Report by Major Maynard on the Kilwa Area and Accompanying Correspondence
To: The Director of Medical Services, East African Expeditionary Force, Dar-es-Salaam
I have the honour to draw your attention to a few of the questions which arose during my visit to Kilwa, under your instructions, and while acting as Senior Medical Officer (temporarily) to the Kilwa Column.
PREVALENT DISEASES IN KILWA DISTRICT
A very large amount of sickness is occurring among the Troops in this District, a good deal of which, could, I believe, he prevented, if greater care and supervision were exercised. The chief diseases appear to be malaria, sun, fever, relapsing fever, and a short fever apparently infective in origin, the exact nature of which is as yet undetermined, possibly pappataci fever. Cerebro-spinal meningitis has also occurred among the Carriers at Kilwa, Kisiwani, and Chemera, and also among Cape Natives at Kisiwani.
To limit the spread of these diseases and ensure proper treatment for the sick, it is necessary to provide means for microscopic examination of blood samples, to make a systematic survey of diseases prevalent in the various occupied areas, and to maintain a strict sanitary supervision of units and posts. So far as I could ascertain, little or no attention has been given to sanitary matters in the 1st Division. No sanitary personnel has been taken forward, camp sites are chosen and laid out without reference to the medical authorities, and the Senior Officers do not appear to realise the importance of these matters.
MARCHING IN HEAT OF DAY
As a predisposing cause of sickness, unnecessary exposure to mid-day sun appears to be a most important factor, and one to which insufficient attention is being paid. Two instances came under my observation.
1. On Saturday, 25 November, a number of Cape natives were marched from Kisiwani to Kilwa in the heat of the day, the march being started about 10 a.m. The men were carrying their full equipment, blanket, overcoat, haversack, water bottles. Further they were most unsuitably clothes for a hot climate.
2. On Monday, 17 November, two Companies of 3 King’s African Rifles were met marching along the same road, with full equipment at 10 a.m.; they were met at this hour close to their place of departure.
It was unofficially reported that the Gold Coast Regiment had also marched through the heat of the day, and had had in consequence a large number of men fall out from heat exhaustion. Short of actual cases of heat or sun fever these marches are most exhausting and lead to a great increase in the sick rate.
I would urge that very stringent orders be issued against all unnecessary exertion during the hot hours of the day, and the Os C units be held personally responsible for breaches of such regulations.
SICKNESS AMONG CAPE NATIVES
A very excessive rate is occurring among Cape Natives in the Kilwa area. Several causes appear to have contributed to this result. Unsuitable clothing, long hours work in the sun with insufficient rest, improper conditions of housing:-
a) Sun or heat appear to be common among these natives; it was consequently recommended that helmets be issued in place of felt hats, and that their ‘Bedford cord breeches’ be replaced by slacks. The GOC of the Column sanctioned the issue of helmets and an indent was put in to replace the breeches.
b) Their hours of work when on convoy are long, viz. from 3.0 a.m. to 9.0 a.m, and 2.0 p.m. to 7 p.m. They average about six days on convoy, and one in camp, Kilway. During their day in camp they work from 6.0 a.m. with two hours off at mid-day.
c) Originally these natives were housed in old local huts. These I ordered to be burnt and the camp site moved to land not previously occupied by natives. This has been done, and bandas have now been erected on a new site. Quinine, 10 grains twice a week, is now being given to all these natives.
SANITATION OF POSTS
It has not been customary in this Division for any personnel of Sanitary Sections to accompany the brigades and Battalions. In consequence the sanitary standard has fallen very low. Sanitary personnel should accompany troops to camp sites and undertake control of water supplies, erection of incinerators, etc. It is not anticipated that there would be any trouble in getting sanction for this, if the value of the sanitation personnel were explained to the GOC. Further, sufficient sanitary appliances should be carried by each unit so that immediately on arrival in camp, incinerators could be erected and latrines equipped. One mule could carry all the equipment required for a battalion and the saving in sickness should amply compensate for the extra personnel and supplies necessitated. From personal observations I am convinced of the urgent necessity for increased sanitary supervision in the Division, and the presence of a trained sanitary personnel.
