allotment authorized for overseas theaters: 194

comparison with M. D. Chest No. 60: 312

"dental ambulances," World War I: 193

description of: 194

Director of Dental Division, comment

on: 195

request for: 311

Mobilization. See also Procurement, officer personnel,

monthly progress of

AUS: 48-62

National Guard: 48-62

Regular Army: 48-62

Reserve: 48-62

Mobilization Regulations (MR) 1-9. See

Standards for military service, dental.

Mockbee, Col. James B.: 12

Morale: 115. See also Medicodental relations,

"amalgam line": 264

"amalgam mills": 116

ASTP graduate personnel, proposed release of: 57, 116, 144

unfavorable assignments: 116

unfavorable promotion status: 113

work quotas: 116

Mordecai, Lt. Col. Alfred, "History of the

Procurement and Assignment Service

for physicians, dentists, veterinarians,

sanitary engineers, and nurses, War

Manpower Commission:" 53, 76

MTO. See Mediterranean Theater of

Operations.

Murray, Sen. James E.: 69, 70, 129

National Defense Act, 3 June 1916: 4, 113

National Dental Association. See also

American Dental Association.

Dental Corps, interest in improved status: 5-6

legislative committee: 4

legislative measures sponsored: 1, 4

National Guard: 63

commissioned dental officers, 1917,1918:5
INDEX 355

National Guard—Continued

Dental Corps organized in, 1916: 5

number called to active duty: 48-51

procurement, role in: 48

National Roster of Scientific and Specialized Personnel: 78

NATO. See North African Theater of

Operations.

Navy Dental Corps: 16, 19, 35

Navy V-12 program: 149

New Guinea: 289. See also Pacific.

New York Port of Embarkation: 171, 276

Ninth Army: 293, 298, 299, 300

Nonprofessional use of dental officers. See

Personnel, officer.

North African Theater of Operations: 166,

192, 194, 233, 317, 318, 319

Occupational classification

enlisted

chair assistants: 155

technicians: 155

officers: 106, 107-108

standards, lack of: 97, 108

Occupational deferment of dentists. See

Selective Service.

Office, Chief of Transportation: 90

Office of Defense Health and Welfare

Service: 76, 133

Office of Production Management (OPM):

130

Office of The Air Surgeon: 31, 32

Office of The Surgeon General. See Surgeon General's Office, the.

Officer Procurement Service: 56, 80, 81, 82,

83

Officers Reserve Corps. See also Reserve,

commissioned dental officers, 1917, 1918:

5

establishment, 1916: 5

Oliver, Col. Robert T.

appointment to Dental Corps after act

of 1911: 3

assignment, Dental Division, SGO: 22

general hospital designated in honor of: 3

OPS. See Officer Procurement Service.

Order of the British Empire: 117

Organization of the Army Dental Corps

prior to World War II: 1-7

Organized Reserve. See Reserve.

Pacific: 192, 194

island: 310, 312, 315

Pacific—Continued

landing: 117

Southwest: 230, 232, 318

Palestine: 175

Panama: 64

PAS. See Procurement and Assignment

Service for Physicians, Dentists, and

Veterinarians.

Patterson, Robert F.

appointment to Dental Corps after act

of 1911: 3

Patterson, Robert P., Under Secretary of

War: 134

Paul , Gen. Willard S., Acting Chief of

Staff: 144

Pearl Harbor: 53, 66, 97

Pepper, Sen. Claude: 70, 102

Personnel, enlisted. See Auxiliary dental

personnel.

Personnel, officer. See also Mobilization;

Procurement, officer personnel,

allotment authorized by tables of organization: 111,299,302

allotment recommended for

camps, ZI: 46

dental clinics, ZI: 46-47

station hospitals: 46

assignment, by type of unit: 107

overseas: 106

ZI: 106

commissioned during 1944: 59

conservation of: 91

estimated number to serve with Corps,

World War II: 61-62

nonprofessional use of: 14, 98-100

as auxiliary medical officers, comment

on: 99, 306

restriction on: 286

number on active duty, 1941: 53

postwar, anticipated shortage of: 60, 91

requirements for. See Manpower requirements, methods for determination,

uneconomical use of as enlisted soldiers:

70

use of at camps and stations: 284-285

Persons authorized to receive dental care.

See Treatment, dental, aspects of.

Pharmacy Corps: 21

Physical standards for commission: 92

Preparation for overseas movement, 1943:

206. See also Criteria, dental, for

overseas service.
556 INDEX

Preparedness League of American Dentists: 118, 193, 225

President of the United States: 5

empowered to call to active duty, with

or without consent, any member of

the Reserve or National Guard, 1940:

52

"salvage" program to rehabilitate individuals rejected for dental defects:

228. See also Dental rehabilitation

prior to induction.

