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International Journal of Military History and Historiography Volume 43 Issue 3 (2023)

Online Publication Date:

16 Jun 2023

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The first major theatre of operations during the Second World War in which South African forces fought was East Africa. Key to the South African role in the campaign was the formation of the 1st sa Infantry Division in 1940. A range of medical units were under command. Using a ‘bottom-up’ view, this article – using a range of personal accounts, which complement richly veined material at the Department of Defence Archives in Pretoria – examines the service they rendered against the backdrop of the policy framework and theatre challenges. It reveals the connection medical personnel experienced between the motives that animated other South African men and women to volunteer for wartime service – travel, adventure, patriotism – and their professional ambitions regarding the growth of medical science in the fluid and varied conditions of a modern war. Sometimes the learning curve was steep; progress depended on good leadership and innovation of practice under often-extreme circumstances. But, as this article contends, they adapted to local conditions, trained on the job, and gained experience and battle-hardiness as the campaign progressed. Steady improvement and the growing size and sophistication of the Allied medical deployment led to remarkably few admissions – and fewer fatalities – from preventable illnesses and diseases as well as improving practice in the treatment and evacuation of patients from vast operational areas characterised by exterior lines and rapidly lengthening supply lines.

The first major theatre of operations during the Second World War in which South African forces fought was East Africa. Key to the South African role in the campaign was the formation of the 1st sa Infantry Division in 1940. A range of medical units were under command. Using a ‘bottom-up’ view, this article – using a range of personal accounts, which complement richly veined material at the Department of Defence Archives in Pretoria – examines the service they rendered against the backdrop of the policy framework and theatre challenges. It reveals the connection medical personnel experienced between the motives that animated other South African men and women to volunteer for wartime service – travel, adventure, patriotism – and their professional ambitions regarding the growth of medical science in the fluid and varied conditions of a modern war. Sometimes the learning curve was steep; progress depended on good leadership and innovation of practice under often-extreme circumstances. But, as this article contends, they adapted to local conditions, trained on the job, and gained experience and battle-hardiness as the campaign progressed. Steady improvement and the growing size and sophistication of the Allied medical deployment led to remarkably few admissions – and fewer fatalities – from preventable illnesses and diseases as well as improving practice in the treatment and evacuation of patients from vast operational areas characterised by exterior lines and rapidly lengthening supply lines.

An article on the medical services rendered during the East African campaign of the Great War appeared in the January 1941 issue of the South African Medical Journal (samj). The views of its writer, Lt Col H.W. Vaughan-Williams – who had been Assistant Director Medical Services (adms) with the 3^rd East African Division during that campaign – on “the chief causes of the troubles, mistakes, and even partial chaos that occurred”, were unwanted and his intention to publish his diary was unwelcomed. The defence authorities – and Barton Keep,¹ particularly – hardly wanted the spotlight on their present operations in East Africa. Yet, Vaughan-Williams was arguably correct: East Africa, with a sickness death rate higher than any other campaign, had been “almost entirely a medical war” in 1916 and 1917.² That would be the case again in 1941.

In September 1939, the South African Medical Corps (samc) was small and managed on a part-time basis by the Director General of the Department of Health. This changed quickly after a Medical Enquiry Committee, set up by Jan Smuts (the South African prime minister) in November 1939, reported. Alexander Orenstein – an epidemiologist, who had served as the Director Medical Services (dms) in East Africa in the last war – became Director General Medical Services (dgms).³ Eighteen medical units were mobilised and a further 25 created. At the end of May 1940, Orenstein became dms of the forces in East Africa – responsible for all medical services in the forthcoming campaign – and, a few months later, Smuts appointed Brigadier Sir Edward Thornton as the dgms in the Union to support him. Orenstein left on 30 June and established his headquarters in Nairobi. His staff came from the Royal Army Medical Corps (ramc), samc, and East Africa Army Medical Corps (eaamc). The headquarters would remain in Nairobi for the duration of the war; although at the end of May 1941, when Orenstein left to take up duties as dms in Cairo, an officer of the African Medical Service filled the post of dms in East Africa.

The British and Indian official histories include useful chapters on the medical operations in East Africa,⁴ but the samc – although providing most of the medical deployment and serving the Allied forces as well as the local, civilian populations – is poorly served. There are scattered references in the main narratives⁵ as well as a chapter on East Africa in the official history of the samc⁶ that rests heavily on the detailed, lengthy account of the samc compiled by Colonel Paul Anning, who ended the war as dms in Italy.⁷ Never published, Anning’s manuscript now forms part of the Union War Histories narratives and reports.⁸ These were all traditional histories of military medicine – focusing on the organisation and delivery of medical services and narrated in laudatory terms. Theirs was a tale of ‘improvement’: in sanitary conditions, in the general health of the servicemen, and of the local, African populations. These approaches, as Joanna Bourke argued, have steadily given way to bottom-up history with its focus on shell shock and dismemberment. Military medical organisations now appeared in harsher roles: of imposition and of mechanic treatment aimed at repairing the men for their rapid return to the frontlines. Senior commanders and decorated heroes – who drew and coveted the limelight – are side-lined in this ‘new medical history’ in which the ‘damaged men’ take centre stage.⁹

The purpose of this article is to examine the medical operations of the East African campaign: a campaign for which there is no recent, close examination. This apparent neglect may be due, if only partly, to the central role South Africa played in the delivery of military medical services in this war theatre and the assumption that South African scholars would fill this gap, and certainly an under-valuing generally of the medical history of the war.¹⁰ It also seeks a bottom-up view of the samc operations in East Africa, which presents certain difficulties. The documentation at the Department of Defence Archives in Pretoria is richly veined and the material collected for Anning’s projected, post-war, official medical history is particularly so. There are sheaves of correspondence between Thornton and Orenstein; interviews with medical personnel conducted by the historical recording officers; and the historical surveys all units were to compile after April 1945. The routine correspondence generated in the office of the dgms supplements this. While vast, this material is also official and, for this campaign, there are few memoirs or reflective pieces to offer an immediate, bottom-up view. And the doctor recovered – a charming, tongue-in-cheek narrative – is the only published, book-length, personal account by a South African medical officer.¹¹ There are a further eight reflective accounts published as articles in the South African Medical Journal, and a small number of unpublished accounts by medical personnel in the Union War Histories collection. To these ‘medical narratives’ might be added the accounts written by ordinary service personnel, who – although not medical staff – addressed medical matters in passing, either as patients or beneficiaries of the medical service, but for East Africa these are also few.¹² Much of the writing uses gendered and pejorative language, which is sexualised and violent.¹³ It also has an imposed Western tone and at times a heavy racial bias. This may be expected. Some had received their training in the United Kingdom or the United States or the Netherlands; most had studied at the medical schools in Cape Town or Johannesburg, which had close links to British counterpart institutions.

The pre-war South African medical establishment – both state infrastructure as well as private practice – was relatively small. Only Cape Town and Johannesburg had medical faculties, while the sa Institute for Medical Research (Johannesburg) focused on medical problems relating to public health and industrial hygiene. Close connections were maintained through the office of the sa high commissioner in London with the United Kingdom’s Department of Scientific and Industrial Research and its many activities. In some cases, a South African representative sat on the council of the scientific committees – providing a link between the British structures and their correspondents in South Africa, who received copies of their publications. Since 1926, South Africa had enjoyed representation at the Standing Conference for the Coordination of Scientific Research and through it to the British Medical Research Council. These links, bridging a range of disciplines, facilitated science and technology research across the empire and enabled institutions to develop knowledge production, advance imperial ascendency, and further claims to dominion nationhood through practice and publication. Anning, for example, had established himself during the 1930s as an expert on tropical sanitation.¹⁴ As Dubow argues, for scientists there were “opportunities for their collective advancement and individual distinction”.¹⁵

However, the medical establishment did not reflect South African society. There were few female doctors – women interested in medicine were largely forced into the nursing profession – and fewer still Black doctors. Dr R.J. Xaba studied medicine in Edinburgh during the 1920s “at a time”, he tells us, “when Bantu medical practitioners were something almost unheard of”.¹⁶ In Scotland, he met Dr Molema and one or two other Black medical students. The Faculty of Medicine at the University of the Witwatersrand – the first South African institution to do so – only opened its doors to people of colour in 1940. Bokwe notes that, by the end of 1944, “there [were] only ten registered African medical practitioners in South Africa as against some 3,000 European medical men”.¹⁷ The doctors in the samc, not unlike their counterparts in the ramc and the medical corps of the other dominions, were all White and male, and reflected the class, racial and gendered hierarchies of military life at the time.

The South African Medical Journal – published from 1884 and known until 1927 as the South African Medical Record – was a general medical journal publishing leading research influencing clinical care in Africa. It was also the South African medical profession’s mouthpiece. Soon after the outbreak of the war, the question of military service re-entered its pages. A call for volunteers to accept commissions in the samc and serve with the forces on campaign evoked a considerable debate in the journal’s pages. Medical practitioners faced a stark choice: to volunteer for full-time military service – or not. If they volunteered to serve in the armed forces, they left their practices and faced rebuilding after their return; this while their counterparts built their practices and established themselves in their communities. The samj noted the lists of men who volunteered.¹⁸ Their names are recorded – in batches, over successive issues from August 1942 – indicating the positions they would fill in the samc, their promotions, and sometimes the towns from whence they came.¹⁹ However, the call for volunteers remained divisive and the men who volunteered for part-time service in the Union faced sustained criticism.

Wartime South Africa faced a manpower crisis that would increase in severity with each passing war year.²⁰ Dr Harvey Pirie, a well-known medical practitioner, was reported in the press to have said that there were “200 doctors too few in the Union and that no more could be taken from civil practice to do military work”.²¹ All members of the medical profession had been circularised at the outbreak of war, to determine what service each was prepared to render. A general practitioner from Durban had signalled his willingness “to do anything short of actually joining the army”: he was beyond the age limit. He had not been called on – although he was serving in the sense that he was acting as a locum for doctors on service, as many of the “stay-at-homes” were doing.²² A correspondent, writing under the name “Ripa”, was more direct than most: “Doctors who take part-time appointments and don uniform are utter humbugs, and if they do not see this for themselves, it is not for us to remain blind and dumb also”.²³ These men were given military rank and status, and often senior rank and – while “willingly accepting the kudos of being on service” – made no sacrifice. These men, he argued, did injury to the profession and should have been forced to resign. The “Ripa” letter gave immediate offence. Part-time appointees were outraged.²⁴ The medical profession was determined to refrain from corroding the “good understanding that should exist between our profession and the military authorities”.²⁵

The doctors, sent to the training depot at Zonderwater, underwent a month’s military training. Dingle was among the first group; they numbered about 100. They marched, wheeled, formed fours, were socialised to the armed forces, and lost their individuality including their right to criticism – explaining perhaps the anonymity of the first pieces they wrote. “By the end of the month”, Dingle tells us jokingly, they “had practically forgotten [their] professions and were hale, hearty and healthy”.²⁶ Criticism and the rigours of military training aside, the volunteer medicos found advantage in the exposure their deployments to East Africa – and later North Africa and Italy – brought them. They encountered a greater range of injuries, including battle-related wounds and military-related trauma, as well as all kinds of tropical and other diseases. Uniquely placed to refine practice, they were soon writing from the front – from Kenya, and later Somaliland and Abyssinia. Their views not only found a readership in the pages of the samj, but the dgms sent a copy of their “Notes on Diseases in Italian East Africa and British and French Somaliland” to Premier Mine for the education of troops leaving for East Africa.²⁷ As pathologist Major Ronald Elsdon-Drew noted in December 1942, “Abyssinia presented a pathologist’s paradise of problems”.²⁸

Eight articles with a specific East Africa focus appeared in the samj between January 1941 and September 1943, when writing about the later campaigns – fought in North Africa, and later Italy – took prominence. Two anonymous articles, appearing in June and August 1941, had followed Vaughan-Williams’s unwanted advice. Their anonymity reflected perhaps a self-imposed censorship applying to both the content of what they wrote and their own identity as the authors.²⁹ Two articles written by named samc officers featured in the December issue; Capt. Willem P. Steenkamp, Jr., and Capt. J.H. Marks, who was attached to the 2^nd Zanzibar Field Ambulance, wrote of their personal impressions of the medical campaign.³⁰ Three more articles followed: on tropical surgery (November 1942);³¹ Elsdon-Drew’s Abyssinian notes (December 1942);³² and an article on tapeworm (September 1943).³³ Anning’s “Official History” and The Doctor Recovered might be added to these. But why did these medical officers take the time – during a campaign, when their medical tents and operating theatres were seldom quiet – to write these accounts. Of course, the reasons varied. The anonymous field ambulance officer offered proposals to improve medical efficiency.³⁴ Steenkamp (see Photo 1) offered practical advice for young officers joining the field ambulances.³⁵ Marks wrote “for the benefit of those unable to come”,³⁶ while Ogilvie, a British officer and consultant surgeon to the East Africa Force, explained “the surgical lessons” of his campaigns for “the general surgeon … already trained in operative technique but new to the surgery of wounds in modern warfare”.³⁷ His account, Ogilvie admits, rested inter alia on discussion with the South African and Colonial forward surgeons in the East Africa Force, and the consultant surgeons in South Africa – Colonels I.W. Brebner and F.P. Fouché – who treated all the seriously wounded from East and North Africa and furnished him with constant reports on their final results. Forward Surgery in Modern War is another product of their combined wisdom.

Steenkamp (right) operating on a casualty at a forward dressing station in Abyssinia. Steenkamp wrote a colourful yet informative account of his experince as a forward surgeon with the East Africa Force. (© wps-pa2. With permission: W.P. Steenkamp, Cape Town, 2022)

Citation: International Journal of Military History and Historiography 43, 3 (2023) ; 10.1163/24683302-bja10052

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What themes come through in this writing? “Deserts and Other Places” covers the story of a field ambulance company: which ambulance is not mentioned, but this can be deduced.³⁸ This was the first article to appear on the medical operations during the war. It outlined the troubles medical officers faced: from the “irksome formalities” of army life, happily ditched when they moved to the front, and the battles associated with untrained nursing staff and the diversity of languages in the war theatre, to the inhospitable terrain, the flies and the fleas, and the erratic army postal service.³⁹ Subsequent writers built on these themes. The most prominent are examined in the following sections.

The topography of the battlespace dictated the lines on which the medical and other services grew and functioned.

However, as the physical environment differed markedly from the East African campaign of the 1914–1918 War, there was no easy experience on which to draw. Orenstein – having battled with the misinformation and incongruities, broadcast partly by men who had been in East Africa during the First World War – chided in October 1940:

It is very difficult to convey to people in South Africa a correct idea of the terrain and conditions of the Campaign here. On the one hand, those who have only book knowledge can have but little idea of the fundamental difference between the textbook and the actual facts. On the other hand, those who had East African experience in the last War are liable to be badly misled because the conditions in this part of the world are utterly different from those which obtained in East Africa twenty-five years ago, and the experience gained then can only be of partial use for the present purposes.⁴¹

The Abyssinian highlands, the primary objective of the campaign, formed a vast, natural fortress: bounded to the north-west by the Sudan, to the north by Eritrea, to the east by Somaliland, and to the south by Kenya. The features of the physical and human environment, which affected the campaign and provided the Italians with powerful defences – the deserts, rivers, hills and mountains, roads, and climate – differed dramatically from those of the East African campaign of the previous war fought largely in tropical Tanganyika.⁴²

The main South African advance was along two primary axes from the south. Nanyuki, the staging area for the 1^st sa Division, lay on the equator at 6,000 feet above sea level and in well-wooded, grassland country. Their advance northwards took them down to the thorn-treed, Kenyan bushveld and beyond Isiolo to the deserts of the Northern Frontier District (nfd). To the north, covering the remaining 180 miles to the Abyssinian border was the Chalbi desert. The terrain, thought unfit for habitation, had few oases, visited by only “a few straggling camel caravans and herds of goats driven by vagrant Seras”.⁴³ Major “Chooks” Blamey of the Natal Mounted Rifles notes: “North Horr is an oasis on the Chalbi Desert but, like many other places to be found on the map, is a place in name only”.⁴⁴ It was sparsely populated – but for an abundance of spiders, flies and snakes – and excessively hot. The lava rock scorched skin.⁴⁵ Beyond Dukana, the South African advance entered the foothills of Abyssinia. Here was open grassland and the road north to Hobok and eventually Addis Ababa. Every advance would augment the medical and supply difficulties and expose the troops to further ailments.

The lateral routes brought their own challenges. There was the lava-stone desert to the west of Lake Rudolph; the thornveld around Moyale; the hot sand and desert scrub of Wajir, where sand temperature reached 146 degrees and was alive with tampan ticks; and the tremendous heat of the coastal plains of the three Somalilands. The Wajir district boasted a thousand wells, but, as the medical officers reported, camels fouled most wells, and the water – brackish to taste – caused a rise in urethral irritation.⁴⁶ Fords recalls that the medical personnel were forever treating men for scratches and jabs from thorns, for spider bites and scorpion stings, and veld sores. Ford never suffered from veld sores: “I always put a few drops of Dettol in shaving and washing water, also in my mug when I cleaned my teeth, using the rest of the water in the mug for gargling. My Aunt Hester invariably enclosed a small bottle of Dettol in my parcels”.⁴⁷ Then bilharzia frequented the major rivers. Clearly, baseline medical and hygiene training for the troops was essential.

Several South African doctors praised the Italians. For their roadbuilding and for their medical and veterinary services, which were of vital importance to the Allied forces as the campaign entered Abyssinia.⁴⁸ Italian scientific knowledge and medical supplies were expected to prove significant to the success of the Allied forces. A memorandum published by the East Africa Force Headquarters (eafhq) on 26 November 1940, ahead of major operations, warned of the possible diseases; it drew heavily on the work of Italian doctors – Corradetti, Lega and Raffaele, who had been active in East Africa before the war – and supplemented by government reports from British Somaliland, from the late-1930s, that corroborated their findings.⁴⁹ This dealt with malaria, influenza and tick-borne and lice-transmitted relapsing fever: the first mostly in and around the inland towns of the three Somalilands; the second largely on the Abyssinian plateau but also the cause of epidemics in the Sudan and once (1929) in British Somaliland. The eafhq staff prepared for both – they demanded different control measures. The louse-carried variant was apt to occur in epidemic form; the other more sporadic. The louse-type was easier to manage – “not that it is easy to discipline or clean up Somalis or Ethiopians”, the pamphlet reproved; the other, which persisted in the tick population, had to be burned out. Either way the control measures involved the local populations and interventions on the part of the military medical services. “Great care”, it warned, “should be used not to camp in places where this disease may be acquired and to forbid men to frequent infested coffee houses, bazaars, etc.”.⁵⁰ The pamphlet was purposefully worded and its readers were probably most concerned about the “etc.”. It certainly indicates the disdain with which many doctors also regarded the Africans. This introduces a related theme.