SANITARY OFFICER FOR KILWA AREA
In order to remedy many of the disabilities referred to above, it is suggested that a GHQ specialist sanitation officer be attached to the Kilwa district including Divisional area. It would appear necessary that at least one trained sanitation officer, who could devote his whole time to sanitation, should be so attached. His duties would be to generally supervise questions of sanitation in the field, to report on defects of clothing, food supplies and hours of marching, to investigate the cause of special incidence of disease in localities or amongst units. To carry out these duties efficiently, he must be constantly moving from district to district, and be therefore supplied with the necessary transport. I am of opinion that a large amount of the sickness now occurring amongst men of this division could be prevented if strict sanitary supervision was kept and proper attention paid to sanitary recommendations.
In view of the approach of the wet season, some energetic measures are required in regard to mosquito control. Also it seems possible that other biting insects may be responsible for some of the disease in the district. It is suggested that if possible the loan of the Economic Entomologist from Zanzibar be obtained, and that he be asked to visit Kilwa and district with a view to advising on the best measures to be adopted to deal with the mosquito situation, and to report as to prevalence and distribution of any other disease carrying insects.
RETAINING SICK AT FRONT
Intimately connected with the heavy sick-rate is the question of retaining sick at the front. It is urged that when men are evacuated to Lines of Communication Hospitals they do not return to the firing line. The question of making proper arrangements for replacing casualties is not a medical matter, but the disadvantages of adopting the practice of retaining the sick in the front line do not seem to be fully realised by the CO’s and General Officers Commanding.
Field units are not equipped or established to deal with large numbers of sick, therefore, unless rapid evacuation to the rear takes place, they become very much overcrowded, with the following inevitable results:-
a) sick do not get proper attention
b) They must be discharged at the earliest possible moment, in order to make room for new arrivals, and therefore, before being really fit for duty.
c) As no detail or rest camps are available, they have to return to their units, and are not infrequently on short rations at a period when rest and good feeding are essential to full recovery.
d) As a result, many of them return to hospital within a short period.
e) The undesirability of this system will be seen when it is remembered that two of the most prevalent diseases are malaria and dysentery, both of which tend rapidly to become chronic, and incapacitate a man for useful service for months, unless complete recovery is made before return to duty.
f) The result of this system is that a considerable number of men are being kept in the front line, nominally as fit men, eating rations and thus adding to the transport difficulties, who are practically useless as fighting units when a move takes place, and they hamper the mobile units, and render them unable to perform their legitimate duties, and give proper attention to the sick.
g) If, after matured consideration it is still considered advisable to adopt this method, which in my opinion merely gives a fictitious value to the fighting strength in the front line, then arrangements should be made to considerably increase the medical units with the Brigades.
h) The permanent damage to the men’s health which also follows from adopting this method of treating sick, should be born in mind.
i) The effect of hampering movement and immobilising field medical units is no doubt fully realised by the General Staff.
EVACUATION OF SICK FROM FRONT
Owing to the state of the roads from Kilwa forward, motor ambulance transport is not practicable. Beyond Mitole and Chemera to the North only bush tracts exist, and no wheeled transport can be used. The road between Kilwa and Mitole is very sandy in places, and wide tyred vehicles are necessary. In wet weather, this road will, from all accounts, be quite impassable for wheeled traffic owing to long stretches of black soil.
The chief method of evacuating serious sick must therefore be by Carriers. During the dry season great assistance can be given by returning supply convoys from Chemera and Mitole. A sufficient supply of sling hammocks or stretchers will be required. These should be as light as possible in order to minimise the number of porters required to return them to the front. For the slightly sick, pack mules, will I think, serve a useful purpose, but more than the ten per section of Field Ambulance will probably be required, as the time taken to clear from even Kibata to Kilwa, will necessitate their absence from the unit for at least eight days. These mules could of course be utilized for returning the stretchers used for carrying down sick.
Owing to the local conditions, absence of water, etc, it does not seem practicable to establish ‘aid posts’ on this route. It appears desirable, therefore, to establish a travelling medical personnel to accompany sick convoys. A Medical Officer or Sub-Assistant Surgeon, one Indian dresser, and two African dressers with a pack mule carrying a small stock of drugs, dressings, and comforts should suffice. As journeys are apt to be unavoidably delayed at times, the discomfort to the sick however, would be minimised by having the medical personnel always available.
INDIAN SUBORDINATE PERSONNEL
Owing to the shortage of Sub-assistant Surgeons, and the great difficulty in replacing these officers, it seems undesirable that much of their time should be taken up doing purely clerical work, as at present appears to be the case. It is suggested that a good clerk be attached to all Indian units, and that in this way a certain number of Sub-assistant Surgeons would be set free for the medical work. This should do something to relieve the pressure on this class of officer, and also facilitate the working of units who are already short of Sub-assistant Surgeons.
