by John Nichol
For days, they either marched or hid up in the hills, until they reached a small bay on the south side of the island. Then, as they waited their turn for a boat, he was faced with another tough decision. It was decreed from on high that only the WWs, the walking wounded, could be guaranteed a place. There would be no room for the many stretcher-cases who had been lugged across the interior of the island. They would have to stay, as would more medics to look after them. Debenham agonized again – ‘horrible job’ – and opted to sacrifice the least experienced of his men in order to hang on to those he thought would contribute the most to the war effort afterwards. ‘Finally, I left with the WWs’ – and later he was cross with himself that he had allowed an undeserving case, a man with gonorrhea rather than a battle wound, to get away among them. In a destroyer, they were whisked away – it was ‘like an express train at 40 knots, with many twists and turns’ – and fifteen hours later disembarked in the safe haven of Alexandria.
Already in the Egyptian port was that young RAMC lieutenant from Bristol, Martin Herford, who had made an equally traumatic exit from mainland Greece a month earlier. British forces had been deployed there to stave off the defeat of the Greek army by invading German and Italian troops. His job had been to coordinate transport between forward medical units and casualty clearing stations, which had meant his criss-crossing the rugged countryside and pot-holed roads on a motorbike, an Enfield 250. But now the Allied expeditionary force was in full-scale retreat down the Greek peninsula, under constant bombardment from enemy planes. Growing numbers of casualties were in danger of being left behind. From the town of Levadia, near the front line, Herford, a newcomer to the army and a mere junior subaltern, ignored military protocol, grabbed a phone and rang the staff officers at headquarters in Athens to demand loudly and indignantly that an ambulance train be sent up the line at once. His cheek brought a positive response, and a train was dispatched. But, before it could arrive, Levadia was blitzed. Fighters, descending like hornets, strafed the roads and railway line, and the station was reduced to rubble as a nearby ammunition dump exploded. The train had made it only as far as Thebes, thirty miles away, and Herford needed to get there to organize the evacuation.
He jumped on his motorbike and took off along a road already littered with wrecked vehicles, dead mules and craters. Over a hill in front of him, a Dornier fighter-bomber appeared and swooped in at tree-top level, spitting bullets. A bomb erupted behind him, then another one ahead, and the twin blast knocked him over the handlebars and into the dusty road. He lay there, too frightened to move, certain he must have been badly wounded, just waiting for the pain to kick in. It didn’t, and he realized that, somehow, he was still in one piece, as, equally miraculously, was his bike. As the air raid continued, he rode on into Thebes.
There, amid chaotic scenes, he found the ambulance train, the windows of its carriages shot out by bullets from the air. The prominent red cross painted on its roof had clearly given it no protection. Hundreds of stretcher-cases had already been loaded on board, but they were going nowhere. The line had been cut by bombing five miles out of town, and the way south to Athens was blocked. The casualties would have to go by road, and he helped to unload them, stretcher by stretcher, amid their cries of pain, on to the platform to wait for lorries to arrive. But Herford had another concern. The ambulance train, one of only a handful in Greece and a valuable asset for saving lives, was a sitting duck and needed to be moved into cover if it was not to be destroyed. First he needed to hook up the carriages to an engine, and the driver of the only spare was nowhere to be seen. The doctor went looking and found him in a shelter, cowering from the air attack. He refused to move, until Herford took out his gun and forced him and his fireman back on to the footplate. The doctor then stood shotgun over the man as he shunted stray wagons out of the way of the ambulance carriages. A quick learner, after watching the driver for a short while, he even took a turn at the controls himself. Doctoring… train-driving… it was all in a day’s work.
All the time, Messerschmitts were buzzing overhead, their guns blazing down. Eventually, the empty ambulance carriages were hitched up and, through a barrage of bombs, the engine pulled them to comparative safety down the line. Over the next twenty-four hours, a gang of navvies repaired the break in the track, the ambulance train was loaded up and the latest collection of casualties, more than two hundred of them, were eventually on their way to Athens. Back in Thebes, Herford, having waved it off, switched back to being a doctor again. One of the German fighter pilots whose low-level attacks had been making his life hell had been shot down and was wounded. Without a second’s thought, he treated his enemy as he would any British soldier.