By 1939, modern medicine had started to move beyond the pursuit of limited effectiveness. It had become, according to James Le Fanu, “the most visible symbol of the fulfilment of the great Enlightenment Project where scientific progress would vanquish the twin perils of ignorance and disease to the benefit of all”.⁵¹ Campaigning in Africa by European troops had also changed. Science had dispelled the notions of a “White Man’s Grave” that had vexed empire builders in the previous century. They now realised that high disease rates were the result not of climate but of the disease environment and scientific medicine seemingly offered the answers. Vaccination and anti-disease treatment programmes – against lice, mosquitoes, and a variety of insects and worms of all kinds – built resistance to the diseases they caused. Some programmes pursued the eradication of parasites.⁵² Armed with new treatments and programmes, European – and South African – doctors worked with an air of scientific superiority.

The medical services were a critical element in the administration of occupied enemy territory. According to The Hague Rules, military government was a temporary regime to be replaced as soon as possible by civil administration. The administration of occupied territories became a War Office responsibility, which involved staffing the administrative machinery with military officers, who had to “make clear to disoriented populations, which had lost their government, that another one was there, at hand and ready to take its place”.⁵³ Human security was primary – people had to eat and they had to be able to buy food but civilian doctors could not be used in the warzones. As a result, the military medical services could play a vital role in establishing confidence in the new administration.

Practically all South African narrators wrote about their patients and the people they encountered: combatants and civilians, in-patients and outpatients.

7.5 million, British Somaliland at 0.4 million, and the Italian civilian population at 120,000 – the last concentrated in Addis Ababa, Mogadishu and Asmara.

In some districts of Abyssinia but also Kenya’s

, syphilis and gonorrhoea were the most frequent diseases; here advanced syphilitic ulceration and gummata were common. The quantity of anti-venereal treatments captured later suggested that venereal diseases (

 s) had been a major problem to the Italians.

There were also hookworm and Guinea-worm infections in Somaliland and Abyssinia; tapeworm and roundworm infections in the

; and trachoma from the coast to Addis. Orenstein, making a case for more personnel in October 1940, noted:

In order to safeguard the health of the troops stationed in and near large centres of population, we have found it necessary in effect to play a major role in the hygiene of such communities. This means that we have to provide personnel.⁵⁶

An air of superiority, of a peculiarly British nature, therefore pervades, which rests on notions of Western scientific superiority and of the benefits, specifically British science could bring. Anning records that some Abyssinian communities outside the Italian medical service developed an unsophisticated form of vaccination against smallpox: “pus is taken from a pock, kept in mud for some days, and then rubbed into cuts on the body”.⁵⁷ While they mused at local African medical practice, some also denigrated French practice in the Somalilands. According to the eafhq’s “Notes on Diseases”: “French Somaliland appears to be like those happy countries which have no history; if one were to judge from what has been recorded it has no diseases, pests or medical problems”.⁵⁸ In this view, the British Empire was a vast developmental agency: bringing in this case medical relief and the benefits of medical science to “the darkest corners of the continent”.⁵⁹ In a very real sense, the war theatre became a large laboratory in which the military doctors could conduct clinical trials on 10 million potential subjects in a war-torn region disrupted societally and ecologically by the combatants London, Rome, and Pretoria imposed on the landscape.⁶⁰

The samc rendered medical services to Allied soldiers, Italian prisoners of war (pow s), and the local civilian populations. They described the local African populations in broad, colonial ethnographic terms. One doctor addressed the questions of language and religion: “attending our hospital natives [sic.] derived from almost every part of Africa, speaking no less than 30 different languages, and worshipping at least three different gods that necessitated their consuming three different kinds of food. There were no interpreters for a considerable time, and not one black man in 100 could speak any European language”.⁶¹ Kiswahili although spoken by many became the situational means of communication. Alongside them were the European outpatients: some came from training camps where sick parades started at 7am each morning, some were Italian civilians, and some were pow s they treated and evacuated. A captured Italian pilot treated in an Allied hospital for 75 days, recounts that “not once did [he] think that [he] was a prisoner”.⁶²

The state of the Italian medical services. An Italian cartoon dated 1941 depicting a rather grisly scene in an Italian surgical hospital at Addis Ababa. The artist, E. Natoli, has inserted himself into the scene. Allied medical officers thought much more of Italian medical practice than Natoli would suggest. Note the racial and gender stereotypes of the Italian figures as well as of the severed body parts. (© Private collection, I.J. van der Waag)

Citation: International Journal of Military History and Historiography 43, 3 (2023) ; 10.1163/24683302-bja10052

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Steenkamp – who had graduated from the medical faculty at the University of Louisville, Kentucky and qualified as a physician at the University of Leiden before becoming a Fellow of the American College of Surgeons⁶³ – discussed the nature and scope of the Italian medical services in greatest detail. He did so largely in laudatory terms, although he stresses the differences with British, and therefore also South African, practice. These descriptions after all had the practical value he stressed. After 1935, the Italians had built infrastructure – roads, hospitals, medical and veterinary services – to consolidate their hold on Ethiopia and built creditable medical facilities for their large garrisons. They had built hospitals totalling eight thousand beds and smaller sickbays (“ambulatoria”) attached to the scattered forts and police posts, which they kept well stocked with drugs and other medical supplies – even the smallest medical outposts were all equipped with the most elaborate sets of instruments. Steenkamp remarked on the prominence of ampoules on the Italian drug schedules. samc personnel joked: “that castor oil seemed to be the only drug that was not administered hypodermically by them”.⁶⁴ There were glucose and saline ampoules, large quantities of vaccines and sera, stocks of strychnine and camphor oil – older styles of heart stimulant, but still in vogue in Italy – and vast quantities of quinine, and morphine. The large supplies of vd drugs told their own story. Steenkamp also noted that, contrary to British and South African military practice, most Italian pills – quinine included – were sugar coated, which reduced their absorbability and therefore their effectiveness. When they captured large quantities of British manufactured drugs – taken by the Italians from British Somaliland – it was “like meeting an old friend amongst a crowd of strangers”.⁶⁵ However, under the circumstances, he argued, the Italians deserved credit for what they accomplished.

Steenkamp was more sceptical of Italian surgery (see Photo 2). They avoided general anaesthetic whenever possible and were thought to tie patients down to the operating table before administering local sedation. In this, he thought them “continental in their outlook”. One Italian pow recorded how he resisted the chloroform mask when operated on by Allied medical staff.⁶⁶ Their brand of Novocain he thought also inferior to the South African equivalent and their standard of surgery, while good, was generally conservative. The Italian doctors treated abdominal gunshot wounds expectantly – treating complications as they arose; administered glucose and saline routinely in all cases, not from a continuous drip but in one sitting; and used cotton gloves, then considered old-fashioned. In contrast, their ambulances were elaborate, with chrome fittings, accommodating four stretchers, and having a cupboard and washbasin, although they were less robust than the smaller, “rough-and-ready”, veld-type South African models.

South African doctors mostly enjoyed good interpersonal relations with their Italian counterparts. Where possible, they left Italian doctors to care for Italian pow s and left the arrangements in civilian hospitals undisturbed. When needed, they easily negotiated space for South African and allied wounded after “mutual discussion”. Steenkamp recounts that recaptured Allied pow s found in Italian hospitals were “all unanimous in lauding the treatment they had received”.⁶⁷ Joining Steenkamp, other doctors praised the Italian doctors they encountered and the standard of their work. Some they mentioned by name – such as the Professor Ribandi at the Italian military hospital at Dessie.

The troops, in their letters and memoirs, thought differently of the wider environment. Water resources were contaminated and the human settlements unsanitary. The troops improvised; as Allan McDonald noted: “To have a bath when one hasn’t a paraffin tin requires only a groundsheet. You dig a hole in the ground and spread your groundsheet over it. Pour in your water and ‘Hullo’ – ‘Ain’t nature Grand?’!!”⁶⁸ Clifford Portsmouth of Natal Carbineers noted the condition of Addis Ababa where “the gutters of the street [were] filled with filth”.⁶⁹ Blamey referred to “the filthy habits of the enemy who had no idea whatsoever of the fundamentals of military hygiene”.⁷⁰ Others referred to the local population, often in racialized terms. Orenstein realised that he would have to manage hygiene matters differently. In the first instance, the samc, focussed on the health of troops, would have to play a major role in the hygiene of the communities where these troops were based. By October 1940, in Nairobi – where the medical services were “virtually doing the bulk of the anti-malaria work” – malaria, which had been very prevalent, was reduced to negligible proportions. But he needed more hygiene personnel especially for such general work. Rather than attachment to specific battalions, he created a pool of hygiene personnel that could supervise sanitary conditions in the towns and military camps – necessarily dispersed to reduce the dangers of aerial bombardment – and work systematically in eradicating pests and improving living conditions.⁷¹ “Here again”, he cautioned Thornton, “practice upsets book theory.”⁷²

“The Medical Headquarters staff”, as Neil Orpen noted, “consisted of British, Colonial and South African officers and other ranks”, but his contention that “there was never even a hint of friction throughout the campaign” was manifestly untrue.⁷³ Senior South African medical officers, including Colonel Blair-Hook, remarked – sometimes casually, but also officially – that “the vast bulk of the military forces in this country is from South Africa, and that the South Africans at the same time play a very minor role in the higher appointments, and that South Africa does not have its voice here as much as it should under these circumstances?”⁷⁴ Astonished, Orenstein raised the matter with his principals at Defence Headquarters. In overall numbers, South Africa provided one soldier in four; and, in the medical establishment, about the same ratio held true. The high command was different. As he argued, “the first consideration [was] capability and experience” and South Africa did not have the cadre of fully trained medical specialists Britain had. The idea, he felt, was caused by “the ballyhoo which has been raised in connection with recruiting”.⁷⁵ That senior officers, knowing better, broadcast such views was troublesome.

Nevertheless, Orpen was correct in another sense; Orenstein, on arrival in Nairobi, had found that assistance – “immediate and on a large scale” – would have to come from South Africa “before any active campaign could be undertaken”.⁷⁶ In a preliminary survey dated 6 June 1940, Orenstein identified the numbers and the range of medical units that would be required in East Africa. These are shown in the first column of table 1. No less than twenty-one of the thirty-eight units, including two of the five general hospitals, would have to come from South Africa. The units available as at 31 December 1940 – in time for the January push, and to serve 11(African)Division, 12(African)Division, 1(sa)Division, and the lines of communication troops – are shown in the second column of table 1. In addition, several units came on strength later.⁷⁷ Moreover, each squadron of the saaf had one regimental medical officer (rmo), each battalion of the three South African brigades had two rmo s, and each battalion of the East African brigades had one rmo.⁷⁸

The priority for the medical staff was military efficiency. Anning noted in his post-war history: “The main task of the medical organisation, bearing in mind the heavy sickness rate among udf [South Africa’s Union Defence Force] troops in East Africa in 1916–1917, was to keep the troops in the field in a tropical country.”⁷⁹ Some ‘lessons’ were flagged from the previous war. They presumed correctly that the numbers of battle casualties would be low, and that special attention would have to be given to the hygiene organisation. Hygiene personnel, including one samc hygiene officer, were attached to each South African battalion and brigade headquarters, and a hygiene demonstration park and training centre was established near Nairobi in November 1940, where staff of the samc and eaamc gave instruction in hygiene matters to personnel from the whole of the East African Force.⁸⁰

As Barton Keep predicted, transport difficulties would mark the whole campaign and affect the provision of medical services. These stretched from the regimental aid posts (rap s) in the forward areas to the field ambulances and casualty clearing stations (ccs s), to the base hospitals. The rap s were associated with their respective regiments, while the field ambulances moved with the Divisions and the casualty clearing stations moved by Force as rapidly as possible in the rear of the advance. The field ambulances and casualty clearing stations provided all forward treatment, which they effected in most cases to completion: all sick and lightly wounded re-joined their units directly.⁸¹ Sited at Mombasa and at Gilgil, the two ccs s functioned as 200-bed, stationary hospitals, while the four general hospitals – remaining at their original sites throughout the campaign – cared for the local sick, serious battle casualties, and some less serious casualties evacuated from ccs s during the initial 1941 advance. Although the War Office required beds in general hospitals for 10 per cent of the force engaged in tropical campaigns, in East Africa less than half this number was provided for and no general hospital worked to capacity. Hospital ships evacuated udf and British troops to Durban, while they treated all African patients in East Africa and opened a Convalescent Depot for Africans on 1 April 1941 at Ndurugu.⁸²

The South African field ambulances, of which there were four, were organised to meet the challenges posed by the climate and terrain. A conference convened by Orenstein in November 1939 – medical officers of the previous East African campaign were present – identified the fundamentals for the re-organisation. They set aside the system of rap s, advanced dressing stations (ads s), main dressing stations (mds s), ccs s, and base hospitals, which had worked so admirably on the Western Front where only a few kilometres separated medical units. In East Africa, where the spaces were larger and the war more mobile, the distances between ads s and mds s would be more than 50 kilometres, and between mds s and ccs s several hundreds of kilometres. The new system they developed had to cater for South Africa’s approach to warfare in Africa: different regiments and battalions operating concurrently, moving and fighting, on several wide mobile fronts.⁸³ As a result, each field ambulance had to serve more than one front simultaneously and provide care for South African troops and enemy casualties as well as a growing number of pow s. The companies of each field ambulance were organised to operate apart from each other “as a practically independent show”⁸⁴ – each equipped to deal with almost any medical procedure. The doctors worked on extended lines of communication and in relative isolation. “A” and “B” companies, each sub-divided into the usual ads s, was positioned with a light section immediately behind the front line. There they kept cases until evacuation to the mds – the hq Company of the Field Ambulance – was possible; again, cases remained at the mds until further evacuation to the ccs, which might be hundreds of kilometres away, was possible. The long distances, poor roads and roadblocks, and insurgent activity halted any rapid evacuation of serious cases. The “salvage” of enemy equipment allowed 12 Field Ambulance’s hq Company to equip two operating theatres at the mds, where the surgeon [Steenkamp] “could walk from one theatre to the second and while working there, the first theatre could be prepared again for the next cases”.⁸⁵ In this way, each field ambulance developed into three light, very mobile, casualty clearing stations, where patients could be hospitalised effectively until evacuation was safe. The system worked well. Almost without exception, Steenkamp records, the South African wounded received attention within six hours, which was then the ideal in treating battle casualties. The Italian wounded were less fortunate; Allied troops conveyed many to South African medical units after discovery on the battlefield.

Another recurrent theme is medical personnel and administration, and the nature and work of their staff – medical orderlies, drivers, storekeepers, and stretcher-bearers. Patriotism and the sense of taking part in large events, the promise of fun and enjoyment, as well as the opportunity to relish comradeship, and a range of personal reasons, animated medical practitioners to volunteer for military service – as they did for all South African service personnel.⁸⁶ Some continued a tradition of family service. Captain Hylda Briscoe was a volunteer nurse in 1940. Her brother, a pilot officer in the Royal Flying Corps, had been killed on the Western Front in 1918, while their father, a medical officer, had served in the Anglo-Boer War, then the Zulu Rebellion, and, wounded twice, won an mc in German South West Africa and then a dso in Tanganyika during the First World War.⁸⁷ Such generational linkages were common throughout the South African forces and indeed of the Commonwealth. Yet, a shortage of medical practitioners volunteering to serve in uniform remained. At the field ambulances, many doctors, who were not qualified surgeons, operated on patients. Blamey recounts that, after the Battle of Dadaba, with the Italian doctors “badly shot up”, Jack Freeman assisted the South African mo – “not exactly a pleasant job, especially for a layman”.⁸⁸ While each field ambulance company was equipped for surgery, not all companies had a registered surgeon – most were attached to the ccs s and base hospitals. As a result, general practitioners practised surgery, and most did excellent work and gained valuable experience under trying conditions. Later the samc would establish the mobile field surgical units – each with a specialist surgeon – that proved of such value in Italy where they could keep up with rapidly moving forces in smaller, tighter spaces.⁸⁹

Recruitment received sustained criticism the volume of which had “become astonishing”. Thornton found it “rather hard carrying on under this intensive bombardment”.⁹⁰ There were complaints about the men in the camps – there were nearly 3,000 cases of illnesses among the troops in the Union at the end of July 1940;⁹¹ of the death of a cadet named Butcher at Roberts Heights; that the men at Medical Directorate were too old – others complained they were too young; that insufficient men had been called up, others complained that the countryside, hospitals and universities were steadily denuded of doctors. In the meantime, Thornton and his staff were employed in mobilising medical units and transferring them to “the North”, while battling to wrest vehicles, equipment and stores from “Q”. He jokingly told Orenstein on 28 July 1940 that: “sometimes I feel like telling them all to go to blazes and appointing myself as mo to the Caprivi Strip, … it is a bit hard having to fight the Germans and one’s own critics too”.⁹²

Thornton tried to surmount the personnel problem in several ways. Recruits came in very slowly. They were so short of medical officers that Thornton considered drawing some experienced officers from Orenstein’s staff in East Africa to form a nucleus for the field units of the 3^rd Division then being formed.⁹³ More doctors and nurses were needed. Well-known medical practitioner, Harvey Pirie aired his “definite impression that we are getting right to the bottom of the pool of men available”.⁹⁴ This did not help. Nurses, male and female, were enlisted from the South African Red Cross – the ad s (men) were first to go and entered with the samc, followed by the vad s (women) who enlisted with the South African Military Nursing Service (samns) – all of whom already had certified training.⁹⁵ Nurses might be acquired from Britain and older, married women might be recruited in South Africa, but doctors presented greater difficulty. Blair-Hook created a programme to recruit medical students from the universities of Cape Town and Johannesburg, but this encountered a range of problems: few aspirant doctors were willing to set a year aside to “gain experience” as orderlies. Twenty-nine volunteered but in some cases their parents objected. The programme was cancelled at the start of 1941 as the ordinary recruitment campaign intensified. Thornton attempted to convince the cgs that “the lads” would learn something of value and have future benefit, but Orenstein was less sanguine.⁹⁶ On the other hand, economic concerns troubled the employment of nurses. The recruitment of women in Kenya to serve as nurses with South African units meant a different uniform and better pay – a disparity that would cause much unhappiness. The first nursing contingent arrived in Mombasa in July 1940: earmarked for Nos 5 and 6 ccs and No 4 General hospital.⁹⁷ The first female clerks and typists arrived in August 1940; they arrived as privates in the Women’s Auxiliary Army Service and Orenstein arranged their ranks and promotions when they arrived in East Africa.⁹⁸

Several doctors commented on the quality of their staff. In one field-ambulance company, there were only two men actually qualified in nursing. One was a sergeant major whose work as a quartermaster monopolised his time and the other was a corporal “upon whom rested the burden of instructing the followers of many diverse callings in the art of nursing”.