Owing to the considerable increase in the number of porters employed in the Kilwa area, and to the fact that it is proposed to largely increase the number in the near future, an increase in the medical personnel of this hospital is required. At present the Medical Officer in charge has as much work as he can cope with, and the work is increasing daily.
I have the honour to be, Sir
Your obedient servant
(sgd) GD Maynard
Major, SAMC, DADMS
1 December 1916
General Headquarters, Dar-es-Salaam
1 December 1916
To: DA & QMG, General Headquarters, Dar-es-Salaam
I forward herewith Report by DADMS (Sanitation) General Headquarters, who, under my instructions, has recently been doing duty at Kilwa, and was asked to report to me on the general Sanitary Conditions of this district.
Copies are being forwarded to GOC, 1st Division and ADMS, 1st Division for their information.
I entirely concur in his general remarks, and early attention should be directed to giving effect to them.
I propose detailing a Specialist Sanitary Officer from GHQ for the Kilwa area and he should be allowed every opportunity to visit the Divisional area and advise on questions of sanitation generally.
I propose approaching the Zanzibar Government as to the question of the Economic Entomologist.
The question of evacuation of sick from field units is an important one and I agree with Major Maynard’s views. An increase in Indian Medical Units with the Division is, I fear, impossible at present, as India cannot supply IMS Officers or Sub-assistant Surgeons, although they have frequently been asked for them.
The addition of European Clerks to Indian Field Ambulances is a good suggestion and would relieve the Sub-assistant Surgeons for medical work. Possibly a certain number of clerks could be found from Section B for this purpose or volunteers from Imperial or South African Infantry Units, if you approve.
The medical charge of an increasing number of Carriers is a growing difficulty, and Medical Personnel is very difficult to provide at present. I am trying to engage African Dressers to assist.
(Sgd) GD Hunter
Surgeon-General, DMS, EAF
General Headquarters, Dar-es-Salaam
1 December 1916
To: The GOC, 1st Division, Kilwa
I forward herewith for your information a copy of a report from DADMS (Sanitation) GHQ, which was called for by me; a copy has also been passed to DA & QMG.
I would draw your attention to several points he brings to notice, viz:
1. Marching in heat of day.
2. Sickness among Cape Natives.
3. Sanitation of Posts.
4. Retention of sick at Front.
5. Evacuation of Sick.
The question of proper sanitary supervision of the troops is an important one, and your ADMS should pay every attention to it. If personnel of Sanitation Section are now required, I will arrange for same to be sent to your Division.
I concur generally in Major Maynard’s remarks and would request that every attention be given to such points as apply to your Division.
Copy for ADMS, 1st Division.
(Sgd) GD Hunter
Surgeon-General, DMS, EAF
Headquarters, 1st Division, Kilwa
14 December 1916
To: The DA & QMG, General Headquarters
I have considered report by Major Maynard, DADMS (Sanitation), GHQ, forwarded under cover of DMS 1682/16 of 2 December, a copy of which was forwarded by him to you:-
1. I would point out that Major Maynard was SMO of the Force operating in the Kilwa area under General Hannyngton and up to the time when I took command and the ADMS, 1st Division assumed his duties. Consequently Major Maynard’s criticisms are, in fact, criticisms of his own administration. I do not consider the few days from 19 November to 27 November, (which he was awaiting the arrival of the Officer to whom he had to hand over his appointment as SMO to the 3rd Brigade), gave him the opportunity to observe the medical administration of the 1st Division, as opposed to the mixed brigade of which he was SMO.
2. As regards the points brought to notice under the heading ‘Prevalent Diseases’ the ADMS had already in his 5/9 of 26 November 1916 to the DMS, suggested the desirability of a medical officer with microscopical outfit being attached to each brigade.
3. Apart from the time Major Maynard was himself in a position to bring points to the notice of the GOC, whose SMO he was, camp sites have always been selected with due regard to medical advice and taking tactical situations into consideration.
So far as I am aware neither the DMS nor the DADMS (Sanitation), GHQ, has been within the Divisional area throughout the operations from May to November, nor am I aware of any comment on camp sites has ever been made by the DADMS, at Adv GHQ. I know of no occasion throughout the period when a camp, if not all it should have been from a sanitary point of view, could have been otherwise sited.