By now, the Greek army had surrendered to the invading Germans, and the remains of the Allied expeditionary force were heading, in a degree of panic, to ports in the south to be evacuated. Herford was picked up by a navy cruiser and taken to Crete and then on to Alexandria. It was the end of the first phase of his war, one in which, in truth, he had made little use of his medical skills. He had hared around organizing the evacuation of the wounded, at constant risk to his own life. But in his dedication and his flouting of danger, he had demonstrated that, for a doctor at war, there were no boundaries. It was his moral duty to put the safety of his patients above his own, and if that meant driving a steam train through an air raid, then so be it.
*
With the fall of Crete and Greece in 1941, the battlefield switched to the deserts of North Africa, an unnatural habitat for soldiers from the temperate climes of northern Europe, uncanny and unsettling. The landscape was vast beyond imagination, the front lines uncertain and often non-existent, supply lines always at breaking point. The terrain was sometimes achingly beautiful but more often harsh and ugly. Emptiness stretched in every flat, arid direction. Underfoot, there was as likely to be stones and grit as soft sand. Tank attacks took place over hundreds of miles, outflanking was routine and the enemy could be (and often was) camped in the next wadi or over a nearby dune, and you never knew until you heard a German or an Italian voice drifting over the night breeze and caught a glimmer of a fire. In this ‘bleak, barren, virgin, stony desert’, the RAMC’s Malcolm Pleydell was dug in, sleeping under the stars in a slit trench, as he revealed in a letter home. ‘A hot wind comes from the Sahara and is very trying. It brings a sandstorm in its train, grit in the hair, in the eyes, in the mouth, down the shirt, everywhere. How I miss England with its soft greens and blues and its changing skies. Damn these flies!’8
For doctors in these conditions, the enemy was more often not so much the Axis forces but the environment. Hygiene was paramount – keeping men clean and healthy and warding off flies and disease, particularly dysentery. Here, that pre-war RAMC training on where to site the latrines came into its own. ‘Mobile bogs’ were constructed from petrol tins and wooden frames, topped with the vital component – a lid. This was a war the Allies won hands down. Sickness rates among British troops were consistently well below half those of German troops throughout the North Africa campaign. Some strategists argue that the war in the desert was so finely balanced that the extra men the Allies were able to deploy were crucial to the outcome. On the eve of the second battle at Alamein, sickness cost Rommel a fifth of his forces.
A new generation of drugs proved important. Inoculation against typhoid was almost universal, while sulphaguanadine, introduced in 1942, transformed the fight against dysentery by slashing recovery times. Those with the disease could be treated in camp instead of having to be shipped back to a main hospital for three weeks of nursing on a liquids-only diet. But what made the biggest difference was that the British buried their human waste, whereas the enemy tended to leave theirs littering the surface.
The Tommies were well schooled medically in the prevention of the spread of infection from hand to mouth to stomach and then by hand to others.9 They were bombarded with blunt messages on cleanliness. ‘Don’t Murder Your Mates’ urged one poster. Injunctions like
this worked – but not when it came to sexually transmitted disease. Men threw caution to the desert wind as they tramped in their thousands through the whorehouses of Cairo and Alexandria. The condoms that could have saved at least some of them from debilitation were the subject of much moral/military debate. The Archbishop of Canterbury denounced the distribution of prophylactics on the grounds that it would invite fornication. Montgomery, on the other hand, was all for his boys having a good time when they deserved it, and most of them agreed with their commander. The dilemma for doctors was that they were often too busy dealing with battle casualties to find the time to lecture the men on the dangers of venereal disease or to carry out health inspections of authorized brothels, another of their supposed duties. But, as a result, their wards were over-burdened with clap cases. At Robert Debenham’s military hospital in Alexandria, two hundred of the seven hundred beds were occupied by VD patients.