The medical orderlies were of mixed provenance and many had no knowledge or interest in nursing. As one medical officer noted:

Our ‘other ranks’, until recently consisting of clerks, journalists, commercial travellers, miners, salesmen, plumbers, shopkeepers and followers of almost every occupation but nursing, found themselves called upon to minister to the sick.¹⁰⁰

One private confided to his officer:

I made a mistake by joining a medical unit. … I do not like the work. This nursing gets me down. Carrying pans and bottles is not my idea of nice work, and I can assure you that if I was offered £5 per day as a civilian, I would not take it on. … I have been put on fatigues since last Tuesday, and I hope this lasts, as I should prefer anything to nursing. I should have joined the M.T. or infantry. The only reason I did not do so was that I thought I would not be fit enough.¹⁰¹

Here lay the complaint – the persisting shortage of qualified, interested staff. We cannot know how many men were discontent, or bored, with nursing but the medical officers suggest this may have been widespread and the call came to appoint only men interested in nursing or, alternatively, use African personnel to fill out the shortages. One field ambulance officer argued that Africans, some of whom had worked in nursing roles in the hospitals of mine compounds, would make good the shortfall as long they worked under a “European nco” and that “provided that suitable propaganda were used to convince the men that natives [sic.] were being employed as nurses to liberate white men for combatant duties, and that the natives [sic.] were properly trained”.¹⁰²

Appropriate training for medical personnel was another concern. Warrant officers and senior

  s in the

, while expert at drill, had little knowledge of first aid or nursing. One field ambulance officer recounted a case where an

staff sergeant in charge of the reception tent at an Indian Mounted Transport camp, was able to clean or dress a septic wound. Most of the

’s

 s knew little of first aid or nursing: few learned this before volunteering. Medical officers – noting the absence of medical subjects – lamented the emphasis placed on the disciplinary side of training. A field ambulance officer:

I spent six months at Sonderwater [Zonderwater] drilling, saluting, attending formal dinners, mounting guards, and dressing and behaving as becomes an officer, without performing 72 hours of useful work that would in any way have assisted the health of the troops. The ultimate effect of all this military ‘kultur’ is to encourage at least some medical officers to believe in it. Some mo s come to take as great a pride in the smartness of their men as in their capacity to render efficient first-aid.¹⁰³

Much more might have been done at the samc depot at Zonderwater, where the men spent a considerable period before deployment. Several doctors wrote that this time would have been better spent on in the training and examination of medical subjects – rather than dissipated on parade-ground drill. As a result, the time spent at Zonderwater “was depressing and monotonous”.¹⁰⁴ The argument was not that first-aid and nursing had not been encouraged in some units, but rather that much more attention should have been paid to medical training. The nurses worked hard, but perhaps many, although having little interest in nursing, had to remain in these roles in the samc.

Promotion policy worsened the shortages of medically trained nco s. In most medical units, nursing orderlies held the rank of corporal – at most sergeant – and if promoted above that they had to “leave the wards for the parade ground, quartermaster’s store, or hygiene personnel”.¹⁰⁵ The medical officers in East Africa argued that senior nco s promoted to warrant officer be retained for the teaching of first aid and nursing and to foster enthusiasm for these disciplines amongst the new, junior nco s. In this way, they argued, the warrant officers and senior nco s in the samc might play a more vital role in winning the war in East Africa.

Stricter selection of medical personnel – particularly for East Africa – complicated recruitment. While there was a shortage of trained orderlies, Orenstein professed to rather do without than have men who would embarrass him. However, Pretoria’s proposal to use personnel from the Non-European Army Service (neas)¹⁰⁶ as stretcher-bearers was immediately political. Some at Barton Keep thought the neas would make poor bearers: while they worked well in a “herd”, they would be unwilling to venture in ones and twos to collect wounded under fire. Others were concerned that the white troops would lose confidence in the medical arrangements. They felt that European supervision of black and coloured bearers would make little difference and that at best they might be used for long-distance hand-porterage only – as had happened in the East Africa campaign of 1916–1918. But this was considered very unlikely.¹⁰⁷ The grim realities of the war shook these racial notions. Men of the neas performed meritoriously as stretcher-bearers in North Africa and Italy and in the forward areas.

By all accounts, the doctors enjoyed their deployments to the battlefronts. Despite the flies and the intense heat, some came to like the desert. Here they could create their own encampments – with boma, medical facilities, and campfire – and, as one explained, escape “the irksome formalities that unhappily constitute so prominent a part in army life”.¹⁰⁸ When in a beautiful location, they had only two concerns: the fleas and flies and the irregularity of their post. For Dingle, who tells his story in charming form, this was all reminiscent of a Scouting adventure – of a robust, outdoors masculinity.

At first, Dingle found his medical duties light in comparison to his military tasks. At Garissa, he was also chief censor, secretary of the officers’ mess, welfare officer, and “chief buyer for our battery”. The last job took him regularly to Nairobi, some 250 miles distant, where he “satisfied the purchasing wishes of a hundred men, bought the unit’s liquor and cigarettes, and brought back luxuries such as soap and toothpaste”. He also returned “with a summary of the

news”.

His regimental aid post served as his personal sleeping quarters, the storeroom for his medical supplies, and as his medical inspection room. The structure he tells us:

was woven from cocoa-nut leaves by friendly [locals], and snuggled against a large mango tree. It crawled with ants of different dimensions and various colours, but afforded necessary shelter from the scorching sun and heavy dew.¹¹⁰

Dingle was the only mo in the area and the line of men, gathered each day at his quarters, was long, although – at this stage, with long days of inactivity – few were ever actually ill. Most arrived to speak to the other men there for the same reason.

For the most, the medical staffs and their patients lived on dry rations. Fresh vegetables collected from the towns, sometimes more than 150 km distant, meant that little survived the journey. Sometimes local farmers or district officers provided sheep – or game poached – for fresh meat. Blamey recounts that parties went out to shoot for the pot. Game was plentiful, but when inspected, something the medical officer insisted on, was often found to be worn-infested and dangerous for human consumption because of the dreaded hookworm.¹¹¹ Slaughtered daily, the local medical officer inspected the meat and pronounced on its suitability.¹¹² Dingle, when at Bura, was called on to pronounce on the fitness-for-consumption of a slaughtered ox: he “passed him first class amid cheers and handshakes”.¹¹³

The troubles did not abate. Britain’s request that South Africa increase space to six thousand acute hospital beds and two thousand convalescent beds for troops from the Middle East increased pressure. The dgms investigated the possibility of recruiting American staff as well as reducing the number of medical officers per battalion from two to one, which was the Imperial establishment. While some medical men looked upon their work in the Union as a nuisance, having their eyes “fixed north”, there were also those wanting to benefit from the enormous explosion of hospital services in South Africa and the concomitant chance for rapid promotion¹¹⁴ Mark Cole-Rous, a surgeon attached to 6 ccs in Mombasa, was bored and with nothing to do played golf.¹¹⁵ Such doctors felt that their skills were wasted. Others, working hard under combat conditions, were dissatisfied with the promotion-hungry ‘base wallahs’.¹¹⁶ South Africa was short of medical personnel, had trouble in completing its medical establishments in East Africa, and concurrently staff the hospitals opened in South Africa at London’s request for British troops. The gradual arrival of ramc reinforcements from Britain eased the position and before the end of 1942 South Africa withdrew her medical commitments from East Africa.

Distances, terrain, and poor-quality vehicles presented the medical staffs in East Africa with unique challenges not satisfied by the existing war establishment tables. Experience forced Orenstein to revise these tables for field ambulances and other medical units. Unnecessary stores were being sent north while essential items were missing. As Orenstein noted: “in the case of No.3 General Hospital we have got tons of equipment which is of no use whatever to us; although it might have been quite useful in the Crimean War!”¹¹⁷ There were steel wedges, presumably for splitting wood, and wooden iceboxes but there was no ice to be had anywhere near hospitals, while picket stakes and ropes for horse lines arrived with No.4 General Hospital.¹¹⁸ Instead, Orenstein compiled a list of essential items, including proper beds, an ice-making plant and refrigerators, and good sets of carpentry tools. The stores for a general hospital were “somewhat formidable” but supplies, if modernised, could be simplified. However, they would not overcome some deficiencies, such as the timely, accurate provision of medicines and the battles with “Q” and “T” continued. The 12^th Field Ambulance’s historian records that the “tools – mark you – not instruments” used by three nco s, who had been embalmers by trade, for an autopsy in a forward area, included “a cross-cut saw and a screwdriver”.¹¹⁹ The author leaves the reader to wonder whether he used fact or hyperbole.¹²⁰

The scarcity of drugs and surgical equipment remained a concern. As Thornton admitted: “The weak spot in our show is the Medical Stores.”

Severe losses in Greece including 3,000 beds and medical equipment, a flu epidemic in South Africa, and the opening of new hospitals and convalescent centres in Egypt and South Africa placed additional pressures on the medical stores in East Africa.

In April 1941, a pharmacist at a

ordered 120 items – many common and essential drugs including aspirin and magnesium sulphate. Of the 120, no less than 85 were “inabilities”. While some of the common drugs could be procured locally, others were unobtainable by some units at least for lengthy periods. Moreover, medical officers were not informed of the reasons for the shortages.

The

hoped that as the Italians withdrew, Italian medical supplies – known to be ample – would fall into their hands. Large quantities of medical supplies were captured at El Wak.

And Dingle tells us he left Mogadishu with “sufficient medical stores to satisfy my needs for several months”.

Sometimes, as Steenkamp vividly recounts, the Ethiopian populace looted and destroyed before the Allies could move forward. At Harrar:

we witnessed the looting of an Italian advanced depot of medical supplies. It was a big barn with walls 40 ft. high, and measured approximately 100 x 200 ft. It was stacked to the roof with cases of ampoules of all kinds, various drugs and dressings, while big jars of ointments and gallon bottles of stock mixtures were stacked on racks. When we arrived on the scene, there were hundreds of [locals] smashing the bottles, breaking open packing-cases and scattering their contents. On the outskirts of the crowd, the children were amusing themselves by playing with balloons, made of inflated caputs Anglaises [condoms], of which boxes, each containing a gross, were very much in evidence – these being the ration issue to Italian soldiers. After the crowd had dispersed and a guard posted over what was left, one walked ankle-deep through boxes of ampoules and each step was followed by miniature explosions caused by crunched ampoules, while one’s boots were coated by a muddy paste of ointments and powders from the floors covered by the mixed contents of jars and cases.¹²⁶

Captured medical supplies undoubtedly saved many Allied lives. This applied to drugs – including glucose and saline for intravenous use – as well as plaster of Paris. The latter, although of inferior quality, was increasingly used when the Allied supplies could not keep up with the advance. That the Italians did not use elasto-adhesive strapping was most annoying especially when Allied supplies were low.¹²⁷

The South African Red Cross Society filled part of the breach. They provided fresh vegetables for the hospitals, books and magazines for the wards, and specially designed field ambulances and mobile laboratories, while their Durban Branch served the transports and hospital ships including the Amra, which they provisioned for each trip. The mobile laboratories, equipped for diagnosis and treatment, could move immediately to the site of any disease outbreak, while two mobile refrigeration units transported drugs, blood plasma and other vital supplies to forward medical units. Yet the greatest gift from the Red Cross was possibly an air ambulance that could transport up to 24 stretcher and sitting cases with equipment and personnel.¹²⁸

The terrain and disposition of the companies of a field ambulance, meant that each company – sometimes separated from each other by hundreds of kilometres – had to function as a small ccs. Each ought to have had a portable x-ray machine for “the early diagnosis and treatment of fractures, the diagnosis of bone and joint conditions, and the location of foreign bodies”.¹²⁹ However, this requirement seemed extravagant. Powerful x-ray units could only be used in Nairobi, where there was suitable electricity supply. Smaller, portable units might be used. But the age group of the military patient in East Africa meant that intestinal work was rare – perhaps more psychological than pathological – and any cases demanding x-ray diagnosis were sent to Nairobi.¹³⁰

By the end of July 1941, the medical services in East Arica provided for 135,000 troops in addition to a growing number of Italian pow s – the number reached 70,000 in that month – and the local civilian populations. In 1941, the medical services provided 1,400 beds for pow s, who were moved to the coast as soon as possible for their own protection. The port of Berbera offered the shortest route. pow s found the medical inspection unpleasant and the hygiene measures humiliating. Between 25 July 1941 and 30 September 1941, the medical service treated 11,500 pow s at the disinfestation centre at Chamgamwe alone. Here the men were deloused and cleansed, treated for any ailments, and their clothing laundered. Notwithstanding the unpleasantness: “Many a doctor received cordial invitations to accept hospitality in Italy after the war.”¹³¹

The doctors naturally wrote about illnesses, the nature of the casualties, and the development of medical procedures. As an anonymous medical officer confirmed, “battle casualties were rare”; the most common diseases suffered by their African patients were dysentery, malaria and venereal diseases, while “among the Europeans the ordinary everyday conditions of general practice”.¹³² The computation of returns of admissions to medical units was difficult during the war and equally so after. However, Anning and other narrators provided returns that indicate admission rates, in broad terms at least, as well as the most frequent causes for hospitalisation. The South African admissions rate contrasted very favourably with theatre for the East Africa campaign of 1916–1918; the sickness rate per thousand troops per annum declined from 2,243 admissions (1916–1918) to less than 850 admissions (1940–1941). Table 2 shows that the admission rates also varied quite considerably by force, race, and area of deployment. South African troops generally had a lower admissions rate: members of the neas were admitted at the lowest rate (773 per 1,000 troops per annum for 1^st Division) and this rose to 2,155 per 1,000 for the East African Brigade, which served under the command of the 1^st sa Division and suffered heavily from dysentery.¹³³

South African troops – although many had been urban youths – were “fresh and keen”. They were not only the fittest drafts to join the udf during the war, but everyone was a volunteer and, their mood buoyed by the rapidity of the advances, managed to overcome most of their personal infirmities. Sick reporting only rose after Addis Ababa was entered. Table 3 shows the most frequent causes for hospital admission. While the sickness rate was low, two major preventable diseases – malaria and the acute bowel infections – were prominent. Springbok troops had been at first too casual regarding the anti-malarial measures. As Anning noted, the malarial numbers were also an indication of unit discipline. Gunner Ford records that: “At the evening and main meal of the day, a medic stood at the head of the queue with a supply of quinine tablets. Each man could only collect his food after swallowing a tablet.”¹³⁴ However, despite the precautions, the men went down with malaria. Dingle notes:

At first it seemed strange seeing them shiver with cold, and trying to cover themselves with all available blankets for warmth when it was so intensely hot, with temperatures of one-hundred-and-ten to one-hundred-and-fifteen in the shade. I treated the vast majority in camp for base hospitals were two-hundred-and-fifty miles away. Evacuating a patient all that way often meant waiting weeks for his return, with consequent loss of stability in the carefully trained gun team.¹³⁵

While malaria was common in parts of East Africa, Italian Somaliland and Abyssinia, most of the infections may have occurred among non-Divisional troops infected along the lines of communication. However, the rate of 215 and 292 per thousand troops per annum among South African troops in East Africa was dangerously high.

The most common group of diseases affecting the Allied forces was gastrointestinal. The same nexus existed between the incidence of the acute bowel infections – caused by dirt and carelessness – and camp and kitchen discipline. Low sanitary standards compromised the health of troops in some camps and Orenstein had cause to admonish senior officers, who “seemed to find it impossible to enforce sanitary discipline or to get their troops to realise their responsibilities in this matter” – including the digging of latrines in appropriate areas, the combat of fly-breeding, and the control and purification of water resources. Enteritis and dysentery occurred at alarming rates. Specimens were sent to the mobile laboratories. The 1^st Transvaal Scottish suffered two outbreaks; the pathologists found that four of the 27 regimental cooks were dysentery carriers. Acute bowel infections were the most frequent cause of incapacity in the forward areas, especially after, Anning recorded, “the occupation by our troops of insanitary area evacuated by an enemy who had little of the appreciation of sanitation”.¹³⁶

Of all conditions, doctors wrote about venereal diseases at greatest length. Venereal diseases, while a regional problem, were particularly severe in Kenya’s nfd where syphilis and gonorrhoea were rampant. The admission rate for venereal disease was highest among African troops. As shown in table 3, the admission rate per thousand South African troops in East Africa during 1941 was as follows: 25 per thousand per annum for “Europeans” and 82 per thousand per annum for “Non-Europeans”.¹³⁷ There were 1,073 venereal cases among udf troops in 1941: 170 due to syphilis, 376 to gonorrhoea, and 527 to soft sore infections or other venereal diseases.¹³⁸

Dingle suggests that most cases of

were contracted in the towns. After months in the bush, short of water for washing and plated food, the troops entered Mogadishu. The local brothel was one of the main attractions. Controlled by the military authorities and inspected regularly by medical officers, it had existed for some years. Dingle described its working: “Twenty-two cubicles fringed three sides of a neat rectangular lawn which provided comfortable chairs for easy repose … Each cubicle had a long, very slowly moving queue of participants. A door would open, a gowned figure smile, and the queue would become shorter by one.”

A veteran recalled:

When you came out of the desert, oh boy! The army established and ran brothels of Italian women. The military saw that hygiene standards were maintained. This was in Asmara. In Addis Ababa, the going rate was 5/- for one poke. There were briefings on vd – the army called for abstinence. If you contracted a vd, you were isolated immediately. In Alexandria, there was a vd hospital for the Australians. South Africans went to the sa General Hospital. Stuck in the desert for bloody months on end, the guys would come back from leave with all kind of rubbish.¹⁴⁰

Control of vd especially among African troops was one of the seven improvements suggested by the anonymous field ambulance officer. Prevalent before the war, by 1940, vd s reached serious proportions, especially among East African troops. However, as a field ambulance officer noted, until a policy change in mid-1941, “no serious attempt was made on a large scale to reduce the incidence of these venereal diseases, by propaganda, prophylaxis, efficient treatment, or in any other way”.¹⁴¹ Hospitals were too few and only complicated cases, requiring bed treatment, were admitted. Ordinary gonorrhoea and chancroid cases were treated as outpatients, while the scarcity of drugs and equipment for irrigative treatment meant that doctors could give only palliative treatment in most cases, which was of little value. While the end of the Abyssinian campaign did not solve the vd problem – the troops deployed to other parts of Africa and the problem resurfaced – the medical officers expressed the hope that the authorities there would tackle the venereal epidemic with more seriousness than had been the case in East Africa before July 1941. Quite probably, troops carried vd with them from East Africa to Cairo and Alexandria, and the Western Desert.¹⁴²

For much of the East African campaign, doctors relied on sulphonamide drugs – the default for std s. As shown in table 4, before the arrival of penicillin, large numbers of troops were hors de combat for relatively long periods. Penicillin shortened the treatment for syphilis from 40 – 50 days to just eight days. It cleared gonorrhoea in 1 – 2 days.¹⁴⁴ But of course other steps were deemed necessary.