4. Major Maynard’s criticisms under the heading ‘Marching in the Heat’ shews he does not appreciate all the difficulties which have to be considered in arranging times of march. Any undue marching in heat is avoided as far as possible.
5. From May to November, while the 1st Division was on the march, incineration was not possible and the great difficulties due to the shortage and breakdown of transport are known to you. The operations in this area at present, may no doubt allow of incineration because some camps may be more of a standing camp nature.
6. The duties of the officer outlined by Major Maynard under the heading ‘Sanitary Officer of the Kilwa area’ are such as presumably fall with others to the DADMS with divisional headquarters already. If the DMS considers an additional officer should be appointed, so much the better, but it must be clearly understood he is under the 1st Division, and not a specialist reporting to GHQ.
7. Major Maynard’s time with the 1st Division was not sufficiently long for him to know that an entomologist (Capt Anderson) has lately been attached to the division.
8. The question as to whether sick should be retained in field ambulances when the troops are not on the march is intimately bound up with the question of keeping up the strength of the troops. Immediate evacuations cannot be avoided when on the move, but it is not always advisable to evacuate cases which may be expected to recover in a few days.
9. The shortage of personnel to carry out the necessary clerical and statistical work has been previously brought to the notice of the DMS (Monthly report for August 1916, Summary). No additional assistance has yet been given.
10. The crux of the whole question is the low percentage of medical units and officers which have been allotted to the division from commencement. This was brought to the notice of the DMS last May. The result has been that medical officers have been overworked and themselves gone sick, and administration generally has been carried out under great difficulties.
11. Kilwa Kivinji, with its large transport camps, requires a medical officer who can be in charge of the personnel and also the sanitation of the place. It is hoped that such an officer will be appointed at once.
12. I would also suggest that all carriers be vaccinated on enlistment and before being sent to this division for work.
In conclusion, I would add that although the DMS sees fit to agree with the DADMS (Sanitation) GHQ, generally, I cannot go far with him in this respect.
Had that officer a close knowledge of the 1st Division and a more practical understanding of its working in the field, he would have written a report of more practical value to the division and one more helpful to the DMS.
(sgd) AJ Hoskins, Major General Commanding 1st EA Division
General Headquarters, Dar-es-Salaam
24 December 1916
To: DA & QMG, General Headquarters, Dar-es-Salaam
With reference to remarks by GOC 1st Division on Major Maynard’s Sanitary Report on Kilwa area, which was called for by me.
It is to be regretted that this Report – which deals with certain points that were actually observed by my representative – should have been received in such a contentious spirit.
It is Major Maynard’s duty as DADMS (Sanitation) GHQ to inform me on any points that may require attention, and to make any suggestions to benefit the health of the troops.
The Report, it will be noticed, is drawn from actual observation of troops at the time in the area, many of which now form part of the 1st Division. It was sent to the GOC 1st Division, and he was requested that every attention should be given to such points that affected his division.
I am glad to see attention has been drawn to some of the points mentioned in Division Routine Orders of 15 December.
With reference to para 6, the Specialist Sanitation Officer is to be attached to GHQ, with powers to visit the Divisional area and report on sanitary measures carried out therein; he is not a Divisional Officer.
I would remark that such Officers were of much use in France, and can often render help and advice and furnish valuable suggestions as to sanitary matters.
I think it should be understood that Reports of this nature are not made in the spirit of criticism, but with the intention of pointing out any defects that may be observed and to draw the attention of Commanding Officers to such, so that they can be remedied and avoided in the future. Our joint endeavour should be to try and lessen preventable diseases by every means in our power.
(Sgd) GD Hunter, Surgeon General, DMS, EAF
AQMG, Adv GHQ Duthumi
C70 Will you please show the GOC-in-C the attached papers. He will remember seeing Major Maynard’s report when in Dar-es-Salaam.
I agree with DMS that the tone of 1st Division reply is not calculated to promote harmonious working. As DMS’s representative, Major Maynard was quite in order in criticizing arrangements he saw, and it will be observed that DMS only drew General Hoskins attention to such points as affected his Division.
I do not suppose the GOC will wish the matter taken further, but I think he should see the correspondence.
(Sgd) RG Ewart, Br General
DA & QMG, EA Force, Dar-es-Salaam
DA & QMG
Seen by the GOC-in-C and returned.
The GOC-in-C naturally wishes the matter dropped.
(Sgd) CF Dobbs, Lt-Col, AQMG
Duthumi, 16 January 1917
[pencil note: 4 days before Gen Hoskins discussed command of force.]