The New Zealand Dental Services
CHAPTER 10 — The Building of Dental Hospitals
The Building of Dental Hospitals
WHEN the New Zealand Dental Corps assumed the responsibility for treatment of the armed forces in the Dominion and overseas, one of the first considerations was the provision of suitable accommodation. The use of tents or converted huts was only excusable under field conditions or when time precluded the building of permanent hospitals. Costly, delicate and complicated equipment is used in the practice of dentistry, and this has to be suitably housed and readily available if treatment is to be of the high standard the forces have a right to expect. In addition to this, there is a considerable strain on an operator working long hours in an exacting profession which demands the best conditions to produce the best results. Suitable hospitals, however, cost money, and enough has been said of the official reluctance at the beginning of the war to recognise the value of the Dental Corps in the general scheme of things, to show that getting authority for the necessary expenditure was not easy. Eventually, good hospitals were built in every permanent camp or station.
An example of tented accommodation in the early part of the war was when the Maori Battalion was in the Manawatu Agricultural and Pastoral Association's showground at Palmerston North. Major L. P. Davies, OBE,1 ADDS of the Central Military District, reported on 14 March 1940:
The dental staff comprised the Principal Dental Officer and four other dental officers, one administrative sergeant, four dental orderlies, three mechanics and one mechanic's orderly. I found the dental quarters to comprise one large marquee and one bell tent.
The marquee was approximately 15' × 30' and here the mechanical work, office work and surgical work were carried out…. There was a duck-board flooring in the mechanical portion but in the surgical part there was no flooring at all…. Conditions were not altogether favourable in wet and rough weather. There was an electric light above each chair and also in the mechanical room and the lighting conditions generally were as satisfactory as could be expected under the circumstances. Electric power was used for an electric vulcaniser and for electric engines. Primuses were used for other heating requirements.
On questioning the PDO I found that the dental plant, including the electric plant, stood up to the weather very well.page 98
Drainage was … by means of a septic tank. Water was laid on and facilities for washing were provided by means of canvas basins. I might also state that space was provided in the marquee for sleeping one member of the staff to act as caretaker.
The bell tent accommodated one officer and one orderly. I found here a close wooden flooring with no provision for lighting or drainage. As this was only a make-shift tent it answered the purpose for which it was intended….
It must have been difficult to maintain reasonable asepsis under these conditions, and even more difficult to impress the patients that the standard of service received was not in some measure commensurate with the surroundings.
Dental hospitals, whether large as in a mobilisation camp where up to nineteen officers were operating, or small as for a single section, have certain essential requirements, and all are constructed on the same principles. A study of these essentials will give some idea of the general layout of all dental hospitals without the need for describing the details of the many different designs, although it must not be forgotten that the numerous designs were the result of much thought and effort by Dental Headquarters and the Public Works Department.
In general, the building had to be so situated as to be easily accessible to the patients. It had to be orientated to provide the best operating light, big enough to accommodate staff and patients, yet small enough to allow hospital cleanliness to be observed. It had to have water, electricity, sewerage, gas, compressed air and heating, as well as having specialised apparatus installed and suitable fittings designed and constructed. There had to be a surgery, office, workroom, waiting room and lavatory. In the case of the larger hospitals, a store, X-ray room, darkroom, and a room for extractions and oral surgery had to be provided.
The centrepiece of the surgery was the chair. While in some cases hydraulic pump chairs were provided, most of them were of the folding type made of wood with adjustable headpiece and back. They were reasonably adequate, though lacking in strength and range of movement in comparison with the pump chairs. On the left of the chair was a unit complete with spittoon, saliva ejector, bracket, electric engine and compressed air atomiser. They were made in New Zealand and proved to be very satisfactory. On the right of the chair was a cabinet for instruments and drugs, with its top designed for use as a writing desk.
The chair, unit and cabinet required a width of 7 ft 6 in. to 8 ft and at least 12 ft from the window to the back wall. When a series of chairs were placed alongside each other as in the larger hospitals, page break page break page break page break page break page break page break page break page 99 8 ft from the centre of one chair to the centre of the next was allotted.