African urban areas, eating-houses, and tearooms run by Africans were declared out of bounds to troops. All men showing any symptoms had to report immediately – within 12 hours – to a medical officer. Troops were not permitted to visit civilian practitioners for treatment; this was viewed as concealment and an aggravation of the offence. Troops concealing their condition were disciplined under Section 11 of the Military Discipline Code. The warnings and punishments were repeated in unit orders, read to units on parade every three months, and a lecture programme instituted every two months by the local doctor. Moreover, “promiscuous women” were controlled and the rank and file inspected monthly.¹⁴⁵ In addition, the Red Cross gave lectures and presented films, and produced leaflets and posters for civilian and military consumption. The first, full-length Red Cross film was produced and shown from February 1940. Aimed at the neas, this film – called The Two Brothers – also went to East Africa, where it was widely used in camps “to warn native [sic] troops against the physical perils of promiscuous living”.¹⁴⁶ Notwithstanding, the vd rate soared in the Middle East after 1941 – amongst black and white troops.

In sum, during the East African campaign, for every single South African battle casualty there were at least 40 casualties due to preventable conditions. In the absence of ready reinforcements, had the Italian opposition been more resolute, the South African armed forces would have been further “crippled from loss of manpower”.¹⁴⁷

Environmental conditions are prominent in the writing. As one soldier announced to his former headmaster, this was “the land of sand, sun, scorpions, spiders and Springboks”.

Garissa, according to Dingle, was “an area of virgin bush”: “There was no town, no building, or any other sign of civilization.”

But they did have an abundance of wild game – so fresh meat presented no difficulty. However, it was sited in “one of the most notorious malarial belts in Africa”: “The nights swarmed with huge blood-thirsty mosquitoes, so I issued regular doses of quinine and saw to it that our mosquito nets were so adequate that they were early suffocating in their efficiency.”

The value of an entomological section had been immediately apparent. But there were other concerns: contact with rats and lice, spider and snake bites, scorpion and insect stings, and contact with insects, beetles and worms that caused rashes and lesions. As Dingle noted:

The sting of the centipede was excruciating. … The millipedes were about four inches … did not sting, but produced blisters when they came in contact with bare skin. There were always cases of jigger fleas. These minute insects burrowed under the skin, usually on the feet or between the toes and laid their eggs in a neat little circular bag. Daily foot inspection revealed the little bag, projecting above the skin. This was easily enucleated with a pin or needle. Failure to treat would lead to sores which took weeks to heal.¹⁵¹

Scorpions were in abundance – sometimes visible on the trunks of trees, sometimes hidden in the bark. At night, they might crawl into a man’s boots. Troops were warned to “hold [their boots] upside down and shake well before putting them on”. Nonetheless, the careless were stung: “I was told that it was a most painful sting, as though a red-hot needle was going into the flesh.”¹⁵² Snakes were many, but incidents were fewer. Dingle had large supplies of antiserum but was seldom called to use it, although on one occasion he tells us that “a three-foot by one-and-a-half-inch snake” slithered out of the roof of his post – falling on his patient, while on another occasion, a large black tarantula momentarily interrupted a medical procedure.¹⁵³

They wrote notes for internal distribution and articles for publication on a range of other conditions that caused varying degrees of loss of manpower.¹⁵⁴ “It was terribly hot”, Ford reminds his readers, “and most of the men went about in vests, shorts and sandshoes. We were as brown as berries and fit for anything”.¹⁵⁵ On the long term, men unprotected from the sun for long periods may have suffered skin cancers later in life and there are probably other, less documented and perhaps poorly understood health hazards – including psychiatric illnesses.¹⁵⁶ More immediately, they were prone to scratches and minor puncture wounds from thorns. Desert sores (septic skin conditions) were frequent in dry sandy areas where water was scarce and dust and dirt irritated small scratches. Then there was “Wajir Clap” – a non-specific urethritis from drinking untreated water; “Habaswein Itch” – a redding of the skin caused by a caterpillar; and some beetles caused lesions; and certain species of trees irritated the skin and sometimes caused sickness. The men of “B” Company, Royal Durban Light Infantry had long been inflicted by terrible sores, which only cleared when the company occupied an Italian farm near Awash; they dug up potatoes, onions, and cabbages and “every man was ordered to consume two raw onions a day”.¹⁵⁷ Within a fortnight, the sores had cleared. The regimental medical officer, Captain W.B. Fiddian-Green would adopt similar measures in North Africa. Not every condition was so easily treated.

Steenkamp operating on a casualty in Abyssinia. (© wps-PA3. With permission: W.P. Steenkamp, Cape Town, 2022)

Citation: International Journal of Military History and Historiography 43, 3 (2023) ; 10.1163/24683302-bja10052

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Considering the nature of the campaign, the loss of life – to accident, disease, and enemy action – was low. The numbers are given in table 5. Battle casualties occurred at a rate of 3 per thousand for “European” troops and 1.7 per thousand for the neas. As Blamey noted during the fighting before El Yibo:

I thought that the volume of fire must surely mean that many of my comrades had been killed or wounded.¹⁵⁸

It seems quite incredible that during the three days of action not a single man in our regiment was even wounded, despite the hail of bullets that whizzed around us.¹⁵⁹

Regarding battle casualties, the samc experienced great difficulty in providing adequate surgical services in the forward areas(see Photo 3). The wounded were treated promptly although specialist surgeons and adequate equipment were sometimes unavailable. The medical staff had to learn quickly. They treated wounds using medical procedures like those employed in the land and air battles in France and Britain at the time: excision, drainage, and fixation in a closed plaster splint. Wound excision was by now less drastic than the debridement that had become standard practice in the Great War. They now focused on “saving rather than removing limbs”.¹⁶⁰ Several factors pointed to the change caused by the unique East African battlespace. Firstly, a high proportion of the wounds sustained were from rifle and machine-gun bullet wounds, and these were less lacerated and contaminated than those caused by shell fragments. Secondly, in East Africa the battles were not fought over agricultural land or in muddy trenches; this meant that the troops and their clothing were reasonably “clean”. Moreover, the new anti-bacterial drugs – developed during the interwar years, and available from 1941 – delayed infections in contaminated wounds and allowed tissue more time to repair. Fourthly, doctors realised that for most wounds debridement could never be complete and attempts to do so were unnecessarily destructive. Once draining was freely established, most wounds repaired well in plaster casts. Treated in this way, wounded men travelled well – “even with little skilled attention on the way, and with methods of transport that were far from ideal”. Sometimes, of course, wounds worsened en route. However, Anning found this to be caused by faults in the primary treatment. Such faults might be apparent in the forward medical units of the armies in Europe, but not in East Africa where surgeons had little opportunity of conferring with colleagues and seeing the final results of their work.

In his War of a Hundred Days, Brown argued that Smuts – determined to avoid the physical exertion of the campaign fought against Lettow-Vorbeck twenty-five years before, and its political consequences – would fight a different campaign in 1940–41 and that the “medical services were to be the most efficient the time could supply”.¹⁶¹ But, beyond pointing to motorisation and the adoption of South African methods of manoeuvre, Brown says little of the men and their innovations in the direct sphere of the samc. The East African campaign passed quickly and, as Smuts noted, Allied losses – taken holistically – were “ridiculously small”.¹⁶² The low udf admission rate for wounds in action (11 per thousand for Europeans and 1 per thousand for the neas) contrasted sharply with the rate of 133 per thousand troops with 6(sa) Armoured Division in Italy (1944–1945). While the South African losses were light, the 4^th and 5^th Indian Divisions lost between four and five thousand men in the battles for Keren.

For the medical practitioners serving in East Africa and later further afield, deployment enabled a stimulating intersection between the motives that animated other South African men and women to volunteer for wartime service – travel, adventure, patriotism – and their professional ambitions regarding the growth of medical science in the fluid and varied conditions of a modern war. They were amateurs in the domain of warfare, and many men – and some of the women – who worked as orderlies and nurses in the military establishments were lay medical personnel. Sometimes the learning curve was steep, and progress depended on good leadership and innovation of practice under often extreme circumstances. But the medical staffs grew in size, knowledge, and expertise as the campaign progressed. They adapted to local conditions, trained on the job, and gained experience and battle-hardiness. Steady improvement and the growing size and sophistication of the Allied medical deployment led to remarkably few admissions – and fewer fatalities – from preventable illnesses and diseases as well as improving practice in the treatment and evacuation from vast operational areas characterised by exterior lines and rapidly lengthening supply lines. Fortunately, as Anning noted, these ‘lessons’ were “learned in a campaign in which few battle casualties occurred”. In East Africa, the samc developed the more fully coordinated medical service that served later in the Western Desert and in Italy.

The medical officers were also a product of their time and place. They depicted their campaign through a common set of tropes, using recurrent themes and motifs. They were all White males, literate and educated, and all were war-time volunteers. Products of their time, there is an unintentional, normalized, gender and racial bias in their writing. Their descriptions – and those of other soldiers – of masculinity and race prejudice is sometimes heavy. They acted, and wrote their narratives, against the backdrop of privilege and power in the hierarchies of military life.

• Beinart, William, and Saul Dubow. The Scientific Imagination in South Africa (Cambridge: Cambridge University Press).

  Beinart , William , and Saul Dubow . The Scientific Imagination in South Africa ( Cambridge : Cambridge University Press ). )| false

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• Blamey, Major A.E. A Company Commander Remembers; From El Yibo to El Alamein (Pietermaritzburg: The Natal Witness, 1963).

  Blamey , Major A.E. A Company Commander Remembers; From El Yibo to El Alamein ( Pietermaritzburg : The Natal Witness , 1963 ). )| false

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• Bourke, Joanna. “New Military History.” In Palgrave Advances in Modern Military History, eds. Matthew Hughes and William J. Philpott (Basingstoke: Palgrave Macmillan, 2006), 258–280.

  Bourke , Joanna . “ New Military History. ” In Palgrave Advances in Modern Military History, eds. Matthew Hughes and William J. Philpott ( Basingstoke : Palgrave Macmillan , 2006 ), 258 – 280 . )| false

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• Brown, James A. The War of a Hundred Days; Springboks in Somalia and Abyssinia, 1940–41 (Johannesburg: Ashanti, 1990).

  Brown , James A. The War of a Hundred Days; Springboks in Somalia and Abyssinia, 1940–41 ( Johannesburg : Ashanti , 1990 ). )| false

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• Crew, F.A.E. The Army Medical Services, Volume 1 (London: H.M.S.O., 1956).

  Crew , F.A.E. The Army Medical Services , Volume 1 ( London : H.M.S.O. , 1956 ). )| false

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• Curtin, Philip D. “The End of the ‘White Man’s Grave’? Nineteenth-Century Mortality in West Africa.” Journal of Interdisciplinary History 21 (1) (1990), 63–88.

  Curtin , Philip D. “ The End of the ‘White Man’s Grave’? Nineteenth-Century Mortality in West Africa .” Journal of Interdisciplinary History 21 ( 1 ) ( 1990 ), 63 – 88 . )| false

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• Delaney, Douglas E., Mark Frost, and Andrew L. Brown, eds. Manpower and the Armies of the British Empire in the Two World Wars (Ithaca, NY, and London: Cornell University Press, 2021).

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• Dingle, D. And the doctor recovered (Cape Town: Howard Timmins, 1959).

  Dingle , D. And the doctor recovered ( Cape Town : Howard Timmins , 1959 ). )| false

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• Dubow, Saul. A Commonwealth of Knowledge; Science, Sensibility and White South Africa 1820–2000 (Oxford and New York: Oxford University Press, 2006).

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• Evenden, Matthew. “Aluminum, Commodity Chains, and the Environmental History of the Second World War”, Environmental History 16 (1) (January 2011), 69–93.

  Evenden , Matthew . “ Aluminum, Commodity Chains, and the Environmental History of the Second World War ”, Environmental History 16 ( 1 ) (January 2011 ), 69 – 93 . )| false

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• Fiasconaro, Gregorio. I’d Do It Again (Cape Town: Books of Africa, 1982).

  Fiasconaro , Gregorio . I’d Do It Again ( Cape Town : Books of Africa , 1982 ). )| false

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• Ford, Keith. From Addis to the Aosta Valley: A South African in the North African and Italian Campaigns, 1940–1945 (Solihull: Helion, 2012).

  Ford , Keith . From Addis to the Aosta Valley: A South African in the North African and Italian Campaigns, 1940–1945 ( Solihull : Helion , 2012 ). )| false

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• Halsted, J. The South African Red Cross in War, 1939–45 (unpublished manuscript).

  Halsted , J. The South African Red Cross in War, 1939–45 (unpublished manuscript). )| false

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• Harrison, Mark. Medicine & Victory: British Military Medicine in the Second World War (Oxford: Oxford University Press, 2012).

  Harrison , Mark . Medicine & Victory: British Military Medicine in the Second World War ( Oxford : Oxford University Press , 2012 ). )| false

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• Hughes, Matthew. “Technology, Science and War.” In Palgrave Advances in Modern Military History, eds. Matthew Hughes and William J. Philpott (Basingstoke: Palgrave Macmillan, 2006), 231–257.

  Hughes , Matthew . “ Technology, Science and War. ” In Palgrave Advances in Modern Military History , eds. Matthew Hughes and William J. Philpott ( Basingstoke : Palgrave Macmillan , 2006 ), 231 – 257 . )| false

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• Kleynhans, Evert. “Armoured Warfare: The South African Experience in East Africa, 1940–1941”, MMil Dissertation (Stellenbosch University, 2014).

  Kleynhans , Evert . “ Armoured Warfare: The South African Experience in East Africa, 1940–1941 ”, MMil Dissertation ( Stellenbosch University , 2014 ). )| false

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• Laakkonen, Simo, Richard Tucker, and Timo Vuorisalo, eds. The Long Shadows: A Global Environmental History of the Second World War (Corvallis, OR: Oregon State University Press, 2017).

  Laakkonen , Simo , Richard Tucker , and Timo Vuorisalo , eds. The Long Shadows: A Global Environmental History of the Second World War ( Corvallis, OR : Oregon State University Press , 2017 ). )| false

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• Le Fanu, James. The Rise and Fall of Modern Medicine (London: Abacus, 2011).

  Le Fanu , James . The Rise and Fall of Modern Medicine ( London : Abacus , 2011 ). )| false

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• Martin, A.C. The Durban Light Infantry, Volumeii: 1935 to 1960 (Durban: Durban Light Infantry, 1969).

  Martin , A.C. The Durban Light Infantry, Volume ii : 1935 to 1960 ( Durban : Durban Light Infantry , 1969 ). )| false

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• Morris, Jan. Pax Britannica: The Climax of an Empire (London: Faber and Faber, 1998).

  Morris , Jan . Pax Britannica: The Climax of an Empire ( London : Faber and Faber , 1998 ). )| false

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• Orpen, Neil. East African and Abyssinian Campaigns (Purnell: Johannesburg and Cape Town, 1968).

  Orpen , Neil . East African and Abyssinian Campaigns ( Purnell : Johannesburg and Cape Town , 1968 ). )| false

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• Pillai, E.K.K. Official History of the Indian Armed Forces in the Second World War, 1939–45: Medical Services – The Campaigns in the Western Desert (Kanpur: Job Press Private Ltd., 1958).

  Pillai , E.K.K. Official History of the Indian Armed Forces in the Second World War, 1939–45: Medical Services – The Campaigns in the Western Desert ( Kanpur : Job Press Private Ltd ., 1958 ). )| false

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• Rennell of Rodd, Lord. British Military Administration of Occupied Territories in Africa: during the Years 1941–1947 (London: hso, 1948).

  Rennell of Rodd , Lord . British Military Administration of Occupied Territories in Africa: during the Years 1941–1947 ( London : hso , 1948 ). )| false

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• Richard P. Tucker, Tait Keller, J.R. McNeill and Martin Schmid, eds. Environmental Histories of the First World War (Cambridge: Cambridge University Press, 2018).

  Richard P. Tucker , Tait Keller , J.R. McNeill and Martin Schmid , eds. Environmental Histories of the First World War ( Cambridge : Cambridge University Press , 2018 ). )| false

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• Smith, E.S. “Die Suid-Afrikaanse Geneeskundige Diens in die Tweede Wêreldoorlog: Die Veldtog in Oos-Afrika en Abessinië, 1940–1941”. In Militêre Geneeskunde in Suid-Afrika, 1913–1983, ed. A.E. van Jaarsveldt (Pretoria: Military Information Bureau, 1983), 79–89.

  Smith , E.S. “ Die Suid-Afrikaanse Geneeskundige Diens in die Tweede Wêreldoorlog: Die Veldtog in Oos-Afrika en Abessinië, 1940–1941 ”. In Militêre Geneeskunde in Suid-Afrika, 1913–1983 , ed. A.E. van Jaarsveldt ( Pretoria : Military Information Bureau , 1983 ), 79 – 89 . )| false

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• Stewart, Andrew. The First Victory: The Second World War and the East Africa Campaign (New Haven, CT: Yale, 2016).

  Stewart , Andrew . The First Victory: The Second World War and the East Africa Campaign ( New Haven, CT : Yale , 2016 ). )| false

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• Stratford, Dennis O., and Hazel M. Collins, Military Nursing in South Africa, 1914–1994 (Pretoria: sandf, 1994).

  Stratford , Dennis O. , and Hazel M. Collins , Military Nursing in South Africa, 1914–1994 ( Pretoria : sandf , 1994 ). )| false

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• van der Poel, Jean, ed. Selections from the Smuts Papers, Vol.vi (Cambridge: University Press, 1973).

  van der Poel , Jean , ed. Selections from the Smuts Papers , Vol. vi ( Cambridge : University Press , 1973 ). )| false

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• van der Waag, Ian, ed. Sights, Sounds, Memories: South African Soldier Experiences of the Second World War (Stellenbosch: sun Press, 2020).

  van der Waag , Ian , ed. Sights, Sounds, Memories: South African Soldier Experiences of the Second World War ( Stellenbosch : sun Press , 2020 ). )| false

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• van der Waag, Ian. “The Union War Histories and the Battle for the History of the Second World War in South Africa.” Wiedza Obronna 274 (1) (2021a), 9–33.

  van der Waag , Ian . “ The Union War Histories and the Battle for the History of the Second World War in South Africa. ” Wiedza Obronna 274 ( 1 ) ( 2021a ), 9 – 33 . )| false

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• van der Waag, Ian. “South African Manpower and the Second World War.” In Manpower and the Armies of the British Empire in the Two World Wars, eds. Douglas E. Delaney, Mark, Frost, and Andrew L. Brown (Ithaca, NY, and London: Cornell University Press, 2021b), 174–186.

  van der Waag , Ian . “ South African Manpower and the Second World War. ” In Manpower and the Armies of the British Empire in the Two World Wars , eds. Douglas E . Delaney , Mark , Frost , and Andrew L . Brown ( Ithaca, NY, and London : Cornell University Press , 2021b ), 174 – 186 . )| false

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• Walker, Jean. Skin Deep; The Autobiography of a Woman Doctor (Kommetjie, Cape Town: Midgley, 1977).