Procurement and Assignment Service for

Physicians, Dentists, and Veterinarians: 55, 56, 65, 72, 91, 97

effectiveness of: 80-82

initial recommendation for: 53

instructors in dental schools, survey of:

145

organization: 76

personnel survey

findings: 41-42

recommendations: 42-43

procurement functions: 77-79

Procurement, equipment and supplies. See

Equipment; Supplies.

Procurement, officer personnel. See also

Mobilization,

ceiling: 45, 58

discontinuance of: 56, 61

grades

as an aid in procurement: 97-98

authorized: 96

offered: 97

improvement in: 74

lack of vacancies, 1944, problem of: 56, 58

methods

ADA: 83-86

Medical Officer Recruiting Boards:

80-82

Officer Procurement Service: 83

PAS: 76-82

Selective Service: 67-76

objectives for

1942: 53-54, 92, 94, 96

1943: 55-56, 142

1945: 60

postwar: 102

draft of dentists: 74, 342

from the Navy: 342

program, summary: 103-104

ratio objectives

analysis: 45

weaknesses: 40-41

Procurement, etc.'—Continued

ratios authorized: 35, 36-37

replacement pools: 53, 125

requirements, table of organization units:

45

sources of

ASTP: 55, 60, 67, 138

civil: 67-86, 91

enlisted reserve: 67

inducted dentists: 60

Medical Administrative Corps Reserve: 56, 60, 67, 133, 136

National Guard: 62, 63

Organized Reserve: 48-53, 63-66

Regular Army: 62

survey (projected to the end of 1943)

defects of: 42-43

maximum number available from civilian practice: 41

PAS findings: 42

PAS recommendations: 43

voluntary program, lag in: 61, 72

World War I: 35, 41

Professional standards for commission: 94

Promotion

Dental and Medical Corps, comparison

of: 10, 112

Director of Dental Division, SGO, comment on: 113, 115

eligibility for, in World War II: 110

general officer: 114

in ZI: 110-111

Judge Advocate General, ruling on: 113

lack of opportunity for: 110

morale factor: 113

overseas: 111-112

increased opportunity: 114

peacetime schedule, establishment of:

6, 109

regulations, suspension of: 109

service required for

Regular Army: 109

Reserve: 109

Prosthetic facilities, ZI

laboratories

camp: 278-281

civilian, use of: 283-284

station: 278-281

laboratory service, operation of: 281-283

need for expansion, World War II:

278-280

prior to World War II: 278
INDEX 357

Prosthetic service. See also Dentures, excessive loss or destruction of.

professional standards: 221-222

requirements for, as revealed by wartime

experience: 219-220

Prosthetic service, overseas

World War I

equipment: 313-314

prostheses constructed: 313

requirement for: 313

World War II

equipment: 314, 316-318

facilities: 314

morale factor: 319-320

prostheses constructed: 315. See also

Statistics.

removal of chests 61 and 62, effect on:

317-319

Prosthetic service, policies for provision of:

211-212

central dental laboratories, establishment

of: 217

during World War I: 216

period between World Wars I and II:

216-218

prior to World War I: 216

World War II: 218-219

Prosthetic supply clerks. »See Auxiliary

dental personnel.

Prosthetic teams: 301, 323

Publications. »See Training aids.

Public Health Service, United States

(USPHS): 227

personnel survey, aid in: 41

Purple Heart: 117

"Quota" dentistry: 117, 223-225

Redeployment center dental service

dental condition of redeploying troops:

308

comparison of with inductees (Camp

Robinson, Ark.): 308

equipment and facilities: 307

organization of (Florence Redeployment

Center, MTO): 307

Regular Army Dental Corps. See Dental

Corps, Army.

Release from active duty. See also Demobilization,

administrative discharges: 87

create vacancies for younger men: 59, 89

dental defects: 255

Release from active duty—Continued

essential to national health: 91

hardship: 91

War Department Circular 485, 1944:

91

limited service: 87

no suitable assignment: 88, 94

physical disqualification: 87

quotas for: 90

Relocation program for civilian dentists

abandoned: 101

applications, number received for: 101

experience gained: 102

funds appropriated

by Congress: 101

local community: 101

initiated: 101

overall utilization of dental manpower,

effected by: 101

payment to volunteers: 101

purpose: 101

Renfrow, Col. Louis H., Selective Service

System: 75

Replacement depot dental service

description of operations (Camp Reynolds, Pa.): 265-266

details of operation: 265

function of: 265

personnel allotment: 265

treatment rendered: 265

Replacement training center dental service

description of operation (Ft. Knox, Ky).:

