According to Napoleon’s famous maxim ‘An army marches on its stomach’. What
he meant was that soldiers lacking food are incapable of fighting well. He might have added that even when presented with adequate food soldiers with painful teeth can’t eat what an army’s quartermasters have provided.
So it was that on the outbreak of the Great War in 1914 General Sir Douglas Haig called for dentists to attend the British Expeditionary Force in France. Yet with more than 60,000 horses the BEF put recruiting vets and blacksmiths far higher than dentists on its list of priorities. The consequence was that when General Haig himself developed toothache soon after the onset of hostilities the BEF did not have a dentist available to treat him.
Haig’s toothache had to be treated by a French ‘dentiste’, Charles Valadier. Sir August Charles Valadier as he later became, was a dental surgeon from Paris. Despite experience there were by the end of 1914 still only 11 dentists treating members of the 160,000 strong BEF – an average of only one dentist to every 14,500 men.
During the war’s early stages there was a serious wastage of fighting manpower due to a lack of proper dental care. RAMC officers did their best to carry out the role of dentists but that arrangement could not be allowed to continue.
The problem was dealt with by granting temporary commissions, with the rank of lieutenant, to a number of dentists. By 1915, some 155 dentists were holders of the King’s commission in the Army Medical Corps.
At the same time a number of civilian dentists volunteered to do their bit doing unpaid work for servicemen. But given the enormous size of the army being recruited to fight Germany and her allies many additional dental officers were needed. The creation of a proper chain of command would eventually lead to the opportunity for dentists to rise as high as Lt Colonel in what would eventually become the Army Dental Corps.
Matters were much improved by the introduction of mobile dental treatment units in 1917. By 1918 over 800 dentists were serving in the army.
Meanwhile Haig could not have made a better choice than being treated Charles Valadier. As the war progressed Valadier became increasingly interested in developing new techniques to treat maxillo-facial injuries suffered by combatants.
Injuries to the face involving shrapnel or bullets frequently required dentistry as well as surgery. As time went on the pace of medical expertise quickened as did the speed of surgery: procedures which would have taken as long as two and a half hours back in Blighty were completed within 15 minutes under local anaesthetic.
A New Zealand surgeon, Harold Gillies who had studied medicine at Cambridge, was sent to France in 1915 where he worked with Valadier at a hospital in Wimereux.
Treatment to replace the missing bone shot away in jaws by bullets or shrapnel was conducted at Wimereux. Reconstructive surgery involved using bone surgically removed from elsewhere in the patient’s body - or, if this was not possible, carefully chosen pieces of metal were used.
During the first 10 days of the Battle of the Somme in July 1916, some 2,000 men were sent back from France for surgery on facial injuries, but there were only 50 beds available.
Harold Gillies, now back in the UK, was the key figure in establishing a new treatment centre, initially housed in wooden huts in the grounds of Frognal House in Sidcup. Gillies’ hospital became known as the Queen’s, after Queen
Mary became a benefactor. In the years between 1917 and 1921, the hospital had 1,000 beds in which over 5,000 injured servicemen received maxillo-facial and plastic surgery. Some patients would have to undergo more than 50 procedures before Gillies was satisfied with the result.
Other doctors and surgeons joined Gillies at the Queen’s, amongst them William Kelsey Fry. Whilst serving on the Western Front, Fry became aware of the critical importance of initial treatment to avoid losing the patient. Fry
introduced a new practice: when anyone suffering from a facial injury was brought in for treatment, they had to be laid down on the stretcher face down, no matter how severe the facial injury. Previously many men had died on a stretcher during transfer simply because that simple practice was not followed.
After the end of the Great War in 1918 Gillies was joined by other able young surgeons. They used their skills to promote better ways of tackling hair lips and cleft palettes.
Two decades later, when Battle of Britain fighter pilots suffered severe facial burns in the early conflicts of the second world war, Gillies and his cousin, Archibald McIndoe, now based at Rooksdown House at Basingstoke and Queen Victoria Hospital at East Grinstead, were available to use their skills in repairing the damage.
By then the Army Dental Corps had been long established. Way back in 1915, no doubt stimulated by the threat, all too soon to become a reality, of the lifting of exemption from military service for dentists and dental mechanics under the Military Service Acts, the BDA had appointed a committee to consider the question of creating an Army Dental Corps and to submit any recommendations it might have for action. The wheels however turned exceedingly slowly: it was not until January 4, 1921, more than two years after the Great War’s end, that the Army Dental Corps was established by
Royal Warrant as a component of the Army Medical Services.
Dental Surgeons joining the ADC were initially granted a short service commission of six years with the opportunity for selection to a permanent commission. They and servicemen who joined for an initial engagement of seven years in a more lowly capacity went initially to the Army Dental Corps
Today the RADC continues to provide a dental service to the army and has served in every campaign and theatre of operations, not least in the Falklands, Bosnia and, of course, most recently, in Iraq and Afghanistan.