The centenary of the outbreak of World War One drew more attention to the campaigns in Africa than might have been expected. This is to be welcomed. The East Africa campaign – by far the most protracted and costly of four on the continent – engulfed 750,000 square miles, an area three times the size of the German Reich. Its financial cost to the Allies was comparable to that of the Boer War, Britain’s most expensive conflict since the Napoleonic Wars. The official British death toll exceeded 105,000 troops and military carriers. As is usually the case in warfare, civilian populations throughout East and Southern Africa suffered worst of all in this final phase of the ‘Scramble for Africa’.

To call the East Africa campaign a ‘sideshow’ to the war in Europe may be correct, but it is demeaning. Its scale and impact were gargantuan. Above all, as one combatant ruefully reflected, it ‘involved having to fight nature in a mood that very few have experienced and will scarcely believe’. In this context ‘nature’, to those passingly familiar with the history, usually brings to mind the nerve-racking hardships of bush fighting, the searing heat and torrential rain, or the continual presence of non-human predators. However Dr Norman Jewell and his medical colleagues were on the front line in the fight against the biggest natural threat of all – disease. Malaria, dysentery, and other afflictions – many caused by malnutrition – accounted for the vast majority of casualties.

The medical aspects of the campaign have not been overlooked by historians, but nor have they been given adequate coverage. Some excellent accounts were left by medical officers. Francis Brett Young’s Marching on Tanga, published before the end of the war, was judged by the great bibliographer Cyril Falls as being ‘one of the comparatively rare classics of the [Great] War’. On the German side, the account of Dr Deppe is excellent. The fact that first-hand published accounts number no more than about a dozen highlights the significance of the publication of ‘On Call in Africa’.

Norman Jewell’s memoir gives a riveting insight into the conditions under which medical staff operated. His account of the battle of Kibata at the end of 1916 is one of the stand-out passages. His unit’s struggle to deal with casualties of 15% inflicted on the Gold Coast Regiment during its attempt to relieve the British garrison was exacerbated by the fact there was nothing to feed the wounded, let alone the medical staff. Jewell worked for 72 hours without sleep. The solution to the ration problem was to persuade the garrison to smuggle supplies out through German lines to the relieving force; and when Jewell succumbed to malaria himself he had to be smuggled in to the garrison for proper care.

Equally important is Jewell’s account of the battle at Nyangao/ Mahiwa in October, considered by him and many others to have been ‘the most savage fighting of the whole campaign’. His small ambulance unit was dealing with 500 casualties by nightfall on the worst day. Later, in another battle, his hospital camp itself came under attack while Jewell was attempting to take a ‘bath’ in a hole in the ground.
This was no ordinary campaign. Combatants who had previously served in France wished themselves back in the trenches.

The reader should be aware that tropical medicine was very much in its infancy. The fact that a doctor had spent time in India or South Africa or, in Norman Jewell’s case, Seychelles did not give them the expertise they needed to deal with the tidal wave of non-surgical cases. What they achieved under the most trying of circumstances is remarkable.

I am especially impressed to see that the long-buried Pike Reports on Medical and Sanitary Matters in German and British East Africa, completed in 1918, have been extensively referenced. These highlighted scandalous oversights and failures in sanitary and medical administration during the campaign, and raised serious questions about nutritionally inadequate and incorrect rations. Laziness and incompetence among staff officers – including many medical professionals – were largely to blame for these and their very, very costly consequences in terms of loss of human life. However Pike, the British Army’s Surgeon-General, commended the general medical and surgical work of doctors. Norman Jewell and his colleagues in the field ambulances and casualty clearing stations would have had nothing to fear from Pike’s findings.

The Pike Reports were so combustible that they were accorded less than a single, sanitised page in the official medical history of the campaign. I have no doubt that a cover-up was deliberately effected. The reports and Norman Jewell’s memoir would be to the fore among the growing number of invaluable new or rediscovered sources that should be incorporated in a new medical history of the war – one that is crying out to be written.

There is much else of value in this memoir besides the sections that deal with Norman Jewell’s war service. His descriptions of pre-war life in the Seychelles, the arrival of the ‘Spanish’ ‘flu epidemic in Kisumu at the end of the war, undertaking a mass inoculation against smallpox in Mombasa and life in Nairobi in the 1920s are fascinating and will add to the knowledge even of historians long-immersed in East Africa. I am glad that I now know that the regimental band of the 3rd King’s African Rifles played on Thursday afternoons in the grounds of the Nairobi Club. This is the sort of detail that may seem trivial in isolation, but it is the sum of such ‘trivial’ details in Norman Jewell’s account of his wartime service that makes it such an important historical source.

One thing above all sets ‘On Call in Africa’ apart: the rigour with which it has been assembled. Many colonial era memoirs are irretrievably devalued by poor editing, a failure to provide the reader with context (or the provision of historically inaccurate commentary), and sloppy production. The scrupulous care that has brought this book to life is exemplary, from the extensive, accurate references to the commendable inclusion of transcripts from the official war diaries for Norman Jewell’s units in Part Two. A valiant attempt has been made to impart more about the good doctor’s non-professional life to the curious reader. The result is as praiseworthy as it is valuable.

Edward Paice
Director of Africa Research Institute and author of ‘Tip & Run: The Untold Tragedy of the Great War in Africa’ (Weidenfeld & Nicolson, 2007)