262-263

function of: 262

personnel allotment: 262-265

treatment rendered: 264

Reserve

age, limitation for initial active duty,

1940: 64

call to active duty, lieutenant colonels

and colonels: 54

commissions, suspension of: 52

disadvantages of membership in: 66

enrollment

1938: 63

1941: 51-52, 63, 121-122

establishment of: 5

evaluation of: 65-66

grade distribution, 1941: 63

number called to active duty, 1939-46:

48-51, 64, 122

number on active duty, 1941: 52

procurement for: 51, 63
358 INDEX

Reserve—Continued

procurement, role in: 48

release from active duty, suspension of:

53

release of ASTP graduates, criticism of:

66

Reserve Officers' Training Corps. See also

Training,

termination of: 48

Reynolds, Brig. Gen. Rüssel B.: 89, 90, 139,

231

Rhoades, Rex H.: 22

appointment to Dental Corps after act

of 1911: 3

Robinson, J. B., President, ADA: 113, 168

ROTC. See Reserve Officers' Training

Corps.

Ryan, Edward P. R.

appointment to Dental Corps after act

of 1911: 3

Saipan: 315. See also Pacific.

San Francisco Port of Embarkation: 276

Sanitary Corps: 21

Scherer, Dr. W. H., President, ADA: lln

Schools, civilian. See also Training.

Columbia University, N. Y.: 126

dental registration

1932 through 1940: 146

1941 through 1945: 146

freshman enrollment, 1945: 147

Harvard University, Cambridge, Mass.:

126

Howard University, Washington, D. C:

138

Mayo Foundation, Minn.: 126

Meharry Medical School, Nashville,

Tenn.: 138

Northwestern University, Chicago: 118

Tulane University, New Orleans: 126

University of Pennsylvania (Thomas W.

Evans Institute), Philadelphia» 118,

126

Washington University, St. Louis: 118,

126

Schools, military. See also Training.

Army Dental School: 119, 120, 125, 126,

128, 156, 157, 160

Armed Forces Institute of Pathology:

120, 128

Army Medical Center: 126

Army Medical School: 120, 125

Brooke Army Medical Center: 124

Schools, military—Continued

Central Dental Laboratory: 120

Command and General Staff: 120, 121

Dental Research Laboratory: 120

Gulf Coast Air Corps Training Center:

125

Medical Field Service School, Carlisle

Barracks: 14, 119, 120, 121, 123, 124,

125

War College: 121

Schwichtenberg, Col. A. H.: 275

Scott, Harold 0.

appointment to Dental Corps after act

of 1911: 3

Scott, Minot E.

appointment to Dental Corps after act

of 1911: 3

Secretary of War: 4, 23, 35, 44, 94, 102,

209, 228, 339

Selective Service: 52, 58, 65, 77, 129. See

also Dental rehabilitation prior to

induction,

deferment directives for

general: 131

preprofessional students: 132

professional students: 130-131, 132

Dental Advisory Committee: 226

draft of dentists: 74

induction boards, dentists appointed to:

203

induction of dentists, criticism of: 68

occupational deferment of dentists, consideration of: 71

prerogatives of: 53, 70

procurement policies: 67-76

Separation center dental service. See also

Treatment, dental, aspects of.

personnel allotment: 267

policies for provision of dental care:

266-267

prosthetic replacements, extensive need

for: 270-271

system of operation (Ft. Monmouth, N.

J.): 268-270

Separation criteria. See Demobilization.

Services of Supply (SOS): 28, 54

Seventh Army: 306

SGO. See Surgeon Generals' Office, the.

Sheppard, Hon. Morris: 69, 129

Shook, Col. C. F.: 172

Silver Star: 117

Skull plates, role of Dental Service in

development of: 238
INDEX 359

Smith, Brig. Gen. Thomas L.: 23, 26, 99,

173, 228, 233, 235, 305, 314, 323

assignment Dental Division, SGO: 23

Soldier's Medal: 117

South Pacific Base Command: 192, 194

Southwest Pacific theater: 179, 192, 194,

230, 318

Sparkman, Hon. John J.: 102

Specialty classification. See Occupational

classification.

Stallman, George E.

appointment to Dental Corps after act

of 1911: 3

Standards for military service, dental.