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In:

International Journal of Military History and Historiography

In:

Volume 43: Issue 3

Received:

01 Apr 2022

Accepted:

28 Apr 2023

Publisher:

Brill

E-ISSN:

2468-3302

Print ISSN:

2468-3299

Subjects:

History of Warfare, History

ProCite

RefWorks

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• Beinart, William, and Saul Dubow. The Scientific Imagination in South Africa (Cambridge: Cambridge University Press).

  Beinart , William , and Saul Dubow . The Scientific Imagination in South Africa ( Cambridge : Cambridge University Press ). )| false

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• Blamey, Major A.E. A Company Commander Remembers; From El Yibo to El Alamein (Pietermaritzburg: The Natal Witness, 1963).

  Blamey , Major A.E. A Company Commander Remembers; From El Yibo to El Alamein ( Pietermaritzburg : The Natal Witness , 1963 ). )| false

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• Bourke, Joanna. “New Military History.” In Palgrave Advances in Modern Military History, eds. Matthew Hughes and William J. Philpott (Basingstoke: Palgrave Macmillan, 2006), 258–280.

  Bourke , Joanna . “ New Military History. ” In Palgrave Advances in Modern Military History, eds. Matthew Hughes and William J. Philpott ( Basingstoke : Palgrave Macmillan , 2006 ), 258 – 280 . )| false

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• Brown, James A. The War of a Hundred Days; Springboks in Somalia and Abyssinia, 1940–41 (Johannesburg: Ashanti, 1990).

  Brown , James A. The War of a Hundred Days; Springboks in Somalia and Abyssinia, 1940–41 ( Johannesburg : Ashanti , 1990 ). )| false

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• Crew, F.A.E. The Army Medical Services, Volume 1 (London: H.M.S.O., 1956).

  Crew , F.A.E. The Army Medical Services , Volume 1 ( London : H.M.S.O. , 1956 ). )| false

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• Curtin, Philip D. “The End of the ‘White Man’s Grave’? Nineteenth-Century Mortality in West Africa.” Journal of Interdisciplinary History 21 (1) (1990), 63–88.

  Curtin , Philip D. “ The End of the ‘White Man’s Grave’? Nineteenth-Century Mortality in West Africa .” Journal of Interdisciplinary History 21 ( 1 ) ( 1990 ), 63 – 88 . )| false

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• Delaney, Douglas E., Mark Frost, and Andrew L. Brown, eds. Manpower and the Armies of the British Empire in the Two World Wars (Ithaca, NY, and London: Cornell University Press, 2021).

  Delaney , Douglas E. , Mark Frost , and Andrew L. Brown , eds. Manpower and the Armies of the British Empire in the Two World Wars ( Ithaca, NY, and London : Cornell University Press , 2021 ). )| false

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• Dingle, D. And the doctor recovered (Cape Town: Howard Timmins, 1959).

  Dingle , D. And the doctor recovered ( Cape Town : Howard Timmins , 1959 ). )| false

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• Dubow, Saul. A Commonwealth of Knowledge; Science, Sensibility and White South Africa 1820–2000 (Oxford and New York: Oxford University Press, 2006).

  Dubow , Saul . A Commonwealth of Knowledge; Science, Sensibility and White South Africa 1820–2000 ( Oxford and New York : Oxford University Press , 2006 ). )| false

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• Evenden, Matthew. “Aluminum, Commodity Chains, and the Environmental History of the Second World War”, Environmental History 16 (1) (January 2011), 69–93.

  Evenden , Matthew . “ Aluminum, Commodity Chains, and the Environmental History of the Second World War ”, Environmental History 16 ( 1 ) (January 2011 ), 69 – 93 . )| false

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• Fiasconaro, Gregorio. I’d Do It Again (Cape Town: Books of Africa, 1982).

  Fiasconaro , Gregorio . I’d Do It Again ( Cape Town : Books of Africa , 1982 ). )| false

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• Ford, Keith. From Addis to the Aosta Valley: A South African in the North African and Italian Campaigns, 1940–1945 (Solihull: Helion, 2012).

  Ford , Keith . From Addis to the Aosta Valley: A South African in the North African and Italian Campaigns, 1940–1945 ( Solihull : Helion , 2012 ). )| false

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• Halsted, J. The South African Red Cross in War, 1939–45 (unpublished manuscript).

  Halsted , J. The South African Red Cross in War, 1939–45 (unpublished manuscript). )| false

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• Harrison, Mark. Medicine & Victory: British Military Medicine in the Second World War (Oxford: Oxford University Press, 2012).

  Harrison , Mark . Medicine & Victory: British Military Medicine in the Second World War ( Oxford : Oxford University Press , 2012 ). )| false

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• Hughes, Matthew. “Technology, Science and War.” In Palgrave Advances in Modern Military History, eds. Matthew Hughes and William J. Philpott (Basingstoke: Palgrave Macmillan, 2006), 231–257.

  Hughes , Matthew . “ Technology, Science and War. ” In Palgrave Advances in Modern Military History , eds. Matthew Hughes and William J. Philpott ( Basingstoke : Palgrave Macmillan , 2006 ), 231 – 257 . )| false

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• Kleynhans, Evert. “Armoured Warfare: The South African Experience in East Africa, 1940–1941”, MMil Dissertation (Stellenbosch University, 2014).

  Kleynhans , Evert . “ Armoured Warfare: The South African Experience in East Africa, 1940–1941 ”, MMil Dissertation ( Stellenbosch University , 2014 ). )| false

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• Laakkonen, Simo, Richard Tucker, and Timo Vuorisalo, eds. The Long Shadows: A Global Environmental History of the Second World War (Corvallis, OR: Oregon State University Press, 2017).

  Laakkonen , Simo , Richard Tucker , and Timo Vuorisalo , eds. The Long Shadows: A Global Environmental History of the Second World War ( Corvallis, OR : Oregon State University Press , 2017 ). )| false

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• Le Fanu, James. The Rise and Fall of Modern Medicine (London: Abacus, 2011).

  Le Fanu , James . The Rise and Fall of Modern Medicine ( London : Abacus , 2011 ). )| false

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• Martin, A.C. The Durban Light Infantry, Volumeii: 1935 to 1960 (Durban: Durban Light Infantry, 1969).

  Martin , A.C. The Durban Light Infantry, Volume ii : 1935 to 1960 ( Durban : Durban Light Infantry , 1969 ). )| false

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• Morris, Jan. Pax Britannica: The Climax of an Empire (London: Faber and Faber, 1998).

  Morris , Jan . Pax Britannica: The Climax of an Empire ( London : Faber and Faber , 1998 ). )| false

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• Orpen, Neil. East African and Abyssinian Campaigns (Purnell: Johannesburg and Cape Town, 1968).

  Orpen , Neil . East African and Abyssinian Campaigns ( Purnell : Johannesburg and Cape Town , 1968 ). )| false

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• Pillai, E.K.K. Official History of the Indian Armed Forces in the Second World War, 1939–45: Medical Services – The Campaigns in the Western Desert (Kanpur: Job Press Private Ltd., 1958).

  Pillai , E.K.K. Official History of the Indian Armed Forces in the Second World War, 1939–45: Medical Services – The Campaigns in the Western Desert ( Kanpur : Job Press Private Ltd ., 1958 ). )| false

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• Rennell of Rodd, Lord. British Military Administration of Occupied Territories in Africa: during the Years 1941–1947 (London: hso, 1948).

  Rennell of Rodd , Lord . British Military Administration of Occupied Territories in Africa: during the Years 1941–1947 ( London : hso , 1948 ). )| false

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• Richard P. Tucker, Tait Keller, J.R. McNeill and Martin Schmid, eds. Environmental Histories of the First World War (Cambridge: Cambridge University Press, 2018).

  Richard P. Tucker , Tait Keller , J.R. McNeill and Martin Schmid , eds. Environmental Histories of the First World War ( Cambridge : Cambridge University Press , 2018 ). )| false

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• Smith, E.S. “Die Suid-Afrikaanse Geneeskundige Diens in die Tweede Wêreldoorlog: Die Veldtog in Oos-Afrika en Abessinië, 1940–1941”. In Militêre Geneeskunde in Suid-Afrika, 1913–1983, ed. A.E. van Jaarsveldt (Pretoria: Military Information Bureau, 1983), 79–89.

  Smith , E.S. “ Die Suid-Afrikaanse Geneeskundige Diens in die Tweede Wêreldoorlog: Die Veldtog in Oos-Afrika en Abessinië, 1940–1941 ”. In Militêre Geneeskunde in Suid-Afrika, 1913–1983 , ed. A.E. van Jaarsveldt ( Pretoria : Military Information Bureau , 1983 ), 79 – 89 . )| false

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• Stewart, Andrew. The First Victory: The Second World War and the East Africa Campaign (New Haven, CT: Yale, 2016).

  Stewart , Andrew . The First Victory: The Second World War and the East Africa Campaign ( New Haven, CT : Yale , 2016 ). )| false

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• Stratford, Dennis O., and Hazel M. Collins, Military Nursing in South Africa, 1914–1994 (Pretoria: sandf, 1994).

  Stratford , Dennis O. , and Hazel M. Collins , Military Nursing in South Africa, 1914–1994 ( Pretoria : sandf , 1994 ). )| false

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• van der Poel, Jean, ed. Selections from the Smuts Papers, Vol.vi (Cambridge: University Press, 1973).

  van der Poel , Jean , ed. Selections from the Smuts Papers , Vol. vi ( Cambridge : University Press , 1973 ). )| false

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• van der Waag, Ian, ed. Sights, Sounds, Memories: South African Soldier Experiences of the Second World War (Stellenbosch: sun Press, 2020).

  van der Waag , Ian , ed. Sights, Sounds, Memories: South African Soldier Experiences of the Second World War ( Stellenbosch : sun Press , 2020 ). )| false

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• van der Waag, Ian. “The Union War Histories and the Battle for the History of the Second World War in South Africa.” Wiedza Obronna 274 (1) (2021a), 9–33.

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• van der Waag, Ian. “South African Manpower and the Second World War.” In Manpower and the Armies of the British Empire in the Two World Wars, eds. Douglas E. Delaney, Mark, Frost, and Andrew L. Brown (Ithaca, NY, and London: Cornell University Press, 2021b), 174–186.

  van der Waag , Ian . “ South African Manpower and the Second World War. ” In Manpower and the Armies of the British Empire in the Two World Wars , eds. Douglas E . Delaney , Mark , Frost , and Andrew L . Brown ( Ithaca, NY, and London : Cornell University Press , 2021b ), 174 – 186 . )| false

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• Walker, Jean. Skin Deep; The Autobiography of a Woman Doctor (Kommetjie, Cape Town: Midgley, 1977).

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• Photo 1

  Steenkamp (right) operating on a casualty at a forward dressing station in Abyssinia. Steenkamp wrote a colourful yet informative account of his experince as a forward surgeon with the East Africa Force. (© wps-pa2. With permission: W.P. Steenkamp, Cape Town, 2022)

• Photo 2

  The state of the Italian medical services. An Italian cartoon dated 1941 depicting a rather grisly scene in an Italian surgical hospital at Addis Ababa. The artist, E. Natoli, has inserted himself into the scene. Allied medical officers thought much more of Italian medical practice than Natoli would suggest. Note the racial and gender stereotypes of the Italian figures as well as of the severed body parts. (© Private collection, I.J. van der Waag)

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  Steenkamp operating on a casualty in Abyssinia. (© wps-PA3. With permission: W.P. Steenkamp, Cape Town, 2022)

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Online Publication Date:

16 Jun 2023

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The first major theatre of operations during the Second World War in which South African forces fought was East Africa. Key to the South African role in the campaign was the formation of the 1st sa Infantry Division in 1940. A range of medical units were under command. Using a ‘bottom-up’ view, this article – using a range of personal accounts, which complement richly veined material at the Department of Defence Archives in Pretoria – examines the service they rendered against the backdrop of the policy framework and theatre challenges. It reveals the connection medical personnel experienced between the motives that animated other South African men and women to volunteer for wartime service – travel, adventure, patriotism – and their professional ambitions regarding the growth of medical science in the fluid and varied conditions of a modern war. Sometimes the learning curve was steep; progress depended on good leadership and innovation of practice under often-extreme circumstances. But, as this article contends, they adapted to local conditions, trained on the job, and gained experience and battle-hardiness as the campaign progressed. Steady improvement and the growing size and sophistication of the Allied medical deployment led to remarkably few admissions – and fewer fatalities – from preventable illnesses and diseases as well as improving practice in the treatment and evacuation of patients from vast operational areas characterised by exterior lines and rapidly lengthening supply lines.

An article on the medical services rendered during the East African campaign of the Great War appeared in the January 1941 issue of the South African Medical Journal (samj). The views of its writer, Lt Col H.W. Vaughan-Williams – who had been Assistant Director Medical Services (adms) with the 3^rd East African Division during that campaign – on “the chief causes of the troubles, mistakes, and even partial chaos that occurred”, were unwanted and his intention to publish his diary was unwelcomed. The defence authorities – and Barton Keep,¹ particularly – hardly wanted the spotlight on their present operations in East Africa. Yet, Vaughan-Williams was arguably correct: East Africa, with a sickness death rate higher than any other campaign, had been “almost entirely a medical war” in 1916 and 1917.² That would be the case again in 1941.

In September 1939, the South African Medical Corps (samc) was small and managed on a part-time basis by the Director General of the Department of Health. This changed quickly after a Medical Enquiry Committee, set up by Jan Smuts (the South African prime minister) in November 1939, reported. Alexander Orenstein – an epidemiologist, who had served as the Director Medical Services (dms) in East Africa in the last war – became Director General Medical Services (dgms).³ Eighteen medical units were mobilised and a further 25 created. At the end of May 1940, Orenstein became dms of the forces in East Africa – responsible for all medical services in the forthcoming campaign – and, a few months later, Smuts appointed Brigadier Sir Edward Thornton as the dgms in the Union to support him. Orenstein left on 30 June and established his headquarters in Nairobi. His staff came from the Royal Army Medical Corps (ramc), samc, and East Africa Army Medical Corps (eaamc). The headquarters would remain in Nairobi for the duration of the war; although at the end of May 1941, when Orenstein left to take up duties as dms in Cairo, an officer of the African Medical Service filled the post of dms in East Africa.

The British and Indian official histories include useful chapters on the medical operations in East Africa,⁴ but the samc – although providing most of the medical deployment and serving the Allied forces as well as the local, civilian populations – is poorly served. There are scattered references in the main narratives⁵ as well as a chapter on East Africa in the official history of the samc⁶ that rests heavily on the detailed, lengthy account of the samc compiled by Colonel Paul Anning, who ended the war as dms in Italy.⁷ Never published, Anning’s manuscript now forms part of the Union War Histories narratives and reports.⁸ These were all traditional histories of military medicine – focusing on the organisation and delivery of medical services and narrated in laudatory terms. Theirs was a tale of ‘improvement’: in sanitary conditions, in the general health of the servicemen, and of the local, African populations. These approaches, as Joanna Bourke argued, have steadily given way to bottom-up history with its focus on shell shock and dismemberment. Military medical organisations now appeared in harsher roles: of imposition and of mechanic treatment aimed at repairing the men for their rapid return to the frontlines. Senior commanders and decorated heroes – who drew and coveted the limelight – are side-lined in this ‘new medical history’ in which the ‘damaged men’ take centre stage.⁹

The purpose of this article is to examine the medical operations of the East African campaign: a campaign for which there is no recent, close examination. This apparent neglect may be due, if only partly, to the central role South Africa played in the delivery of military medical services in this war theatre and the assumption that South African scholars would fill this gap, and certainly an under-valuing generally of the medical history of the war.¹⁰ It also seeks a bottom-up view of the samc operations in East Africa, which presents certain difficulties. The documentation at the Department of Defence Archives in Pretoria is richly veined and the material collected for Anning’s projected, post-war, official medical history is particularly so. There are sheaves of correspondence between Thornton and Orenstein; interviews with medical personnel conducted by the historical recording officers; and the historical surveys all units were to compile after April 1945. The routine correspondence generated in the office of the dgms supplements this. While vast, this material is also official and, for this campaign, there are few memoirs or reflective pieces to offer an immediate, bottom-up view. And the doctor recovered – a charming, tongue-in-cheek narrative – is the only published, book-length, personal account by a South African medical officer.¹¹ There are a further eight reflective accounts published as articles in the South African Medical Journal, and a small number of unpublished accounts by medical personnel in the Union War Histories collection. To these ‘medical narratives’ might be added the accounts written by ordinary service personnel, who – although not medical staff – addressed medical matters in passing, either as patients or beneficiaries of the medical service, but for East Africa these are also few.¹² Much of the writing uses gendered and pejorative language, which is sexualised and violent.¹³ It also has an imposed Western tone and at times a heavy racial bias. This may be expected. Some had received their training in the United Kingdom or the United States or the Netherlands; most had studied at the medical schools in Cape Town or Johannesburg, which had close links to British counterpart institutions.

The pre-war South African medical establishment – both state infrastructure as well as private practice – was relatively small. Only Cape Town and Johannesburg had medical faculties, while the sa Institute for Medical Research (Johannesburg) focused on medical problems relating to public health and industrial hygiene. Close connections were maintained through the office of the sa high commissioner in London with the United Kingdom’s Department of Scientific and Industrial Research and its many activities. In some cases, a South African representative sat on the council of the scientific committees – providing a link between the British structures and their correspondents in South Africa, who received copies of their publications. Since 1926, South Africa had enjoyed representation at the Standing Conference for the Coordination of Scientific Research and through it to the British Medical Research Council. These links, bridging a range of disciplines, facilitated science and technology research across the empire and enabled institutions to develop knowledge production, advance imperial ascendency, and further claims to dominion nationhood through practice and publication. Anning, for example, had established himself during the 1930s as an expert on tropical sanitation.¹⁴ As Dubow argues, for scientists there were “opportunities for their collective advancement and individual distinction”.¹⁵

However, the medical establishment did not reflect South African society. There were few female doctors – women interested in medicine were largely forced into the nursing profession – and fewer still Black doctors. Dr R.J. Xaba studied medicine in Edinburgh during the 1920s “at a time”, he tells us, “when Bantu medical practitioners were something almost unheard of”.¹⁶ In Scotland, he met Dr Molema and one or two other Black medical students. The Faculty of Medicine at the University of the Witwatersrand – the first South African institution to do so – only opened its doors to people of colour in 1940. Bokwe notes that, by the end of 1944, “there [were] only ten registered African medical practitioners in South Africa as against some 3,000 European medical men”.¹⁷ The doctors in the samc, not unlike their counterparts in the ramc and the medical corps of the other dominions, were all White and male, and reflected the class, racial and gendered hierarchies of military life at the time.

