The Pike Report (TNA: WO 141/31) was produced in January 1918. It was the result of an enquiry into the military medical services in East Africa during World War 1. The War Office had become concerned at the large loss of manpower for health reasons especially after one of Commander-in-Chief General Jan Smuts’ officers, Colonel Headley John Kirkpatrick of 9 South African Infantry (SAI) submitted an official complaint of the treatment of the forces in October 1916.
It is estimated that 75% of manpower losses were mainly due to malaria, dysentery, blackwater fever and malnutrition. Gunshot and other war-related losses accounted for only 10% of the losses.
In December 1917, Surgeon General William Watson Pike, Army Medical Corps (1860-1940), and Lieutenant Andrew Balfour, Royal Army Medical Corps (1873-1931), travelled to East Africa undertake an inspection. They produced two reports: one on the situation in British East Africa (BEA; Kenya) and the other on German East Africa (GEA; Tanzania). The two reports signify the difference between the two territories. By 1918, BEA was no longer a war-zone although it was still involved in the war. It was predominantly a climatisation/convalescent base and recruitment source (albeit limited). In the main, GEA was still a war-zone although the German forces were moving into Portuguese East Africa (PEA; Mozambique) in their attempt to keep as many allied forces caught up in Africa and away from the Western Front.
In addition to the white losses which caused concern, there had been a large number of Seychelloise (25) who had died on return to their homeland in 1917. Ed Paice estimates a 30% mortality rate. These labourers had been given an inappropriate diet on top of all the other pressures of campaigning in East Africa. Further the SS Aragon saw 135 (19%) Cape Labourers die on a return voyage to the Union of South Africa. Although not as devastating as the loss of the SS Mendi, the proportion of men and the belief that they had ‘they made up their minds to die and die they did’ (TNA: CAB 45/44, Fendall diary, 1 Jun 1917) was of concern. Pike was to investigate.
An initial read of the report is damning. This is not surprising given the losses involved and the conditions Pike reports on. However, one should treat these reports with caution – not to detract from the findings, but to put them in perspective. In addition to the negative highlighted, there are positives which Pike reports. Pike himself notes that he is not commenting on the good practice but on the issues. At least 68 doctors served in East Africa. In his report, 9 (13%) are particularly criticised. Some are praised. Significantly for cultural historians, the reports focus on all who served in East Africa, which at the time of the report consisted predominantly of black soldiers (KAR), labour and carriers. This is often overlooked as the report was commissioned as a result of white soldier losses. This recognition instinctly suggests that some of the poor medical treament was due to discrimination. It may well have been, but before conclusive decisions are made in this regard, it is worth considering the following:
1. The BEA report was completed before that of GEA. Pike had served on the Western Front and Balfour had been in Salonika. How much of the harsh critique of the medical conditions were due to their lack of knowledge of the challenges of the war in Africa expecting services to be of a similar quality to that in Europe/Salonika?
2. Captain Duke, EAMC, is severely criticised and was placed under open arrest by Pike for the mistreatment of patients with cerebro-spinal fever, leaving dead bodies in the same room as those still living. Another doctor, Lieutenant-Colonel Scott, RAMC, is criticised for not visiting one of his hospitals within his first week of taking up post and leaving it to the supervision of Miss Donkin, East African Nursing Services. Where were they serving before their arrival at their respective posts in December 1917? (Their time in East Africa needs to be further investigated at the time of writing the context.) Perhaps they had been sent ‘north’ to a ‘quiet’ zone to recouperate from arduous campaign services in GEA. Pike doesn’t comment on any of the doctors’ personal medical conditions but would these doctors have been in as fit state of health as Pike when he undertook the enquiry? What other conditions were prevalent which resulted in the dead bodies being left with the living? There was a scarcity of doctors – what other medical roles were scarce?
3. By the time Pike gets to the end of his investigation, how much has he tempered his initial views? If he had visited GEA first, would his report on that theatre have been more damning than what it is?
4. There are many positives as which are noted in the report. As previously stated, good practice by many of the doctors under very trying conditions. Support for the doctors who had been requesting medical supplies and microscopes to test for tropical diseases, but ignored as it was believed, following Smuts’ optimism that ‘only mopping up’ operations were required, that the war would be over soon and the equipment not needed. Not all of the poor service was due to the doctors on the ground but also the result of information on new techniques and discoveries not making their way down the line to those on the front line. The richness of reports by some doctors provide insight into what they thought would be useful statistics at the time. The breakdown of admissions and deaths into broad ethnic groupings as well as soldiers and labourers are valuable to understanding the composition of the forces and their susceptibility to specific conditions. Looking back 100 years we see that all who served received attention, not just the white soldiers.
In addition to the written report is a book containing 30 pages of photos which Pike and Balfour took (not reproduced for copyright reasons). These can be found in WO 141/30. The photos are of hospitals and conditions providing a visual insight into the medical services and some idea of the environment the doctors encountered. Other sources which shed insight into the medical services are:
Seventeen Letters to Tatham – Ann Crichton-Harris
On Call in War and Peace, 1910-1932 – Norman Parsons Jewell [website] Medical services, General History vol 1 & 4 – William Grant McPherson
African Native medical corps in the East African Campaign – JG Keane & DG Tomblings
Tip and Run: The forgotten conflict of the First World War – Edward Paice
Norman Parsons Jewell collection – Mary Evans Photo Library
Sources not linked above
‘Our Sacred Burial Sites’ in Seychelles Nation, 21 April 2013
South Africa and the German East Africa Campaign in International Encyclopedia of the First World War (WW1)