It was to these hospitals in the rear that casualties were brought from the fighting hundreds of miles away in the desert. Out there, clashes were intermittent but brutal. When a tank was hit and ‘brewed up’, the injuries from fire were horrific. An armour-penetrating shell could shear off a man’s head as cleanly as a guillotine. Mines, scattered like seeds over mile after mile of sand, blew off limbs. Initial surgery was done as close to the action as possible, in highly mobile field medical units. Just behind the fighting, two desert-camouflaged, hard-top lorries would back up to each other and park a few yards apart. When the gap between them was covered over with canvas, a big enough space was created for an operating theatre. Here, complex abdominal and chest operations were attempted. Even ‘Max Factor’ (maxillo-facial) procedures such as skin grafting were started on to meet a growing problem. In the heat of the desert, sweating tank crews tended to discard their anti-flash protective clothing, with the result that more than a quarter of casualties were now burns cases. Surgeons at the front jumped smartly to meet all these new challenges.
To help them, they had an increasingly efficient supply of the battlefield’s number-one life-saver – blood. Initially, it had to be transfused for each patient, sometimes arm to arm, directly from the donor, but the introduction of mobile transfusion units transformed all that. They arrived at the front carrying bottled blood stored in oil-burning refrigerators. As he watched the life pouring back into a badly wounded corporal from the Nottinghamshire Yeomanry, ‘his blood pressure rising, his colour improving’, RAMC surgeon Captain J. C. Watts could see with his own eyes that this was ‘one of the most outstanding advances in war surgery’.10 In this particular case, it meant a life-saving operation to amputate the soldier’s crushed leg could begin immediately. If the doctor had had to wait for a live donor to be found, his blood cross-matched and then extracted before it was available for use, then he was sure the patient would have died. Stored blood, on the other hand, brought quick results when speed was of the essence, as, in war surgery, it so often was.
Less of a success story were the logistics for evacuating the wounded from the battle area to hospitals in the rear. The distances involved presented huge problems. Planes were rarely an option, to the disgust of the army’s adjutant general, who was appalled to discover there was not a single dedicated air ambulance in use. His protestations – ‘it is impossible to get accurate figures as to the number of lives lost and the suffering inflicted through the non-provision of ambulance aircraft’11 – went unheeded. The Axis forces were routinely evacuating their wounded by air, the Germans in specially adapted Junkers planes attached to each medical unit. But the best British casualties could hope for was to be loaded on to transporter planes returning to base after delivering supplies to the front.
Generally, their journey to hospital was overland and arduous. An RAMC report likened the situation to having a base hospital in London, casualties in York and the area in between not only uninhabited and uninhabitable but served by one narrow road and a single-line railway. Every train and ambulance convoy was a tempting target for enemy planes. Nonetheless, across the desert wastes they trundled back, many of those with leg fractures immobilized for the uncomfortable journey in what became known as a ‘Tobruk splint’. This was based on a traditional metal-framed Thomas splint – much used in the First World War and whose origins went back to its eponymous inventor, a Welsh-born doctor, who treated badly maimed dockers in Liverpool in the 1870s and then navvies building the Manchester Ship Canal. But in the ‘Tobruk’, an equally inventive (and unknown) RAMC medic of the Second World War, treating casualties in that besieged city, added a cast of plaster of Paris around the splint. It became a standard technique for safely transporting those with broken legs.
As fighting in the desert intensified, casualty numbers sent back to hospitals on the Nile rose to more than thirty thousand in one six-month period alone. During the big set-piece encounters, such as Rommel’s victory at the first battle of Alamein, so many casualties arrived at hospital that, in the theatre, instruments were laid out on a central table cafeteria-style, and surgeons, with their different patients, grabbed what they needed. Debenham thought that war surgery was generally ‘very crude’ and not very interesting to perform, a view shared by a surprisingly large number of army surgeons. There was a tendency for the work to be fast and pressured but otherwise routine, ‘an endless round of cleaning, shaving, trimming, packing and plastering’, in the words of one medical historian.12 No great intellectual challenges were posed or inventiveness required – unlike, say, the demands made on doctors in the jungle prison camps in the Far East. But on occasions when the casualty convoys were coming in a non-stop stream from the front, Debenham rose to the occasion. Work then was very satisfying, he declared, ‘because we are achieving something’.