The South African Medical Journal – published from 1884 and known until 1927 as the South African Medical Record – was a general medical journal publishing leading research influencing clinical care in Africa. It was also the South African medical profession’s mouthpiece. Soon after the outbreak of the war, the question of military service re-entered its pages. A call for volunteers to accept commissions in the samc and serve with the forces on campaign evoked a considerable debate in the journal’s pages. Medical practitioners faced a stark choice: to volunteer for full-time military service – or not. If they volunteered to serve in the armed forces, they left their practices and faced rebuilding after their return; this while their counterparts built their practices and established themselves in their communities. The samj noted the lists of men who volunteered.¹⁸ Their names are recorded – in batches, over successive issues from August 1942 – indicating the positions they would fill in the samc, their promotions, and sometimes the towns from whence they came.¹⁹ However, the call for volunteers remained divisive and the men who volunteered for part-time service in the Union faced sustained criticism.

Wartime South Africa faced a manpower crisis that would increase in severity with each passing war year.²⁰ Dr Harvey Pirie, a well-known medical practitioner, was reported in the press to have said that there were “200 doctors too few in the Union and that no more could be taken from civil practice to do military work”.²¹ All members of the medical profession had been circularised at the outbreak of war, to determine what service each was prepared to render. A general practitioner from Durban had signalled his willingness “to do anything short of actually joining the army”: he was beyond the age limit. He had not been called on – although he was serving in the sense that he was acting as a locum for doctors on service, as many of the “stay-at-homes” were doing.²² A correspondent, writing under the name “Ripa”, was more direct than most: “Doctors who take part-time appointments and don uniform are utter humbugs, and if they do not see this for themselves, it is not for us to remain blind and dumb also”.²³ These men were given military rank and status, and often senior rank and – while “willingly accepting the kudos of being on service” – made no sacrifice. These men, he argued, did injury to the profession and should have been forced to resign. The “Ripa” letter gave immediate offence. Part-time appointees were outraged.²⁴ The medical profession was determined to refrain from corroding the “good understanding that should exist between our profession and the military authorities”.²⁵

The doctors, sent to the training depot at Zonderwater, underwent a month’s military training. Dingle was among the first group; they numbered about 100. They marched, wheeled, formed fours, were socialised to the armed forces, and lost their individuality including their right to criticism – explaining perhaps the anonymity of the first pieces they wrote. “By the end of the month”, Dingle tells us jokingly, they “had practically forgotten [their] professions and were hale, hearty and healthy”.²⁶ Criticism and the rigours of military training aside, the volunteer medicos found advantage in the exposure their deployments to East Africa – and later North Africa and Italy – brought them. They encountered a greater range of injuries, including battle-related wounds and military-related trauma, as well as all kinds of tropical and other diseases. Uniquely placed to refine practice, they were soon writing from the front – from Kenya, and later Somaliland and Abyssinia. Their views not only found a readership in the pages of the samj, but the dgms sent a copy of their “Notes on Diseases in Italian East Africa and British and French Somaliland” to Premier Mine for the education of troops leaving for East Africa.²⁷ As pathologist Major Ronald Elsdon-Drew noted in December 1942, “Abyssinia presented a pathologist’s paradise of problems”.²⁸

Eight articles with a specific East Africa focus appeared in the samj between January 1941 and September 1943, when writing about the later campaigns – fought in North Africa, and later Italy – took prominence. Two anonymous articles, appearing in June and August 1941, had followed Vaughan-Williams’s unwanted advice. Their anonymity reflected perhaps a self-imposed censorship applying to both the content of what they wrote and their own identity as the authors.²⁹ Two articles written by named samc officers featured in the December issue; Capt. Willem P. Steenkamp, Jr., and Capt. J.H. Marks, who was attached to the 2^nd Zanzibar Field Ambulance, wrote of their personal impressions of the medical campaign.³⁰ Three more articles followed: on tropical surgery (November 1942);³¹ Elsdon-Drew’s Abyssinian notes (December 1942);³² and an article on tapeworm (September 1943).³³ Anning’s “Official History” and The Doctor Recovered might be added to these. But why did these medical officers take the time – during a campaign, when their medical tents and operating theatres were seldom quiet – to write these accounts. Of course, the reasons varied. The anonymous field ambulance officer offered proposals to improve medical efficiency.³⁴ Steenkamp (see Photo 1) offered practical advice for young officers joining the field ambulances.³⁵ Marks wrote “for the benefit of those unable to come”,³⁶ while Ogilvie, a British officer and consultant surgeon to the East Africa Force, explained “the surgical lessons” of his campaigns for “the general surgeon … already trained in operative technique but new to the surgery of wounds in modern warfare”.³⁷ His account, Ogilvie admits, rested inter alia on discussion with the South African and Colonial forward surgeons in the East Africa Force, and the consultant surgeons in South Africa – Colonels I.W. Brebner and F.P. Fouché – who treated all the seriously wounded from East and North Africa and furnished him with constant reports on their final results. Forward Surgery in Modern War is another product of their combined wisdom.

Steenkamp (right) operating on a casualty at a forward dressing station in Abyssinia. Steenkamp wrote a colourful yet informative account of his experince as a forward surgeon with the East Africa Force. (© wps-pa2. With permission: W.P. Steenkamp, Cape Town, 2022)

Citation: International Journal of Military History and Historiography 43, 3 (2023) ; 10.1163/24683302-bja10052

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What themes come through in this writing? “Deserts and Other Places” covers the story of a field ambulance company: which ambulance is not mentioned, but this can be deduced.³⁸ This was the first article to appear on the medical operations during the war. It outlined the troubles medical officers faced: from the “irksome formalities” of army life, happily ditched when they moved to the front, and the battles associated with untrained nursing staff and the diversity of languages in the war theatre, to the inhospitable terrain, the flies and the fleas, and the erratic army postal service.³⁹ Subsequent writers built on these themes. The most prominent are examined in the following sections.

The topography of the battlespace dictated the lines on which the medical and other services grew and functioned.

However, as the physical environment differed markedly from the East African campaign of the 1914–1918 War, there was no easy experience on which to draw. Orenstein – having battled with the misinformation and incongruities, broadcast partly by men who had been in East Africa during the First World War – chided in October 1940:

It is very difficult to convey to people in South Africa a correct idea of the terrain and conditions of the Campaign here. On the one hand, those who have only book knowledge can have but little idea of the fundamental difference between the textbook and the actual facts. On the other hand, those who had East African experience in the last War are liable to be badly misled because the conditions in this part of the world are utterly different from those which obtained in East Africa twenty-five years ago, and the experience gained then can only be of partial use for the present purposes.⁴¹

The Abyssinian highlands, the primary objective of the campaign, formed a vast, natural fortress: bounded to the north-west by the Sudan, to the north by Eritrea, to the east by Somaliland, and to the south by Kenya. The features of the physical and human environment, which affected the campaign and provided the Italians with powerful defences – the deserts, rivers, hills and mountains, roads, and climate – differed dramatically from those of the East African campaign of the previous war fought largely in tropical Tanganyika.⁴²

The main South African advance was along two primary axes from the south. Nanyuki, the staging area for the 1^st sa Division, lay on the equator at 6,000 feet above sea level and in well-wooded, grassland country. Their advance northwards took them down to the thorn-treed, Kenyan bushveld and beyond Isiolo to the deserts of the Northern Frontier District (nfd). To the north, covering the remaining 180 miles to the Abyssinian border was the Chalbi desert. The terrain, thought unfit for habitation, had few oases, visited by only “a few straggling camel caravans and herds of goats driven by vagrant Seras”.⁴³ Major “Chooks” Blamey of the Natal Mounted Rifles notes: “North Horr is an oasis on the Chalbi Desert but, like many other places to be found on the map, is a place in name only”.⁴⁴ It was sparsely populated – but for an abundance of spiders, flies and snakes – and excessively hot. The lava rock scorched skin.⁴⁵ Beyond Dukana, the South African advance entered the foothills of Abyssinia. Here was open grassland and the road north to Hobok and eventually Addis Ababa. Every advance would augment the medical and supply difficulties and expose the troops to further ailments.

The lateral routes brought their own challenges. There was the lava-stone desert to the west of Lake Rudolph; the thornveld around Moyale; the hot sand and desert scrub of Wajir, where sand temperature reached 146 degrees and was alive with tampan ticks; and the tremendous heat of the coastal plains of the three Somalilands. The Wajir district boasted a thousand wells, but, as the medical officers reported, camels fouled most wells, and the water – brackish to taste – caused a rise in urethral irritation.⁴⁶ Fords recalls that the medical personnel were forever treating men for scratches and jabs from thorns, for spider bites and scorpion stings, and veld sores. Ford never suffered from veld sores: “I always put a few drops of Dettol in shaving and washing water, also in my mug when I cleaned my teeth, using the rest of the water in the mug for gargling. My Aunt Hester invariably enclosed a small bottle of Dettol in my parcels”.⁴⁷ Then bilharzia frequented the major rivers. Clearly, baseline medical and hygiene training for the troops was essential.

Several South African doctors praised the Italians. For their roadbuilding and for their medical and veterinary services, which were of vital importance to the Allied forces as the campaign entered Abyssinia.⁴⁸ Italian scientific knowledge and medical supplies were expected to prove significant to the success of the Allied forces. A memorandum published by the East Africa Force Headquarters (eafhq) on 26 November 1940, ahead of major operations, warned of the possible diseases; it drew heavily on the work of Italian doctors – Corradetti, Lega and Raffaele, who had been active in East Africa before the war – and supplemented by government reports from British Somaliland, from the late-1930s, that corroborated their findings.⁴⁹ This dealt with malaria, influenza and tick-borne and lice-transmitted relapsing fever: the first mostly in and around the inland towns of the three Somalilands; the second largely on the Abyssinian plateau but also the cause of epidemics in the Sudan and once (1929) in British Somaliland. The eafhq staff prepared for both – they demanded different control measures. The louse-carried variant was apt to occur in epidemic form; the other more sporadic. The louse-type was easier to manage – “not that it is easy to discipline or clean up Somalis or Ethiopians”, the pamphlet reproved; the other, which persisted in the tick population, had to be burned out. Either way the control measures involved the local populations and interventions on the part of the military medical services. “Great care”, it warned, “should be used not to camp in places where this disease may be acquired and to forbid men to frequent infested coffee houses, bazaars, etc.”.⁵⁰ The pamphlet was purposefully worded and its readers were probably most concerned about the “etc.”. It certainly indicates the disdain with which many doctors also regarded the Africans. This introduces a related theme.

By 1939, modern medicine had started to move beyond the pursuit of limited effectiveness. It had become, according to James Le Fanu, “the most visible symbol of the fulfilment of the great Enlightenment Project where scientific progress would vanquish the twin perils of ignorance and disease to the benefit of all”.⁵¹ Campaigning in Africa by European troops had also changed. Science had dispelled the notions of a “White Man’s Grave” that had vexed empire builders in the previous century. They now realised that high disease rates were the result not of climate but of the disease environment and scientific medicine seemingly offered the answers. Vaccination and anti-disease treatment programmes – against lice, mosquitoes, and a variety of insects and worms of all kinds – built resistance to the diseases they caused. Some programmes pursued the eradication of parasites.⁵² Armed with new treatments and programmes, European – and South African – doctors worked with an air of scientific superiority.

The medical services were a critical element in the administration of occupied enemy territory. According to The Hague Rules, military government was a temporary regime to be replaced as soon as possible by civil administration. The administration of occupied territories became a War Office responsibility, which involved staffing the administrative machinery with military officers, who had to “make clear to disoriented populations, which had lost their government, that another one was there, at hand and ready to take its place”.⁵³ Human security was primary – people had to eat and they had to be able to buy food but civilian doctors could not be used in the warzones. As a result, the military medical services could play a vital role in establishing confidence in the new administration.

Practically all South African narrators wrote about their patients and the people they encountered: combatants and civilians, in-patients and outpatients.

7.5 million, British Somaliland at 0.4 million, and the Italian civilian population at 120,000 – the last concentrated in Addis Ababa, Mogadishu and Asmara.

In some districts of Abyssinia but also Kenya’s

, syphilis and gonorrhoea were the most frequent diseases; here advanced syphilitic ulceration and gummata were common. The quantity of anti-venereal treatments captured later suggested that venereal diseases (

 s) had been a major problem to the Italians.

There were also hookworm and Guinea-worm infections in Somaliland and Abyssinia; tapeworm and roundworm infections in the

; and trachoma from the coast to Addis. Orenstein, making a case for more personnel in October 1940, noted:

In order to safeguard the health of the troops stationed in and near large centres of population, we have found it necessary in effect to play a major role in the hygiene of such communities. This means that we have to provide personnel.⁵⁶

An air of superiority, of a peculiarly British nature, therefore pervades, which rests on notions of Western scientific superiority and of the benefits, specifically British science could bring. Anning records that some Abyssinian communities outside the Italian medical service developed an unsophisticated form of vaccination against smallpox: “pus is taken from a pock, kept in mud for some days, and then rubbed into cuts on the body”.⁵⁷ While they mused at local African medical practice, some also denigrated French practice in the Somalilands. According to the eafhq’s “Notes on Diseases”: “French Somaliland appears to be like those happy countries which have no history; if one were to judge from what has been recorded it has no diseases, pests or medical problems”.⁵⁸ In this view, the British Empire was a vast developmental agency: bringing in this case medical relief and the benefits of medical science to “the darkest corners of the continent”.⁵⁹ In a very real sense, the war theatre became a large laboratory in which the military doctors could conduct clinical trials on 10 million potential subjects in a war-torn region disrupted societally and ecologically by the combatants London, Rome, and Pretoria imposed on the landscape.⁶⁰

The samc rendered medical services to Allied soldiers, Italian prisoners of war (pow s), and the local civilian populations. They described the local African populations in broad, colonial ethnographic terms. One doctor addressed the questions of language and religion: “attending our hospital natives [sic.] derived from almost every part of Africa, speaking no less than 30 different languages, and worshipping at least three different gods that necessitated their consuming three different kinds of food. There were no interpreters for a considerable time, and not one black man in 100 could speak any European language”.⁶¹ Kiswahili although spoken by many became the situational means of communication. Alongside them were the European outpatients: some came from training camps where sick parades started at 7am each morning, some were Italian civilians, and some were pow s they treated and evacuated. A captured Italian pilot treated in an Allied hospital for 75 days, recounts that “not once did [he] think that [he] was a prisoner”.⁶²

The state of the Italian medical services. An Italian cartoon dated 1941 depicting a rather grisly scene in an Italian surgical hospital at Addis Ababa. The artist, E. Natoli, has inserted himself into the scene. Allied medical officers thought much more of Italian medical practice than Natoli would suggest. Note the racial and gender stereotypes of the Italian figures as well as of the severed body parts. (© Private collection, I.J. van der Waag)

Citation: International Journal of Military History and Historiography 43, 3 (2023) ; 10.1163/24683302-bja10052

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Steenkamp – who had graduated from the medical faculty at the University of Louisville, Kentucky and qualified as a physician at the University of Leiden before becoming a Fellow of the American College of Surgeons⁶³ – discussed the nature and scope of the Italian medical services in greatest detail. He did so largely in laudatory terms, although he stresses the differences with British, and therefore also South African, practice. These descriptions after all had the practical value he stressed. After 1935, the Italians had built infrastructure – roads, hospitals, medical and veterinary services – to consolidate their hold on Ethiopia and built creditable medical facilities for their large garrisons. They had built hospitals totalling eight thousand beds and smaller sickbays (“ambulatoria”) attached to the scattered forts and police posts, which they kept well stocked with drugs and other medical supplies – even the smallest medical outposts were all equipped with the most elaborate sets of instruments. Steenkamp remarked on the prominence of ampoules on the Italian drug schedules. samc personnel joked: “that castor oil seemed to be the only drug that was not administered hypodermically by them”.⁶⁴ There were glucose and saline ampoules, large quantities of vaccines and sera, stocks of strychnine and camphor oil – older styles of heart stimulant, but still in vogue in Italy – and vast quantities of quinine, and morphine. The large supplies of vd drugs told their own story. Steenkamp also noted that, contrary to British and South African military practice, most Italian pills – quinine included – were sugar coated, which reduced their absorbability and therefore their effectiveness. When they captured large quantities of British manufactured drugs – taken by the Italians from British Somaliland – it was “like meeting an old friend amongst a crowd of strangers”.⁶⁵ However, under the circumstances, he argued, the Italians deserved credit for what they accomplished.

Steenkamp was more sceptical of Italian surgery (see Photo 2). They avoided general anaesthetic whenever possible and were thought to tie patients down to the operating table before administering local sedation. In this, he thought them “continental in their outlook”. One Italian pow recorded how he resisted the chloroform mask when operated on by Allied medical staff.⁶⁶ Their brand of Novocain he thought also inferior to the South African equivalent and their standard of surgery, while good, was generally conservative. The Italian doctors treated abdominal gunshot wounds expectantly – treating complications as they arose; administered glucose and saline routinely in all cases, not from a continuous drip but in one sitting; and used cotton gloves, then considered old-fashioned. In contrast, their ambulances were elaborate, with chrome fittings, accommodating four stretchers, and having a cupboard and washbasin, although they were less robust than the smaller, “rough-and-ready”, veld-type South African models.

South African doctors mostly enjoyed good interpersonal relations with their Italian counterparts. Where possible, they left Italian doctors to care for Italian pow s and left the arrangements in civilian hospitals undisturbed. When needed, they easily negotiated space for South African and allied wounded after “mutual discussion”. Steenkamp recounts that recaptured Allied pow s found in Italian hospitals were “all unanimous in lauding the treatment they had received”.⁶⁷ Joining Steenkamp, other doctors praised the Italian doctors they encountered and the standard of their work. Some they mentioned by name – such as the Professor Ribandi at the Italian military hospital at Dessie.

The troops, in their letters and memoirs, thought differently of the wider environment. Water resources were contaminated and the human settlements unsanitary. The troops improvised; as Allan McDonald noted: “To have a bath when one hasn’t a paraffin tin requires only a groundsheet. You dig a hole in the ground and spread your groundsheet over it. Pour in your water and ‘Hullo’ – ‘Ain’t nature Grand?’!!”⁶⁸ Clifford Portsmouth of Natal Carbineers noted the condition of Addis Ababa where “the gutters of the street [were] filled with filth”.⁶⁹ Blamey referred to “the filthy habits of the enemy who had no idea whatsoever of the fundamentals of military hygiene”.⁷⁰ Others referred to the local population, often in racialized terms. Orenstein realised that he would have to manage hygiene matters differently. In the first instance, the samc, focussed on the health of troops, would have to play a major role in the hygiene of the communities where these troops were based. By October 1940, in Nairobi – where the medical services were “virtually doing the bulk of the anti-malaria work” – malaria, which had been very prevalent, was reduced to negligible proportions. But he needed more hygiene personnel especially for such general work. Rather than attachment to specific battalions, he created a pool of hygiene personnel that could supervise sanitary conditions in the towns and military camps – necessarily dispersed to reduce the dangers of aerial bombardment – and work systematically in eradicating pests and improving living conditions.⁷¹ “Here again”, he cautioned Thornton, “practice upsets book theory.”⁷²

“The Medical Headquarters staff”, as Neil Orpen noted, “consisted of British, Colonial and South African officers and other ranks”, but his contention that “there was never even a hint of friction throughout the campaign” was manifestly untrue.⁷³ Senior South African medical officers, including Colonel Blair-Hook, remarked – sometimes casually, but also officially – that “the vast bulk of the military forces in this country is from South Africa, and that the South Africans at the same time play a very minor role in the higher appointments, and that South Africa does not have its voice here as much as it should under these circumstances?”⁷⁴ Astonished, Orenstein raised the matter with his principals at Defence Headquarters. In overall numbers, South Africa provided one soldier in four; and, in the medical establishment, about the same ratio held true. The high command was different. As he argued, “the first consideration [was] capability and experience” and South Africa did not have the cadre of fully trained medical specialists Britain had. The idea, he felt, was caused by “the ballyhoo which has been raised in connection with recruiting”.⁷⁵ That senior officers, knowing better, broadcast such views was troublesome.