Camp Dental Hospital surgery, Trentham, 1943
At work in a carvan trailer, Trentham
1 New Zealand Camp Dental Hospita, Maadi. Patients clean their teeth at the Oral Hygiene Bench before entering the surgery
Lieutenant-Colonel J. F. Fuller, OBE, ADDS 2 NZEF
2 New Zealand Camp Dental Hospital, Maadi, before its building was completed
In the Western Desert, 1940. Patients wait outside the surgery of a field ambulance dental officer
There is an age-old controversy among dentists about the most suitable daylight for operating. In the southern hemisphere the majority, as revealed by a poll taken among the dental officers, favoured the southern light, some almost to the point of fanaticism, while the minority with equal vehemence swore by the northern. As there were some hospitals in long narrow army huts where the chairs were placed back to back, it is hoped that officers of appropriate schools of thought were employed. There was one point, however, of universal agreement, that direct sunlight must be avoided at all costs because of eye strain from glare. This made the eastern and western aspects unsuitable. Some form of artificial light was necessary for dull days and evening work, but this was discouraged whenever adequate daylight was available. All the hospitals were equipped with a rise and fall light fitted with a suitable reflector above each chair. In addition, a battery operated light which could be worn on the forehead was a standard issue to each section.
It is reasonable to presume that, with the development of the fluorescent tube, this will be the lighting of the future, but its first trial in Waiouru Camp was a failure owing to technical faults in the light itself. A better type was installed in HMNZS Cook in 1945 with more success.
Every surgery was provided with hot and cold water. It was found necessary to filter the cold water to prevent blocking the saliva ejector system, and for this purpose a strainer was fitted outside the hospital. Some hospitals had their own electric hot-water system, some were connected with the camp supply, some used the ‘Zip’ type heater and one, at least, had a coke boiler. A steriliser bench, a plaster bench covered with battleship linoleum and a wash-hand basin completed the furnishing of the surgery.
The walls, ceiling and joinery were painted and enamelled, usually in a light green colour which was very restful for the eyes. The floor was either covered with linoleum or left bare, in which case the wood was highly polished. In Papakura, Trentham and Burnham it was remarkable how well the floor kept its ballroom appearance in spite of the tramp of many pairs of hobnailed boots, and it reflects great credit on the orderlies who spent so much time and effort on its care.
Heating in winter was in most cases of the tubular electric type although some of the smaller hospitals had a coke heater standing on a concrete block. Adequate heat is essential in a dental hospital as without it the work must suffer. The occasion of the treatment of the Railway Construction companies in Ngaruawahia in 1940, already mentioned, is a case in point. Without drums of red-hot page 100 coke between the chairs, the operators' hands would have been too cold to work and the patients could not have sat out the appointments. The method of using braziers such as this is not recommended as a routine practice, however, and the writer who was in charge of the unit at that time must confess that he was haunted by the spectre of carbon monoxide poisoning, which happily did not arise.
Compressed air for the unit was provided by an electric motor and tank situated in the workroom with a pipe through to the surgery.
The hospitals in the mobilisation camps and the larger Air Force stations had, besides the main surgery, two rooms for extractions, oral surgery, general anaesthetics and X-rays, with a darkroom for processing films. The attempt to provide a private surgery for the use of the PDO of mobilisation camps, presumably to work on Very Important Personages, was not a success. In the first place, it was placed right opposite the main door, which was the draughtiest part of the building, and secondly the exalted patients usually expressed a wish to take their seats in the common row.
Only the bigger hospitals had a room set aside as an office. In the smaller ones all the clerical work was done in the surgery and, while admitting some convenience in this arrangement because of the smallness of the staff, it would appear that a separate office, not necessarily large but close to the waiting room, is more efficient and easier to run. Clerical duties such as calling up and interviewing patients, filing records, writing reports, telephoning and typewriting should not be allowed to interfere with the work of the dental officer in the surgery. Little emphasis was put on providing efficient office equipment, probably because in most cases not enough emphasis was placed on the business capability of those expected to carry out the work. Untrained people were expected to run the clerical side of the equipment of perhaps sixteen or seventeen dental practices working to full capacity. They had to see that every man in camp was called for treatment in time to be made dentally fit before leaving for overseas. They had to study the movements of men from unit to unit as laid down in routine orders. They had to keep a record of work to be done, work completed and stores needed and expended. They had to type reports and correspondence, see that the dental records for each patient were forwarded to the proper quarter at the correct time, as well as arranging all details for the unit such as pay, leave and clothing. When it is remembered that, except by a fortunate accident, none of them could use a typewriter, except later when girls were employed, and that in the early part of the war it was even difficult to get a typewriter, their work stands out page 101 as an example of willing service, often misdirected and needlessly prolonged. The result was that the Principal Dental Officer was continually submerged in a morass of clerical duties because there was no trained clerk to help him. There is a strong case not only for an office in every dental building but for trained clerical staff to run it.
