It’s healthy to separate – apparently

Over the past few months while looking into home front aspects in Africa around World War One, I couldn’t help but notice that town planning in the pre-war days revolved around segregation for health reasons.

Instead of finding ways to accommodate different cultural practices in one space, it was felt better to separate them. The issue became one of containment – and then finance. Despite concerns about infection spreading, funding improvements was an issue. The long term impact of improving sanitation and thereby the health and economic potential was ignored with significant consequences when plague and small pox broke out, and then the 1918 flu.

Towns I’ve read about include some in the Eastern Cape and Johannesburg in the pre-1920s and Nairobi. While it might be more understandable in territories such as British East Africa, I find it difficult to comprehend how the South African territories having experienced the consequences of the 1901/2 war (and not just the camps) did not realise the wider implications of restricting health initiatives.  But then, Nairobi was a new town in a British controlled territory as well… and given the coverage of the camps and hygiene issues in Britain during the 1899-1902 war, one (I) would have thought they’d learnt their lesson.

Similarly, looking at the early division in the Presbyterian church in South Africa, the divide came about due to meeting different needs: those who had prior knowledge of the Bible required more analytical type sermons than those who were still new to the contents.

I can’t help but wonder, whether, if our ancestors had been bold enough to find a common ground working and living together, our situation today would be any different. Are we any further along the journey to considering collaborative solutions? I’m not so sure when I see all the separate groups calling for equality and inclusion. We have some indications that it can be done: the countries which have united or federated (South Africa, USA, Australia, EU), the UPCSA (Uniting Presbyterian Church of Southern Africa), and SADC?. It’s not been easy journeys for any of them but if it’s been done at such a macro-level, can we do the same at more micro-levels? Seeing the consequences of decisions made to separate 100 years ago because it was easier, makes me think it’s worth the risk to find some common ground and struggle through the growing pains of creating something new.

References:

Sana Aiyar – Indians in Kenya
Alan Cobley – On the shoulders of giants: The black petty bourgeoisie in politics and society in South Africa, 1924-1948
Jack Dalziel on the early history of the Presbyterian history in South Africa and various other sources (forthcoming publication)
Heyman Mandlakayise Zituta, The spatial planning of racial residential segregation in King William’s Town 1826-1991 amongst others
Norman Parsons Jewell – On call in Africa in war and peace, 1910-1932

The importance of transport

One of the biggest complaints one hears in connection with the East Africa campaign of the First World War concerns logistics and the lack of food getting to the front line. The person who is most riled against in this regard is Jan Smuts when he was commander in chief between February 1916 and January 1917. His rapid moves meant that his lines of communication became overstretched with the result that on occasion men were on as low as 1/4 rations for a few days. This when rations were already at their minimum.

So, it was with interest that reading Conan Doyle’s Letters to the Press (pp60-), I discovered that he had something to say about the importance of transport during the Second Anglo-Boer or South African War of 1899-1902. Early in the war, Conan Doyle was a doctor in a private hospital in Bloemfontein, his offer of service to the War Office having been declined (see Something of themselves for more detail on Conan Doyle’s work in South Africa).

On 7 July 1900 in a letter to The British Medical Journal under the heading “The Epidemic of Enteric Fever at Bloemfontein”, he wrote:

When the nation sums up its debt of gratitude to the men who have spent themselves in this war I fear that they will almost certainly ignore those who have done the hardest and most essential work. There are three classes, as it seems to me, who have put in more solid and unremitting toil than any others. They are the commissariat, the railway men, and the medical orderlies. Of the three, the first two are the most essential, since the war cannot proceed without food and without railways. But the third is the most laborious, and infinitely the most dangerous.

He continues to expound the word of the orderlies who had to deal with the enteric outbreak where in one month there “were from 10,000 to 12,000 men down with this, the most debilitating and lingering of continued fevers. I know that in one month 600 men were laid inn the Bloemfontein Cemetery. A single day in this one town saw 40 deaths.”

The medical men and “the devotion of the orderlies” saw this through:

When a department is confronted by a task which demands four times more men than it has, the only way of meeting it for each man to work four times as hard. This is exactly what occurred, and the crisis was met. In some of the general hospitals orderlies were on duty for thirty-six hours in forty-eight…

The rest of the article is devoted to the medical conditions and how despite the lack of resources, the Medical Services achieved what they did.