Nevertheless, Orpen was correct in another sense; Orenstein, on arrival in Nairobi, had found that assistance – “immediate and on a large scale” – would have to come from South Africa “before any active campaign could be undertaken”.⁷⁶ In a preliminary survey dated 6 June 1940, Orenstein identified the numbers and the range of medical units that would be required in East Africa. These are shown in the first column of table 1. No less than twenty-one of the thirty-eight units, including two of the five general hospitals, would have to come from South Africa. The units available as at 31 December 1940 – in time for the January push, and to serve 11(African)Division, 12(African)Division, 1(sa)Division, and the lines of communication troops – are shown in the second column of table 1. In addition, several units came on strength later.⁷⁷ Moreover, each squadron of the saaf had one regimental medical officer (rmo), each battalion of the three South African brigades had two rmo s, and each battalion of the East African brigades had one rmo.⁷⁸

The priority for the medical staff was military efficiency. Anning noted in his post-war history: “The main task of the medical organisation, bearing in mind the heavy sickness rate among udf [South Africa’s Union Defence Force] troops in East Africa in 1916–1917, was to keep the troops in the field in a tropical country.”⁷⁹ Some ‘lessons’ were flagged from the previous war. They presumed correctly that the numbers of battle casualties would be low, and that special attention would have to be given to the hygiene organisation. Hygiene personnel, including one samc hygiene officer, were attached to each South African battalion and brigade headquarters, and a hygiene demonstration park and training centre was established near Nairobi in November 1940, where staff of the samc and eaamc gave instruction in hygiene matters to personnel from the whole of the East African Force.⁸⁰

As Barton Keep predicted, transport difficulties would mark the whole campaign and affect the provision of medical services. These stretched from the regimental aid posts (rap s) in the forward areas to the field ambulances and casualty clearing stations (ccs s), to the base hospitals. The rap s were associated with their respective regiments, while the field ambulances moved with the Divisions and the casualty clearing stations moved by Force as rapidly as possible in the rear of the advance. The field ambulances and casualty clearing stations provided all forward treatment, which they effected in most cases to completion: all sick and lightly wounded re-joined their units directly.⁸¹ Sited at Mombasa and at Gilgil, the two ccs s functioned as 200-bed, stationary hospitals, while the four general hospitals – remaining at their original sites throughout the campaign – cared for the local sick, serious battle casualties, and some less serious casualties evacuated from ccs s during the initial 1941 advance. Although the War Office required beds in general hospitals for 10 per cent of the force engaged in tropical campaigns, in East Africa less than half this number was provided for and no general hospital worked to capacity. Hospital ships evacuated udf and British troops to Durban, while they treated all African patients in East Africa and opened a Convalescent Depot for Africans on 1 April 1941 at Ndurugu.⁸²

The South African field ambulances, of which there were four, were organised to meet the challenges posed by the climate and terrain. A conference convened by Orenstein in November 1939 – medical officers of the previous East African campaign were present – identified the fundamentals for the re-organisation. They set aside the system of rap s, advanced dressing stations (ads s), main dressing stations (mds s), ccs s, and base hospitals, which had worked so admirably on the Western Front where only a few kilometres separated medical units. In East Africa, where the spaces were larger and the war more mobile, the distances between ads s and mds s would be more than 50 kilometres, and between mds s and ccs s several hundreds of kilometres. The new system they developed had to cater for South Africa’s approach to warfare in Africa: different regiments and battalions operating concurrently, moving and fighting, on several wide mobile fronts.⁸³ As a result, each field ambulance had to serve more than one front simultaneously and provide care for South African troops and enemy casualties as well as a growing number of pow s. The companies of each field ambulance were organised to operate apart from each other “as a practically independent show”⁸⁴ – each equipped to deal with almost any medical procedure. The doctors worked on extended lines of communication and in relative isolation. “A” and “B” companies, each sub-divided into the usual ads s, was positioned with a light section immediately behind the front line. There they kept cases until evacuation to the mds – the hq Company of the Field Ambulance – was possible; again, cases remained at the mds until further evacuation to the ccs, which might be hundreds of kilometres away, was possible. The long distances, poor roads and roadblocks, and insurgent activity halted any rapid evacuation of serious cases. The “salvage” of enemy equipment allowed 12 Field Ambulance’s hq Company to equip two operating theatres at the mds, where the surgeon [Steenkamp] “could walk from one theatre to the second and while working there, the first theatre could be prepared again for the next cases”.⁸⁵ In this way, each field ambulance developed into three light, very mobile, casualty clearing stations, where patients could be hospitalised effectively until evacuation was safe. The system worked well. Almost without exception, Steenkamp records, the South African wounded received attention within six hours, which was then the ideal in treating battle casualties. The Italian wounded were less fortunate; Allied troops conveyed many to South African medical units after discovery on the battlefield.

Another recurrent theme is medical personnel and administration, and the nature and work of their staff – medical orderlies, drivers, storekeepers, and stretcher-bearers. Patriotism and the sense of taking part in large events, the promise of fun and enjoyment, as well as the opportunity to relish comradeship, and a range of personal reasons, animated medical practitioners to volunteer for military service – as they did for all South African service personnel.⁸⁶ Some continued a tradition of family service. Captain Hylda Briscoe was a volunteer nurse in 1940. Her brother, a pilot officer in the Royal Flying Corps, had been killed on the Western Front in 1918, while their father, a medical officer, had served in the Anglo-Boer War, then the Zulu Rebellion, and, wounded twice, won an mc in German South West Africa and then a dso in Tanganyika during the First World War.⁸⁷ Such generational linkages were common throughout the South African forces and indeed of the Commonwealth. Yet, a shortage of medical practitioners volunteering to serve in uniform remained. At the field ambulances, many doctors, who were not qualified surgeons, operated on patients. Blamey recounts that, after the Battle of Dadaba, with the Italian doctors “badly shot up”, Jack Freeman assisted the South African mo – “not exactly a pleasant job, especially for a layman”.⁸⁸ While each field ambulance company was equipped for surgery, not all companies had a registered surgeon – most were attached to the ccs s and base hospitals. As a result, general practitioners practised surgery, and most did excellent work and gained valuable experience under trying conditions. Later the samc would establish the mobile field surgical units – each with a specialist surgeon – that proved of such value in Italy where they could keep up with rapidly moving forces in smaller, tighter spaces.⁸⁹

Recruitment received sustained criticism the volume of which had “become astonishing”. Thornton found it “rather hard carrying on under this intensive bombardment”.⁹⁰ There were complaints about the men in the camps – there were nearly 3,000 cases of illnesses among the troops in the Union at the end of July 1940;⁹¹ of the death of a cadet named Butcher at Roberts Heights; that the men at Medical Directorate were too old – others complained they were too young; that insufficient men had been called up, others complained that the countryside, hospitals and universities were steadily denuded of doctors. In the meantime, Thornton and his staff were employed in mobilising medical units and transferring them to “the North”, while battling to wrest vehicles, equipment and stores from “Q”. He jokingly told Orenstein on 28 July 1940 that: “sometimes I feel like telling them all to go to blazes and appointing myself as mo to the Caprivi Strip, … it is a bit hard having to fight the Germans and one’s own critics too”.⁹²

Thornton tried to surmount the personnel problem in several ways. Recruits came in very slowly. They were so short of medical officers that Thornton considered drawing some experienced officers from Orenstein’s staff in East Africa to form a nucleus for the field units of the 3^rd Division then being formed.⁹³ More doctors and nurses were needed. Well-known medical practitioner, Harvey Pirie aired his “definite impression that we are getting right to the bottom of the pool of men available”.⁹⁴ This did not help. Nurses, male and female, were enlisted from the South African Red Cross – the ad s (men) were first to go and entered with the samc, followed by the vad s (women) who enlisted with the South African Military Nursing Service (samns) – all of whom already had certified training.⁹⁵ Nurses might be acquired from Britain and older, married women might be recruited in South Africa, but doctors presented greater difficulty. Blair-Hook created a programme to recruit medical students from the universities of Cape Town and Johannesburg, but this encountered a range of problems: few aspirant doctors were willing to set a year aside to “gain experience” as orderlies. Twenty-nine volunteered but in some cases their parents objected. The programme was cancelled at the start of 1941 as the ordinary recruitment campaign intensified. Thornton attempted to convince the cgs that “the lads” would learn something of value and have future benefit, but Orenstein was less sanguine.⁹⁶ On the other hand, economic concerns troubled the employment of nurses. The recruitment of women in Kenya to serve as nurses with South African units meant a different uniform and better pay – a disparity that would cause much unhappiness. The first nursing contingent arrived in Mombasa in July 1940: earmarked for Nos 5 and 6 ccs and No 4 General hospital.⁹⁷ The first female clerks and typists arrived in August 1940; they arrived as privates in the Women’s Auxiliary Army Service and Orenstein arranged their ranks and promotions when they arrived in East Africa.⁹⁸

Several doctors commented on the quality of their staff. In one field-ambulance company, there were only two men actually qualified in nursing. One was a sergeant major whose work as a quartermaster monopolised his time and the other was a corporal “upon whom rested the burden of instructing the followers of many diverse callings in the art of nursing”.

The medical orderlies were of mixed provenance and many had no knowledge or interest in nursing. As one medical officer noted:

Our ‘other ranks’, until recently consisting of clerks, journalists, commercial travellers, miners, salesmen, plumbers, shopkeepers and followers of almost every occupation but nursing, found themselves called upon to minister to the sick.¹⁰⁰

One private confided to his officer:

I made a mistake by joining a medical unit. … I do not like the work. This nursing gets me down. Carrying pans and bottles is not my idea of nice work, and I can assure you that if I was offered £5 per day as a civilian, I would not take it on. … I have been put on fatigues since last Tuesday, and I hope this lasts, as I should prefer anything to nursing. I should have joined the M.T. or infantry. The only reason I did not do so was that I thought I would not be fit enough.¹⁰¹

Here lay the complaint – the persisting shortage of qualified, interested staff. We cannot know how many men were discontent, or bored, with nursing but the medical officers suggest this may have been widespread and the call came to appoint only men interested in nursing or, alternatively, use African personnel to fill out the shortages. One field ambulance officer argued that Africans, some of whom had worked in nursing roles in the hospitals of mine compounds, would make good the shortfall as long they worked under a “European nco” and that “provided that suitable propaganda were used to convince the men that natives [sic.] were being employed as nurses to liberate white men for combatant duties, and that the natives [sic.] were properly trained”.¹⁰²

Appropriate training for medical personnel was another concern. Warrant officers and senior

  s in the

, while expert at drill, had little knowledge of first aid or nursing. One field ambulance officer recounted a case where an

staff sergeant in charge of the reception tent at an Indian Mounted Transport camp, was able to clean or dress a septic wound. Most of the

’s

 s knew little of first aid or nursing: few learned this before volunteering. Medical officers – noting the absence of medical subjects – lamented the emphasis placed on the disciplinary side of training. A field ambulance officer:

I spent six months at Sonderwater [Zonderwater] drilling, saluting, attending formal dinners, mounting guards, and dressing and behaving as becomes an officer, without performing 72 hours of useful work that would in any way have assisted the health of the troops. The ultimate effect of all this military ‘kultur’ is to encourage at least some medical officers to believe in it. Some mo s come to take as great a pride in the smartness of their men as in their capacity to render efficient first-aid.¹⁰³

Much more might have been done at the samc depot at Zonderwater, where the men spent a considerable period before deployment. Several doctors wrote that this time would have been better spent on in the training and examination of medical subjects – rather than dissipated on parade-ground drill. As a result, the time spent at Zonderwater “was depressing and monotonous”.¹⁰⁴ The argument was not that first-aid and nursing had not been encouraged in some units, but rather that much more attention should have been paid to medical training. The nurses worked hard, but perhaps many, although having little interest in nursing, had to remain in these roles in the samc.

Promotion policy worsened the shortages of medically trained nco s. In most medical units, nursing orderlies held the rank of corporal – at most sergeant – and if promoted above that they had to “leave the wards for the parade ground, quartermaster’s store, or hygiene personnel”.¹⁰⁵ The medical officers in East Africa argued that senior nco s promoted to warrant officer be retained for the teaching of first aid and nursing and to foster enthusiasm for these disciplines amongst the new, junior nco s. In this way, they argued, the warrant officers and senior nco s in the samc might play a more vital role in winning the war in East Africa.

Stricter selection of medical personnel – particularly for East Africa – complicated recruitment. While there was a shortage of trained orderlies, Orenstein professed to rather do without than have men who would embarrass him. However, Pretoria’s proposal to use personnel from the Non-European Army Service (neas)¹⁰⁶ as stretcher-bearers was immediately political. Some at Barton Keep thought the neas would make poor bearers: while they worked well in a “herd”, they would be unwilling to venture in ones and twos to collect wounded under fire. Others were concerned that the white troops would lose confidence in the medical arrangements. They felt that European supervision of black and coloured bearers would make little difference and that at best they might be used for long-distance hand-porterage only – as had happened in the East Africa campaign of 1916–1918. But this was considered very unlikely.¹⁰⁷ The grim realities of the war shook these racial notions. Men of the neas performed meritoriously as stretcher-bearers in North Africa and Italy and in the forward areas.

By all accounts, the doctors enjoyed their deployments to the battlefronts. Despite the flies and the intense heat, some came to like the desert. Here they could create their own encampments – with boma, medical facilities, and campfire – and, as one explained, escape “the irksome formalities that unhappily constitute so prominent a part in army life”.¹⁰⁸ When in a beautiful location, they had only two concerns: the fleas and flies and the irregularity of their post. For Dingle, who tells his story in charming form, this was all reminiscent of a Scouting adventure – of a robust, outdoors masculinity.

At first, Dingle found his medical duties light in comparison to his military tasks. At Garissa, he was also chief censor, secretary of the officers’ mess, welfare officer, and “chief buyer for our battery”. The last job took him regularly to Nairobi, some 250 miles distant, where he “satisfied the purchasing wishes of a hundred men, bought the unit’s liquor and cigarettes, and brought back luxuries such as soap and toothpaste”. He also returned “with a summary of the

news”.

His regimental aid post served as his personal sleeping quarters, the storeroom for his medical supplies, and as his medical inspection room. The structure he tells us:

was woven from cocoa-nut leaves by friendly [locals], and snuggled against a large mango tree. It crawled with ants of different dimensions and various colours, but afforded necessary shelter from the scorching sun and heavy dew.¹¹⁰

Dingle was the only mo in the area and the line of men, gathered each day at his quarters, was long, although – at this stage, with long days of inactivity – few were ever actually ill. Most arrived to speak to the other men there for the same reason.

For the most, the medical staffs and their patients lived on dry rations. Fresh vegetables collected from the towns, sometimes more than 150 km distant, meant that little survived the journey. Sometimes local farmers or district officers provided sheep – or game poached – for fresh meat. Blamey recounts that parties went out to shoot for the pot. Game was plentiful, but when inspected, something the medical officer insisted on, was often found to be worn-infested and dangerous for human consumption because of the dreaded hookworm.¹¹¹ Slaughtered daily, the local medical officer inspected the meat and pronounced on its suitability.¹¹² Dingle, when at Bura, was called on to pronounce on the fitness-for-consumption of a slaughtered ox: he “passed him first class amid cheers and handshakes”.¹¹³

The troubles did not abate. Britain’s request that South Africa increase space to six thousand acute hospital beds and two thousand convalescent beds for troops from the Middle East increased pressure. The dgms investigated the possibility of recruiting American staff as well as reducing the number of medical officers per battalion from two to one, which was the Imperial establishment. While some medical men looked upon their work in the Union as a nuisance, having their eyes “fixed north”, there were also those wanting to benefit from the enormous explosion of hospital services in South Africa and the concomitant chance for rapid promotion¹¹⁴ Mark Cole-Rous, a surgeon attached to 6 ccs in Mombasa, was bored and with nothing to do played golf.¹¹⁵ Such doctors felt that their skills were wasted. Others, working hard under combat conditions, were dissatisfied with the promotion-hungry ‘base wallahs’.¹¹⁶ South Africa was short of medical personnel, had trouble in completing its medical establishments in East Africa, and concurrently staff the hospitals opened in South Africa at London’s request for British troops. The gradual arrival of ramc reinforcements from Britain eased the position and before the end of 1942 South Africa withdrew her medical commitments from East Africa.

Distances, terrain, and poor-quality vehicles presented the medical staffs in East Africa with unique challenges not satisfied by the existing war establishment tables. Experience forced Orenstein to revise these tables for field ambulances and other medical units. Unnecessary stores were being sent north while essential items were missing. As Orenstein noted: “in the case of No.3 General Hospital we have got tons of equipment which is of no use whatever to us; although it might have been quite useful in the Crimean War!”¹¹⁷ There were steel wedges, presumably for splitting wood, and wooden iceboxes but there was no ice to be had anywhere near hospitals, while picket stakes and ropes for horse lines arrived with No.4 General Hospital.¹¹⁸ Instead, Orenstein compiled a list of essential items, including proper beds, an ice-making plant and refrigerators, and good sets of carpentry tools. The stores for a general hospital were “somewhat formidable” but supplies, if modernised, could be simplified. However, they would not overcome some deficiencies, such as the timely, accurate provision of medicines and the battles with “Q” and “T” continued. The 12^th Field Ambulance’s historian records that the “tools – mark you – not instruments” used by three nco s, who had been embalmers by trade, for an autopsy in a forward area, included “a cross-cut saw and a screwdriver”.¹¹⁹ The author leaves the reader to wonder whether he used fact or hyperbole.¹²⁰

The scarcity of drugs and surgical equipment remained a concern. As Thornton admitted: “The weak spot in our show is the Medical Stores.”

Severe losses in Greece including 3,000 beds and medical equipment, a flu epidemic in South Africa, and the opening of new hospitals and convalescent centres in Egypt and South Africa placed additional pressures on the medical stores in East Africa.

In April 1941, a pharmacist at a

ordered 120 items – many common and essential drugs including aspirin and magnesium sulphate. Of the 120, no less than 85 were “inabilities”. While some of the common drugs could be procured locally, others were unobtainable by some units at least for lengthy periods. Moreover, medical officers were not informed of the reasons for the shortages.

