British dental surgery and the First World War: the treatment of facial and jaw injuries from the battleield to the home front K. D. Hussey 1 surgeon had experienced in civilian prac- tice. Over the course of the war, the value of dental knowledge was increasingly recog- nised and dental professionals played a cru- cial role in the health of the ighting force. The beneits of involving dental surgeons as full members of the teams treating these injuries established a fundamental principle in the evolution of oral and maxillofacial surgery over the next 100 years. This article will examine the contribution of specialist dental surgeons to the management of severe facial and jaw injuries in the First World War along the chain of evacuation from the battleield to the home front. Set against the background of the development of general dentistry during the war, objects from the collections at the Hunterian Museum of the Royal College of Surgeons of England will serve to illustrate the foundation of oral sur- gery as a speciality. DENTISTRY GOES TO WAR Since the seventeenth century, it was believed that general army surgeons could adequately tend the dental needs of soldiers. With the invention of automatic riles, the retention of teeth was a low priority, as they were no longer required to load a gun. 2 The passing of the Dentists Act in 1878 brought about an important time of change in the dental profession with the founding of the Dentists Register. From that point, the term dentist oficially referred to a registered practi- tioner with a Licentiate in Dental Surgery (LDS) or a Bachelor of Dental Surgery (BDS). Despite this professionalisation, when the INTRODUCTION On 29 August 1916, the ield dressing sta- tion of the 7 th Division Royal Welch Fusiliers had just been established outside the Delville Wood (the Devil’s Wood) in Northern France as a part of the Somme Offensive. The unit’s medical oficer, William Kelsey Fry (1889– 1963), would have been going about his duties, tending to severely wounded patients and preparing to receive more casualties. Well-liked by his battalion for his friendly manner and bravery under ire, Kelsey Fry had already been injured in the line of duty. He received the Military Cross for his actions at Festubert, where he was shot in the back of both legs while retrieving an injured sol- dier from the battleield. 1 At 4 pm, a shell hit the division’s medical post, instantly killing patients and doctors alike. Under heavy ire, the battalion searched for survivors. Only Kelsey Fry was dragged from the rubble alive. One of the few ways for a dental surgeon like Kelsey Fry to be posted to the Front at the beginning of the First World War was serving in the dangerous role of Regimental Medical Oficer in the Royal Army Medical Corps (RAMC). In his time at the Front, Kelsey Fry was presented with traumatic facial and jaw injuries unlike any dental When Britain went to war in 1914, the British Expeditionary Force was deployed without a single dentist. Initially con- sidered combatants, the only dental professionals who could serve at the Front were medically qualiied dental surgeons in the Royal Army Medical Corps. In treating the traumatic facial and jaw injuries caused by trench warfare, the dental surgeons of this era earned their place on specialist surgical teams and established the principles of oral and maxillofa- cial surgery. This article will examine the contribution of specialist dental surgeons to the management of facial and jaw wounds in the First World War along the chain of evacuation from the battleield to the home front, using illustrative examples from the Hunterian Museum at the Royal College of Surgeons of England. Second Boer War began in 1899, no dentists were sent with the Army to South Africa. However, oral problems were a leading cause of troops becoming unit for duty, with over one-third of admissions to the hospital for dental caries being discharged from the Army. 2 In 1900, dentist Frederick Newland Pedley was permitted to treat the troops in South Africa, provided he brought his own equipment and incurred no expense to the government. 3 When Britain went to war in 1914, the Army’s dental provision was no better than it had been at the turn of the century. As the Great War began, dentists were ini- tially enlisted as combatants. Upon mobilisa- tion, the British Expeditionary Force (BEF) was sent to France without a single den- tist. It wasn’t until General Douglas Haig, commander of the BEF, had a toothache in the autumn of 1914 that the Army’s view of dentistry started to change. Haig was attended by a French-American dental sur- geon, Charles August Valadier (1873–1931), who was subsequently appointed the irst dental surgeon to treat British troops on the Continent. By the end of the year there were 20 dentists treating the military. 2 In 1916, the Military Services Act was passed and the number of dentists sent to the front lines began to increase. The Act introduced mandatory conscription but dental pathol- ogy was a leading cause of rejection for new recruits. Army dental oficers were required to render the inlux of conscripts it for duty. Dentists also began to be attached to casu- alty clearing stations and by August 1916 1 Former Assistant Curator, Hunterian Museum at the Royal College of Surgeons of England Correspondence to: Kristin Hussey Email: kristin.hussey@qmul.ac.uk Refereed Paper Accepted 27 August 2014 DOI: 10.1038/sj.bdj.2014.1001 © British Dental Journal 2014; 217: 597-600 • Enables a greater understanding of the development of the Army’s dental provision during the First World War. • Highlights the role of dental surgeons in the treatment of patients with facial and jaw injuries. • Develops a broader knowledge of key dental surgeons from the era. IN BRIEF GENERAL BRITISH DENTAL JOURNAL VOLUME 217 NO. 10 NOV 21 2014 597 © 2014 Macmillan Publishers Limited. All rights reserved Author copy