See also Dental Corps, Army,

airborne duty: 203

cadets: 203

changes in: 201-202

divers: 203

for overseas service: 229-232

lowering: 202, 211

mobilization regulations

disqualifications under: 200-201

rate, 1942: 203

rate, 1943: 203

revision of: 202-203

peacetime: 199

Regular Army: 203

rejections, causes for: 201

voluntary enlistment in National Guard:

201

Station hospital dental service, overseas.

See Communications Zone dental

service.

Station hospital dental service, ZI: 271-272

Station Hospital, Fort Sam Houston: 121,

125

Statistics

dental diagnoses, 1938-45

cellulitis of dental origin: 239

fractured mandible: 240

fractured maxillae: 241

osteomyelitis of oral structures: 242

Vincent's stomatitis: 243

dental diseases, incidence of, 1942-45

cellulitis, dental origin: 244

osteomyelitis, oral structures: 246

Vincent's stomatitis: 245

output per dental officer (five principal

operations), 1 Jan 1942-31 Aug 1945:

256

output per laboratory technician,

1943-44: 283

Statistics—Continued

protheses constructed

bridges: 223, 252

dentures: 223

full: 249

partial: 250

prosthetic operations per 1,000 men per

year: 219-220

repairs: 223, 251

treatment, cash value of: 255

treatment rendered, 1 Jan 42-31 Aug 45

extractions: 248

fillings: 247

prophylaxes: 254

teeth replaced: 253

Stimson, Henry L.: 69, 129

Stone, Frank P.

appointment to Dental Corps after act

of 1911: 3

assignment to Dental Division, SGO: 22

Students, dental, deferment of. See Education; Selective Service.

Supplies

burs i

collection of, from civilian sources: 168

Medical Supplies Commission, report

on civilian purchase of: 168

requirement of, 1943, compared with

average prewar demand: 168

War Production Board report on status

of, 1943: 166

conservation of: 176

dental items, simplification of: 169

distribution, improvement in: 170

effects of climate: 177

experience gained in World War II:

197-198

local procurement

overseas: 175

Zone of Interior: 174

methods to assure effective utilization:

169

packing, general principles for: 177

porcelain teeth, storage, and issue: 170

shipping, general principles for: 177

shortages: 165-168

storage and issue of: 170-171

substitution of: 177

Supply Division, SGO: 167

dental officer assigned to: 30, 170

surplus burs, comment on: 168
360 INDEX

Surgeon General, The: 2, 9, 35, 43, 44, 45,

48, 51, 52, 54, 55, 56, 59, 60, 64, 67, 73,

77, 79, 80, 81, 82, 83, 84, 85, 88, 89, 90,

91, 92, 93, 94, 96, 97, 99, 107, 118, 133,

134, 135, 138, 139, 144, 151, 155, 169,

170, 172, 173, 176, 193, 211, 214, 216,

225, 227, 230, 232, 234, 238, 266, 277,

278, 288, 323, 335, 336, 338

administrative action for improvement

of dental service: 16

authority, extent of: 10, 23, 28-29, 33

demobilization of Medical Department

officers, on progress of: 333-334, 340-

341

exemption from military service through

Reserve commissions, views on: 53, 70

female civilian assistants, conditions

specified for hire: 159-160

increased responsibility for dental surgeons, interest in: 19

inducted professional personnel, commissions recommended for: 68

nonprofessional use of dental officers,

action concerning: 14

on legislative action to increase efficiency

of the Dental Corps: 4, 6

promotion announcement: 16

promotion efforts in behalf of dental

officers: 11

release from active duty of "limited

service" personnel, recommendations

for: 57-58

subordinated status of Dental Corps,

disapproval of: 13-14

wasteful use of physicians and dentists

as enlisted soldiers, views on: 70

Surgeon General's Office, the: 22, 29, 30,

45, 61, 66, 79, 82, 96, 194

Surgeons, dental. See also Contract dental surgeons.

first lieutenants appointed after act of

1911: 3

Table of Organization and Equipment 8-16,

1 June 1945. See Division dental

service.

Table of organization medical units, overseas

auxiliary surgical group: 299, 301

clearing company: 299, 301

convalescent camp: 302

convalescent center: 302

Table of organization medical units, overseas—Continued

detachments

dental operating, mobile: 302

dental prosthetic, fixed: 301, 302, 304

dental prosthetic, mobile: 302

maxillofacial: 302, 303

medical: 302, 303

dispensaries, medical

aviation: 302, 303

general: 302

gas treatment battalion: 299

hospitals

centers: 302, 303

convalescent: 299

evacuation: 299

field: 299

general: 302

station: 302

medical depot company: 299

medical supply depot: 302

Tactical units dental service: 287-289

Technical Manuals

TM 8-255. See Separation center, dental

service.