*
Out in the desert, Malcolm Pleydell was a medical officer with the Brigade of Guards and found his regimental aid post suddenly caught in the middle of a fierce battle. From out of nowhere, there was ‘a big circus’ of fifty German planes in the sky above him, and he witnessed a vast dog-fight as half a dozen Hurricanes took on the Stukas and Messerschmitt 109s. ‘Some came pretty low over our heads,’ he recorded in his diary, ‘and there was a good deal of machine-gunning. Five planes brought down – three of theirs and two of ours.’ For all his non-combatant status, he was not averse to taking pot-shots at the low-flying enemy himself. ‘I knew pilots disliked small-arms fire, and I often had a rifle to hand. The deliberate Axis bombing of Tobruk hospital in daylight destroyed completely any confidence I had in the Geneva Convention.’ The following day he was at the heart of the battle himself as the Germans attacked. ‘Much consternation, with trucks dashing round. Shelling very hard on both sides. Suddenly there were thirty German tanks on our doorstep. Several shells landed close. Walking with the padre when one banged down about 80 yards away. Went flat. Dust and earth pattering all around.’ The attack was beaten off, ‘with plenty of bangs and smoke’… for now.
Soon Pleydell was on the move with his ambulances, setting out in a bitterly cold wind and seeing fires blazing on the horizon where an enemy ammunition dump had blown up. There was no let-up from the action. ‘Machine-gunned by five ME109s. One man wounded in the genitals, forearm and wrist.’ In the early-morning fog – another hindrance to visibility – he lost contact with the rest of the column, a frequent occurrence in this vast terrain, and drove around aimlessly until the chatter of their Bren guns steered him in the right direction. He was lucky. He could just as easily have crossed some invisible front line and found himself in enemy hands. After a tank battle with Italian forces, he drove out to pick up casualties. ‘Very bad. Chloroformed one who was mad with pain, and he died. Shattered leg and eye blown out. Treated about seven. Then followed wire back through minefield to battalion HQ. Treated wounded there. One vomited over me – very messy.’ On another occasion he went out to a shot-down Hurricane burning in the sand. ‘Pilot dead a few yards off with fractured skull. Not very nice. His parachute had failed to open.’
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nbsp; There were many dangers peculiar to desert warfare. First was the very real risk of getting lost. Pleydell recalled wandering off from the bedded-down and darkened column one night to relieve himself and then realizing that, in the pitch black all around him, he did not have a clue where they were. He forced himself not to panic. ‘You have to sit down, light a cigarette and keep your head. After what seemed hours, a noise gave their location away. But without that indication, any step I took might be leading me further and further into solitude.’ Another problem was the weather, which could change in an instant. ‘Dust storm blowing up,’ he reported, ‘and trucks around are slowly slipping out of sight. The sand blows along in rapid waves like a fire licking along the ground. The sky is turning a dirty yellow. Men lean against the wind as they walk, with their heads down, shielding their eyes. The trucks look ghostly and my slit trench is slowly filling up with sand. My red cross flag flaps wildly, torn in half by the wind.’
And if the sand wasn’t getting in your eyes, then a heat haze was clouding your vision, making it difficult to discern whether the half-track looming into view was one of yours or one of theirs. Pleydell treated the buttock wounds of an officer who had sworn the approaching armoured car was friendly – until its occupants opened fire. The mistake wasn’t fatal this time, but it was uncomfortable and undignified. On other occasions, he found to his horror that the enemy had sneaked so close he could almost touch them. ‘Suddenly very surprised to see German troop transport about 200 yards to my left. We opened up on them and moved on.’ It was easy to find yourself surrounded. ‘German column moving up on us from the south, another to our west, another to east. We moved north, and met a large concentration of Germans in front of us. They shelled us. Our position seemed hopeless and I thought my last hour of freedom had come, but we slowly zig-zagged away. German vehicles followed in parallel with us on flanks and shelled us. Dusk came to our rescue.’