An army marches on its stomach (Napoleon?) and ill men need decent food to heal properly, and for this transport would be required. When Millicent Fawcett met Kitchener to find ways to ease the issues in the concentration camps, he acknowledged that food was important but for him as commander of the army, the army was his priority. However, he had no issue adding an extra carriage with food (providing Fawcett’s group paid for it) to the trains delivering food along the railway lines. His soldiers had been suffering too from food shortages.

While South Africa had the railway line which ran the length of the country, as opposed to the three lines in East Africa which ran across, all three were single track meaning trains could move only in one direction or the other limiting the time they could run. More significantly, those needing to be fed were not always close to the railway line requiring other means to get them their rations. Porters in East Africa, ox-wagons in South Africa – each with their own limitations and challenges to overcome. As Army Surgeon General Dr Pike recorded in the report he wrote on the East Africa campaign, the transport drivers were the most hardworking, often up before most in camp and the last to go to bed, often without meals as they ensured their vehicles were fit to undertake the journey.

One could argue about whose role was most difficult and important in conducting the war, in both conflicts all were called on to exceed expectations and did. It’s where they worked together harmoniously and in sync that success was achieved. What Conan Doyle and Pike remind us of in their comments, is that those working “behind the scenes” are as significant as those on the front line.

Can we compare?

I’ve had a number of people suggest making links between the current virus situation and that of 1918. Some saying they’re similar, others disagreeing. Many say we’re in unprecedented times, I’m not so sure. I’ve commented before on how comments in one situation are almost identical to another (the 1899-1902 2nd Anglo Boer or South Africa War and the East Africa campaign of 1914-18 in particular). This one resonates with comments circulating during 2020 across numerous countries.

On 5 November 1918, six days before the armistice, South African Governor General Lord Buxton wrote to Jan Smuts in England with news from South Africa.* Prime Minister Louis Botha was on his way to England in preparation for the peace discussions (Smuts had earlier written to friends saying he knew the Sunday before the armistice was the last Sunday of the war).

There is going to be trouble over the Epidemic. The Health Department of ‘Interior’ was extraordinarily stupid and wanting in foresight, pedantically allowing the Influenza to come in from the Transport (Native) where it had been raging; and further throughout the epidemic, it has shewn want of energy, courage, and resource, in dealing with the position.

The ‘Health’ powers of the Government are of course lamentably limited, but Watt ought to have thrown himself with energy into the affair, and done all, and indeed more than he legally could, to cope with such a grave position as that which has arisen.

At that stage in South Africa, there had been 20,000 deaths. Buxton was also lamenting the fact that the opportunity had gone to pass a Public Health Bill and to sort out Housing.

This is one of a number of instances where the Spanish flu was mentioned, all resonating with comments I’ve heard and read in recent times. I’ve also seen similar comments expressed in relation to the Ebola outbreak, the 1980s HIV/AIDS and other significant crises during the past 100 years.

How do we, as historians, therefore determine how ‘unique’ a situation is? Should we be trying to decide whether our time is worse than that experienced with the 1918/9 pandemic or the Ebola outbreaks? Where does Foot and Mouth and BSE management regimes fit in all of this? The situations prevailing for each crisis has been different, although commonalities can be identified. Does this mean that we can draw conclusions that people in 1918 felt the range of emotions we encounter today? Were there the same concerns about people flouting what was seen to be essential practice to contain the spread? I haven’t read enough of the situation 100 years ago to be able to answer this confidently, but I don’t recall having seen much documented in the diaries and memoirs I have worked with where the flu is mentioned. For those writing diaries and commentaries on the current time – how do you plan to give future readers a clearer picture of what you’ve been through so they can distinguish between your feelings and those of other similar circumstances?

Perhaps as part of the Great War in Africa Association medical project some more might come to light as doctors explain and set out what was groundbreaking for them 100 years ago. Looking back, medical knowledge had made huge leaps and bounds – Norman Jewell talks of his first x-ray machine in Africa, plastic surgery and the manufacture of artificial limbs occurred and there were discoveries around tropical diseases. When compared with complaints around medical issues in the 1899-1902 war and Kitchener’s engagements in Sudan and other conflicts dating to the Crimean war, I’m astounded as to how medical knowledge developed, yet today we find similar questions being asked and concerns raised. How is it that we find ourselves in a similar situation today?

Can we compare? or do we simply acknowledge – it was different and when explaining the past make reference to ‘in memory’ events to help our readers understand.