The Mechanical Laboratory or Workroom
This was where the mechanical construction of artificial dentures was carried out. All work for the patient was carried out in the surgery by the dental officer but the actual construction was done in the workroom by the mechanic to his instructions.
Benches were built round the walls for plaster work, vulcanisation, boiling out wax, packing rubber, setting up teeth and the hundred and one procedures connected with the work. Water, light and electricity were needed and gas for Bunsen burners, vulcanisers and gas rings. It was not possible to rely on a supply of coal gas for every dental hospital and, as it was the policy of the Corps to standardise all equipment, bottled gas was used. This was a rock gas mined in California and stored in cylinders of 20 lb and 210 lb. A smaller jet was required than that used for coal gas so special burners and connections were necessary. It was very satisfactory and had the advantage over coal gas of being portable. Although classed as ‘Dangerous’, with a recommendation that it be stored in a magazine, no fires, with the exception of one due to carelessness in leaving a vulcaniser unattended, occurred during the whole war, and it was used in mobile laboratories as well as hospitals. There were some anxious moments about supplies at the time of Japan's entry into the war, when America placed an embargo on the export of steel cylinders, but these difficulties were overcome and no shortages were experienced.
The bench accommodation, including space for plaster work, polishing, packing, vulcanising, soldering, inlay casting and general work, together with the cupboards and drawers, was well designed on conventional lines and need not be described in detail.
In a small hospital the room was about 12 ft by 8 ft and in the big mobilisation camps was 40 ft by 13 ft 6 in., which was none too large for the volume of work that passed through it.
W aiting Room
In the bigger hospitals a room some 18 ft square with benches round the walls was provided, and in the smaller ones a tent was usually used. The first sight to greet a patient in any NZDC hospital was a notice reading:
All ranks must parade with their toothbrushes and clean their teeth thoroughly before dental examination or treatment.
In most cases a sink was supplied for this purpose, but when there was no sink or running water, a field oral hygiene outfit and soakage pit were used. This was a metal tank of about 2 ft cube, containing water and standing on a wooden platform 3 ft 6 in. high. A rubber tube fitted with a clip came from the tank and rested when not in use in a jar of antiseptic attached to the stand. Alongside the outfit a hole was dug in the ground and filled with stones to form a soakage pit. To use it one wet the toothbrush by removing the tube from the antiseptic and pressing the clip. The teeth were then cleaned over the soakage pit, the tube being replaced in the antiseptic.
This, while obviously not as satisfactory as a sink with running water and proper sewerage, was a distinct advance on what existed in the 1914–18 War, and which continued through the Territorial interlude and even made an appearance in this war. To quote a memorandum to all dental officers dated 22 December 1939:
Where sinks and other facilities are not provided, Principal Dental Officers will take steps to have two buckets branded ‘Clean Water’ and ‘Waste’ respectively, placed on a bench two feet high in a prominent position at the entrance to the clinic, preferably inside the building, with a mug and a receptacle for common salt.
This was known as an oral hygiene bench, a name which expresses the meritorious intention but not the complete failure of its activities. Far from promoting oral hygiene, it was a menace to health and an encouragement to the spread of infection. The buckets were unprotected from dust and flies. Patients were puzzled by the whole outfit and sometimes mistook the clean bucket for the waste, and even if they correctly carried out the instructions, the water and mug were contaminated by the first user. The outfit has long since been discarded and it is inconceivable that enlightened knowledge of health will tolerate its resurrection.
From this general description it should be possible to visualise the conditions under which the NZDC worked in the various camps in New Zealand. Good, well-equipped hospitals built of wood, painted in many cases with camouflage, the interior polished and shining, a setting to impress the patient that this was no temporary service, no rough and ready tooth carpentry, but dentistry equal to that he received from the dentist of his choice before he joined the forces.