TM 8-638. See Auxiliary dental personnel.

TM 12-406. See Occupational classification.

Technicians. See Auxiliary dental personnel.

Thomas M. England General Hospital.

See Hospitals.

Tignor, Edwin P.

appointment to Dental Corps after act

of 1911: 3

Tingay, Col. Lynn H.: 300, 301, 318

Training. See also Training aids,

consultants: 127

during World War II

basic, Medical Department replacement pools: 125

basic, Medical Field Service Schools

duration: 124

number graduated: 125

maxillofacial and plastic

civilian institutions: 126

hospitals: 126

professional, Army Dental School: 125

refresher courses, Army hospitals: 126

unit: 126

enlisted personnel. See Auxiliary dental

personnel.
INDEX 361

Training—Continued

officers, Regular Army, prior to World

War II

advanced graduate course, Army Dental School

duration: 120

number graduated: 120

advanced officers' course, Medical

Field Service School

duration: 120

number graduated: 120

basic graduate course, Army Dental

School

duration: 119

enrollment: 119

dental internship: 121

extension courses: 121

instruction in civilian institutions: 120

nonmedical service schools: 120

officers' basic course, Medical Field

Service School

duration: 119

number graduated: 120

officers, Reserve, prior to World War II

extension courses: 122

ROTC: 122

summer camps: 123

World War I

field service school, Camp Greenleaf,

Ga.: 118-119

Preparedness League of American

Dentists: 118

Surgery of the Head, SGO, section

established: 118

Training aids

film strips: 127

moving pictures: 127

publications

Atlas of Dental and Oral Pathology:

128

Dental Bulletin, supplement to the

Medical Bulletin: 128

technical manuals: 128

Treatment, amount rendered. See Statistics.

Treatment, dental, aspects of. See also

Dental rehabilitation prior to induction,

before and during an invasion: 306

cash value of. See Statistics,

classification, precedence for: 205-206

consultants, report on: 214

criticism of: 213-216

Treatment, dental, aspects of—Continued

enlisted personnel, attitude of: 214-216

extent of: 210

for General George Washington: 1

limitations on: 211, 212

persons entitled to

civilian dependents: 207

civilian employees: 209

military: 207

Red Cross: 209

policy for: 211

quality rendered: 212

refusal of: 223

rehabilitation requirements

for inductees: 266

for separatees: 266-267

Twelfth Air Force: 312

Undergraduate dental education. See

Army Specialized Training Program;

Education; Selective Service.

United States Public Health Service

(USPHS): 76, 79

Vail, Col. Walter D.: vii

Valley Forge General Hospital: 236

Veterans Administration: 97, 237, 255

dentists commissioned: 56

Veterinary Corps: 21

Voorhees, Hugh G.

appointment to Dental Corps after act of

1911: 3

WAC. See Women's Army Corps.

WAC personnel. See Auxiliary dental personnel.

Wakeman General Hospital: 159

Walter Reed General Hospital: 120, 121,

125, 238

Army Dental School: 119, 120, 125,

126, 128, 156, 157, 160

War College. See Schools.

War Department: 2, 10, 11, 18, 20, 35, 56,

57, 69, 70, 72, 73, 87, 88, 100, 102, 281,

336

War Department Circular

No. 85, 1943. See Criteria, dental, for

overseas service.

No. 32, 1945. See Dentures, excessive

loss or destruction of.

War Manpower Commission (WMC): 41,

55, 72, 73, 76, 131, 132
362 INDEX

War Production Board

burs, report on: 166

general limitation order, 1942: 169

general limitation order, 1943: 170

Washington, General George: 1

Westerman, Cmdr. J. V., USN: 75

Weible, Brig. Gen. Walter L.: 230, 231

White, Maj. Gen. M. G.: 58, 87, 139

White, Col. William D.: 165, 166, 167, 276,

316

Wilson, Lt. Graves H., co-author, "History

of wartime research and development

of medical field equipment:" 188, 193,

194, 311

Wing, Franklin F.

appointment to Dental Corps after act

of 1911: 3

Wirtz, Maj. Milton: 236

Wolven, Frank H.

appointment to Dental Corps after act

of 1911: 3

Women's Army Corps: 161

Yates, Capt. Richard E., "The procurement and distribution of medical supplies in the Zone of Interior during

World War II": 165

Zone of Interior (ZI): 45, 46, 47, 86, 90,

100, 110, 111, 114, 154, 174, 178, 265,

271, 272, 273, 333, 335, 336, 338, 340,

341

U. S. GOVERNMENT PRINTING OFFICE: 1955 O—330324