* From Hancock and vd Poel, Smuts Papers, vol 3, p684,

Sleepy vs Sleeping Sickness

Working through WW Campbell’s East Africa by Motor Lorry (reprinted with additions by GWAA), I was intrigued to read about ‘sleeping sickness … (which, by the way, is not to be confused with sleepy sickness)’. I just had to look up sleepy sickness.

This sleepy sickness is not caused by the tsetse fly which causes sleeping sickness, otherwise known as trypanosomiasis. Its cause is not known and it apparently presents with typical flu symptoms by which time it’s too late to prevent the virus from attacking the brain. Its official name is Encephalitis lethargica and it was identified about 1915/6. An Austrian neurologist Constantin von Economo and the pathologist Jean-René Cruchet brought it to world wide attention. Over its run between 1915 and early 1920 approximately 1 million people died from it but its impact was swamped by the Spanish Influenza pandemic which caused the death of over 5 million people world wide (January 1918 to December 1920). At the time of writing, Corona had resulted in fewer than 150,000 cases world wide, with 4,300 deaths (www.worldometers.info – 11 March 2020), a month later these figures had risen to 1,872,014 cases with 116,071 (13 April 2020) . Howard Phillips provides some interesting insights regarding the 1918 flu.

Thoughts of Sleepy Sickness having disappeared were dispelled in 1993 when Professor John Oxford diagnosed it in a young girl which led to further investigations. A linked disease/variation is Parkinsonism popularly brought to public attention in the Oliver Sacks 1973 book and film, Awakenings.

Sleeping Sickness or trypanosomiasis gained notoriety during the First World War for the number of animals who died as a result of it. Misinformation given to (through ignorance, as we know the British held maps of German East Africa were poor) the South African investigators in late 1915 as to the feasibility of horse-power in the East African theatre resulted in the mounted forces suffering extraordinary losses when they hit tsetse fly areas, by which time it was too late to save the animals. The demands of the theatre and drive to push the Germans into a corner, led to all, including animals, being asked to give their all. Today, trypanosomiasis is still prevalent in 36 African countries affecting both humans and animals. Concerted efforts have been implemented following an outbreak in the 1970s with the result that by 2030 it is hoped the disease will be completely eradicated.

War-time sanitation

At the start of the First World War, a review appeared in the Times Literary Supplement (27 August 1914) on two books dealing with sanitation in war.

The review provides some interesting figures on how since the Crimean War instances of dysentery had been reduced. The reviewer notes that while the idea of missiles and other weapons carry the imagination of the civilian as the main cause of death, the figures show it’s disease.

Going further back to Napoleon, in 1809 he apparently had 241,000 men in Spain and 58,000 in hospital.
A month before the battle of Corunna, Sir John Moore had 25,858 men available and 4,035 in hospital. He lost 800 in the battle.

Of the 52,584 men admitted to hospital in Crimea between 1 October 1854 and 31 March 1885 of which 3,806 were wounds, the remainder being due to illness.

The greater understanding of how disease spread and simple methods to hinder their extension went a long way to reduce the number of lives lost through disease. Preservation of health moved up the priority lists for the military authorities.

This was evident during the 1899-1902 war in Southern Africa where the deaths among NCOs and rank and file was 12,669 from disease against 7,010 from military action. Amongst officer ranks there were 716 deaths from military causes compared with 404 from disease.

The point of the article was to remind readers and in turn ‘young soldiers’ to not forget what they’d learned in training and that just one small drink from contaminated water could have dire results. Similarly, camps were to be kept as clean as possible and ‘filth’ as far away as possible. The review ends:

The recruit who masters the information which [the books] contain will not be likely, by a carelessness which would amount to criminality, to jeopardize either his own life or the lives of his comrades.

Although great strides were made to reduce the impact of disease in the war, it being the first where battlefield deaths exceeded disease deaths, in Africa it still accounted for all but 10% of deaths. Malaria, Blackwater Fever, Dysentery being the worst. Accounts by Norman Parsons Jewell, letters by Edward Harris and Francis Brett Young at the Cadbury Library, give insight into what doctors had to deal with while Gerald Keane explains how the African Native Medical Corps came into being and the work they did. The Pike report gives an overview of what conditions in Africa were like when an official investigation into the medical provision in East Africa was undertaken. None of this however, prepared the continent for what was to come in 1918.