The

hoped that as the Italians withdrew, Italian medical supplies – known to be ample – would fall into their hands. Large quantities of medical supplies were captured at El Wak.

And Dingle tells us he left Mogadishu with “sufficient medical stores to satisfy my needs for several months”.

Sometimes, as Steenkamp vividly recounts, the Ethiopian populace looted and destroyed before the Allies could move forward. At Harrar:

we witnessed the looting of an Italian advanced depot of medical supplies. It was a big barn with walls 40 ft. high, and measured approximately 100 x 200 ft. It was stacked to the roof with cases of ampoules of all kinds, various drugs and dressings, while big jars of ointments and gallon bottles of stock mixtures were stacked on racks. When we arrived on the scene, there were hundreds of [locals] smashing the bottles, breaking open packing-cases and scattering their contents. On the outskirts of the crowd, the children were amusing themselves by playing with balloons, made of inflated caputs Anglaises [condoms], of which boxes, each containing a gross, were very much in evidence – these being the ration issue to Italian soldiers. After the crowd had dispersed and a guard posted over what was left, one walked ankle-deep through boxes of ampoules and each step was followed by miniature explosions caused by crunched ampoules, while one’s boots were coated by a muddy paste of ointments and powders from the floors covered by the mixed contents of jars and cases.¹²⁶

Captured medical supplies undoubtedly saved many Allied lives. This applied to drugs – including glucose and saline for intravenous use – as well as plaster of Paris. The latter, although of inferior quality, was increasingly used when the Allied supplies could not keep up with the advance. That the Italians did not use elasto-adhesive strapping was most annoying especially when Allied supplies were low.¹²⁷

The South African Red Cross Society filled part of the breach. They provided fresh vegetables for the hospitals, books and magazines for the wards, and specially designed field ambulances and mobile laboratories, while their Durban Branch served the transports and hospital ships including the Amra, which they provisioned for each trip. The mobile laboratories, equipped for diagnosis and treatment, could move immediately to the site of any disease outbreak, while two mobile refrigeration units transported drugs, blood plasma and other vital supplies to forward medical units. Yet the greatest gift from the Red Cross was possibly an air ambulance that could transport up to 24 stretcher and sitting cases with equipment and personnel.¹²⁸

The terrain and disposition of the companies of a field ambulance, meant that each company – sometimes separated from each other by hundreds of kilometres – had to function as a small ccs. Each ought to have had a portable x-ray machine for “the early diagnosis and treatment of fractures, the diagnosis of bone and joint conditions, and the location of foreign bodies”.¹²⁹ However, this requirement seemed extravagant. Powerful x-ray units could only be used in Nairobi, where there was suitable electricity supply. Smaller, portable units might be used. But the age group of the military patient in East Africa meant that intestinal work was rare – perhaps more psychological than pathological – and any cases demanding x-ray diagnosis were sent to Nairobi.¹³⁰

By the end of July 1941, the medical services in East Arica provided for 135,000 troops in addition to a growing number of Italian pow s – the number reached 70,000 in that month – and the local civilian populations. In 1941, the medical services provided 1,400 beds for pow s, who were moved to the coast as soon as possible for their own protection. The port of Berbera offered the shortest route. pow s found the medical inspection unpleasant and the hygiene measures humiliating. Between 25 July 1941 and 30 September 1941, the medical service treated 11,500 pow s at the disinfestation centre at Chamgamwe alone. Here the men were deloused and cleansed, treated for any ailments, and their clothing laundered. Notwithstanding the unpleasantness: “Many a doctor received cordial invitations to accept hospitality in Italy after the war.”¹³¹

The doctors naturally wrote about illnesses, the nature of the casualties, and the development of medical procedures. As an anonymous medical officer confirmed, “battle casualties were rare”; the most common diseases suffered by their African patients were dysentery, malaria and venereal diseases, while “among the Europeans the ordinary everyday conditions of general practice”.¹³² The computation of returns of admissions to medical units was difficult during the war and equally so after. However, Anning and other narrators provided returns that indicate admission rates, in broad terms at least, as well as the most frequent causes for hospitalisation. The South African admissions rate contrasted very favourably with theatre for the East Africa campaign of 1916–1918; the sickness rate per thousand troops per annum declined from 2,243 admissions (1916–1918) to less than 850 admissions (1940–1941). Table 2 shows that the admission rates also varied quite considerably by force, race, and area of deployment. South African troops generally had a lower admissions rate: members of the neas were admitted at the lowest rate (773 per 1,000 troops per annum for 1^st Division) and this rose to 2,155 per 1,000 for the East African Brigade, which served under the command of the 1^st sa Division and suffered heavily from dysentery.¹³³

South African troops – although many had been urban youths – were “fresh and keen”. They were not only the fittest drafts to join the udf during the war, but everyone was a volunteer and, their mood buoyed by the rapidity of the advances, managed to overcome most of their personal infirmities. Sick reporting only rose after Addis Ababa was entered. Table 3 shows the most frequent causes for hospital admission. While the sickness rate was low, two major preventable diseases – malaria and the acute bowel infections – were prominent. Springbok troops had been at first too casual regarding the anti-malarial measures. As Anning noted, the malarial numbers were also an indication of unit discipline. Gunner Ford records that: “At the evening and main meal of the day, a medic stood at the head of the queue with a supply of quinine tablets. Each man could only collect his food after swallowing a tablet.”¹³⁴ However, despite the precautions, the men went down with malaria. Dingle notes:

At first it seemed strange seeing them shiver with cold, and trying to cover themselves with all available blankets for warmth when it was so intensely hot, with temperatures of one-hundred-and-ten to one-hundred-and-fifteen in the shade. I treated the vast majority in camp for base hospitals were two-hundred-and-fifty miles away. Evacuating a patient all that way often meant waiting weeks for his return, with consequent loss of stability in the carefully trained gun team.¹³⁵

While malaria was common in parts of East Africa, Italian Somaliland and Abyssinia, most of the infections may have occurred among non-Divisional troops infected along the lines of communication. However, the rate of 215 and 292 per thousand troops per annum among South African troops in East Africa was dangerously high.

The most common group of diseases affecting the Allied forces was gastrointestinal. The same nexus existed between the incidence of the acute bowel infections – caused by dirt and carelessness – and camp and kitchen discipline. Low sanitary standards compromised the health of troops in some camps and Orenstein had cause to admonish senior officers, who “seemed to find it impossible to enforce sanitary discipline or to get their troops to realise their responsibilities in this matter” – including the digging of latrines in appropriate areas, the combat of fly-breeding, and the control and purification of water resources. Enteritis and dysentery occurred at alarming rates. Specimens were sent to the mobile laboratories. The 1^st Transvaal Scottish suffered two outbreaks; the pathologists found that four of the 27 regimental cooks were dysentery carriers. Acute bowel infections were the most frequent cause of incapacity in the forward areas, especially after, Anning recorded, “the occupation by our troops of insanitary area evacuated by an enemy who had little of the appreciation of sanitation”.¹³⁶

Of all conditions, doctors wrote about venereal diseases at greatest length. Venereal diseases, while a regional problem, were particularly severe in Kenya’s nfd where syphilis and gonorrhoea were rampant. The admission rate for venereal disease was highest among African troops. As shown in table 3, the admission rate per thousand South African troops in East Africa during 1941 was as follows: 25 per thousand per annum for “Europeans” and 82 per thousand per annum for “Non-Europeans”.¹³⁷ There were 1,073 venereal cases among udf troops in 1941: 170 due to syphilis, 376 to gonorrhoea, and 527 to soft sore infections or other venereal diseases.¹³⁸

Dingle suggests that most cases of

were contracted in the towns. After months in the bush, short of water for washing and plated food, the troops entered Mogadishu. The local brothel was one of the main attractions. Controlled by the military authorities and inspected regularly by medical officers, it had existed for some years. Dingle described its working: “Twenty-two cubicles fringed three sides of a neat rectangular lawn which provided comfortable chairs for easy repose … Each cubicle had a long, very slowly moving queue of participants. A door would open, a gowned figure smile, and the queue would become shorter by one.”

A veteran recalled:

When you came out of the desert, oh boy! The army established and ran brothels of Italian women. The military saw that hygiene standards were maintained. This was in Asmara. In Addis Ababa, the going rate was 5/- for one poke. There were briefings on vd – the army called for abstinence. If you contracted a vd, you were isolated immediately. In Alexandria, there was a vd hospital for the Australians. South Africans went to the sa General Hospital. Stuck in the desert for bloody months on end, the guys would come back from leave with all kind of rubbish.¹⁴⁰

Control of vd especially among African troops was one of the seven improvements suggested by the anonymous field ambulance officer. Prevalent before the war, by 1940, vd s reached serious proportions, especially among East African troops. However, as a field ambulance officer noted, until a policy change in mid-1941, “no serious attempt was made on a large scale to reduce the incidence of these venereal diseases, by propaganda, prophylaxis, efficient treatment, or in any other way”.¹⁴¹ Hospitals were too few and only complicated cases, requiring bed treatment, were admitted. Ordinary gonorrhoea and chancroid cases were treated as outpatients, while the scarcity of drugs and equipment for irrigative treatment meant that doctors could give only palliative treatment in most cases, which was of little value. While the end of the Abyssinian campaign did not solve the vd problem – the troops deployed to other parts of Africa and the problem resurfaced – the medical officers expressed the hope that the authorities there would tackle the venereal epidemic with more seriousness than had been the case in East Africa before July 1941. Quite probably, troops carried vd with them from East Africa to Cairo and Alexandria, and the Western Desert.¹⁴²

For much of the East African campaign, doctors relied on sulphonamide drugs – the default for std s. As shown in table 4, before the arrival of penicillin, large numbers of troops were hors de combat for relatively long periods. Penicillin shortened the treatment for syphilis from 40 – 50 days to just eight days. It cleared gonorrhoea in 1 – 2 days.¹⁴⁴ But of course other steps were deemed necessary.

African urban areas, eating-houses, and tearooms run by Africans were declared out of bounds to troops. All men showing any symptoms had to report immediately – within 12 hours – to a medical officer. Troops were not permitted to visit civilian practitioners for treatment; this was viewed as concealment and an aggravation of the offence. Troops concealing their condition were disciplined under Section 11 of the Military Discipline Code. The warnings and punishments were repeated in unit orders, read to units on parade every three months, and a lecture programme instituted every two months by the local doctor. Moreover, “promiscuous women” were controlled and the rank and file inspected monthly.¹⁴⁵ In addition, the Red Cross gave lectures and presented films, and produced leaflets and posters for civilian and military consumption. The first, full-length Red Cross film was produced and shown from February 1940. Aimed at the neas, this film – called The Two Brothers – also went to East Africa, where it was widely used in camps “to warn native [sic] troops against the physical perils of promiscuous living”.¹⁴⁶ Notwithstanding, the vd rate soared in the Middle East after 1941 – amongst black and white troops.

In sum, during the East African campaign, for every single South African battle casualty there were at least 40 casualties due to preventable conditions. In the absence of ready reinforcements, had the Italian opposition been more resolute, the South African armed forces would have been further “crippled from loss of manpower”.¹⁴⁷

Environmental conditions are prominent in the writing. As one soldier announced to his former headmaster, this was “the land of sand, sun, scorpions, spiders and Springboks”.

Garissa, according to Dingle, was “an area of virgin bush”: “There was no town, no building, or any other sign of civilization.”

But they did have an abundance of wild game – so fresh meat presented no difficulty. However, it was sited in “one of the most notorious malarial belts in Africa”: “The nights swarmed with huge blood-thirsty mosquitoes, so I issued regular doses of quinine and saw to it that our mosquito nets were so adequate that they were early suffocating in their efficiency.”

The value of an entomological section had been immediately apparent. But there were other concerns: contact with rats and lice, spider and snake bites, scorpion and insect stings, and contact with insects, beetles and worms that caused rashes and lesions. As Dingle noted:

The sting of the centipede was excruciating. … The millipedes were about four inches … did not sting, but produced blisters when they came in contact with bare skin. There were always cases of jigger fleas. These minute insects burrowed under the skin, usually on the feet or between the toes and laid their eggs in a neat little circular bag. Daily foot inspection revealed the little bag, projecting above the skin. This was easily enucleated with a pin or needle. Failure to treat would lead to sores which took weeks to heal.¹⁵¹

Scorpions were in abundance – sometimes visible on the trunks of trees, sometimes hidden in the bark. At night, they might crawl into a man’s boots. Troops were warned to “hold [their boots] upside down and shake well before putting them on”. Nonetheless, the careless were stung: “I was told that it was a most painful sting, as though a red-hot needle was going into the flesh.”¹⁵² Snakes were many, but incidents were fewer. Dingle had large supplies of antiserum but was seldom called to use it, although on one occasion he tells us that “a three-foot by one-and-a-half-inch snake” slithered out of the roof of his post – falling on his patient, while on another occasion, a large black tarantula momentarily interrupted a medical procedure.¹⁵³

They wrote notes for internal distribution and articles for publication on a range of other conditions that caused varying degrees of loss of manpower.¹⁵⁴ “It was terribly hot”, Ford reminds his readers, “and most of the men went about in vests, shorts and sandshoes. We were as brown as berries and fit for anything”.¹⁵⁵ On the long term, men unprotected from the sun for long periods may have suffered skin cancers later in life and there are probably other, less documented and perhaps poorly understood health hazards – including psychiatric illnesses.¹⁵⁶ More immediately, they were prone to scratches and minor puncture wounds from thorns. Desert sores (septic skin conditions) were frequent in dry sandy areas where water was scarce and dust and dirt irritated small scratches. Then there was “Wajir Clap” – a non-specific urethritis from drinking untreated water; “Habaswein Itch” – a redding of the skin caused by a caterpillar; and some beetles caused lesions; and certain species of trees irritated the skin and sometimes caused sickness. The men of “B” Company, Royal Durban Light Infantry had long been inflicted by terrible sores, which only cleared when the company occupied an Italian farm near Awash; they dug up potatoes, onions, and cabbages and “every man was ordered to consume two raw onions a day”.¹⁵⁷ Within a fortnight, the sores had cleared. The regimental medical officer, Captain W.B. Fiddian-Green would adopt similar measures in North Africa. Not every condition was so easily treated.

Steenkamp operating on a casualty in Abyssinia. (© wps-PA3. With permission: W.P. Steenkamp, Cape Town, 2022)

Citation: International Journal of Military History and Historiography 43, 3 (2023) ; 10.1163/24683302-bja10052

• Download Figure

Considering the nature of the campaign, the loss of life – to accident, disease, and enemy action – was low. The numbers are given in table 5. Battle casualties occurred at a rate of 3 per thousand for “European” troops and 1.7 per thousand for the neas. As Blamey noted during the fighting before El Yibo:

I thought that the volume of fire must surely mean that many of my comrades had been killed or wounded.¹⁵⁸

It seems quite incredible that during the three days of action not a single man in our regiment was even wounded, despite the hail of bullets that whizzed around us.¹⁵⁹

Regarding battle casualties, the samc experienced great difficulty in providing adequate surgical services in the forward areas(see Photo 3). The wounded were treated promptly although specialist surgeons and adequate equipment were sometimes unavailable. The medical staff had to learn quickly. They treated wounds using medical procedures like those employed in the land and air battles in France and Britain at the time: excision, drainage, and fixation in a closed plaster splint. Wound excision was by now less drastic than the debridement that had become standard practice in the Great War. They now focused on “saving rather than removing limbs”.¹⁶⁰ Several factors pointed to the change caused by the unique East African battlespace. Firstly, a high proportion of the wounds sustained were from rifle and machine-gun bullet wounds, and these were less lacerated and contaminated than those caused by shell fragments. Secondly, in East Africa the battles were not fought over agricultural land or in muddy trenches; this meant that the troops and their clothing were reasonably “clean”. Moreover, the new anti-bacterial drugs – developed during the interwar years, and available from 1941 – delayed infections in contaminated wounds and allowed tissue more time to repair. Fourthly, doctors realised that for most wounds debridement could never be complete and attempts to do so were unnecessarily destructive. Once draining was freely established, most wounds repaired well in plaster casts. Treated in this way, wounded men travelled well – “even with little skilled attention on the way, and with methods of transport that were far from ideal”. Sometimes, of course, wounds worsened en route. However, Anning found this to be caused by faults in the primary treatment. Such faults might be apparent in the forward medical units of the armies in Europe, but not in East Africa where surgeons had little opportunity of conferring with colleagues and seeing the final results of their work.

In his War of a Hundred Days, Brown argued that Smuts – determined to avoid the physical exertion of the campaign fought against Lettow-Vorbeck twenty-five years before, and its political consequences – would fight a different campaign in 1940–41 and that the “medical services were to be the most efficient the time could supply”.¹⁶¹ But, beyond pointing to motorisation and the adoption of South African methods of manoeuvre, Brown says little of the men and their innovations in the direct sphere of the samc. The East African campaign passed quickly and, as Smuts noted, Allied losses – taken holistically – were “ridiculously small”.¹⁶² The low udf admission rate for wounds in action (11 per thousand for Europeans and 1 per thousand for the neas) contrasted sharply with the rate of 133 per thousand troops with 6(sa) Armoured Division in Italy (1944–1945). While the South African losses were light, the 4^th and 5^th Indian Divisions lost between four and five thousand men in the battles for Keren.

For the medical practitioners serving in East Africa and later further afield, deployment enabled a stimulating intersection between the motives that animated other South African men and women to volunteer for wartime service – travel, adventure, patriotism – and their professional ambitions regarding the growth of medical science in the fluid and varied conditions of a modern war. They were amateurs in the domain of warfare, and many men – and some of the women – who worked as orderlies and nurses in the military establishments were lay medical personnel. Sometimes the learning curve was steep, and progress depended on good leadership and innovation of practice under often extreme circumstances. But the medical staffs grew in size, knowledge, and expertise as the campaign progressed. They adapted to local conditions, trained on the job, and gained experience and battle-hardiness. Steady improvement and the growing size and sophistication of the Allied medical deployment led to remarkably few admissions – and fewer fatalities – from preventable illnesses and diseases as well as improving practice in the treatment and evacuation from vast operational areas characterised by exterior lines and rapidly lengthening supply lines. Fortunately, as Anning noted, these ‘lessons’ were “learned in a campaign in which few battle casualties occurred”. In East Africa, the samc developed the more fully coordinated medical service that served later in the Western Desert and in Italy.

The medical officers were also a product of their time and place. They depicted their campaign through a common set of tropes, using recurrent themes and motifs. They were all White males, literate and educated, and all were war-time volunteers. Products of their time, there is an unintentional, normalized, gender and racial bias in their writing. Their descriptions – and those of other soldiers – of masculinity and race prejudice is sometimes heavy. They acted, and wrote their narratives, against the backdrop of privilege and power in the hierarchies of military life.

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