Medical Units of 2 NZEF in Middle East and Italy
CHAPTER 11 — BATTLE OF ALAMEIN
BATTLE OF ALAMEIN
THROUGHOUT September and October Eighth Army continued its preparations for the offensive, but the medical personnel heard little of these plans. Patients were the main source of information although they knew only their own particular sectors. Daily, convoys of guns rolled along the dusty roads past the camp areas, while at night there was an almost ceaseless clatter of tanks and transporters moving into position. The medical officers attended conferences and made arrangements for the part their particular units were to play in the medical chain. Increased activity in the air indicated that the day was near.
It arrived on 23 October 1942. During the day all members of the units were assembled, General Montgomery's order of the day read, and plans for the battle due to begin that night outlined. The day was comparatively quiet. All the sick had been cleared from the forward medical units and the lines of evacuation were ready. Most of the men did some last-minute washing and letter-writing, while page 230 the units generally made final preparations for the heavy casualties expected. Extra tentage was erected at the CCS as soon as it was dusk. The job had been left until this time because in enemy reconnaissance photographs such an obvious increase in the layout of a medical unit would indicate the nearness of large-scale operations at the front. Evening came, and an air of expectant hush seemed to settle over the whole desert as the moon rose. For once there was no sound of transport. Everything was silent and waiting. The Eighth Army's guns, nearly a thousand of them, were ready, and the infantry and armour were awaiting zero hour.
Battle of El Alamein—Dispositions at 23 October 1942
The New Zealand Division, as part of 30 Corps, was to capture and hold the Miteiriya Ridge west of the Qattara Track. It was then to revert to the command of 10 Corps, an armoured formation which, passing through gaps in the minefields westwards, would try to cut off the enemy.
The ADSs in Position
After functioning as an ADS in Swordfish area (between Amiriya and Burg el Arab and about 16 miles inland) A Company, 5 Field Ambulance, under Capt J. M. Tyler, moved on 21 October. It drove along the coast road in complete darkness, then turned inland to an allotted area. Here slit trenches were dug, but no tents or bivouacs were erected and the Red Cross signs were again not displayed. Five extra American Field Service ambulance cars, with seven drivers, were attached to the ADS. No movement of troops was permitted during the next few days, and because of this some difficulty was experienced in dealing with the intake of patients. At 7 p.m. on 23 October the company again moved forward and about 9.20 p.m. sited an ADS behind a low escarpment. Here the brown and white 40ft by 40ft tarpaulins with large Red Crosses were erected, and a small German tent was set up to serve as an MI Room.
Ten minutes before zero hour, A Company, 6 Field Ambulance, under Maj R. A. Elliott, moved up in the dark to set up its ADS in a forward position well in front of the artillery and in close support of 6 Brigade infantry battalions.
The Battle Begins
The artillery opened fire at 9.40 p.m. on 23 October. Gun flashes floodlit the desert and the air reverberated with the continuous concussion of the gunfire. By the time A Company, 6 Field Ambulance, page 231 reached its position the barrage was thundering overhead and the men set to work immediately to erect and sandbag the tents. The tense atmosphere of battle, the incredible noise, the throbbing air, and the unnatural light spurred them on, and the dressing station was very soon established and ready for operation. Nearby were some dugouts left by South Africans, and the men were able to use these for themselves. The enemy must have been stunned by the terrific weight of the barrage, for he threw little back.
At ten o'clock the infantry went forward under the barrage. Men wounded in the advance from the infantry start line to the first minefields reached 6 ADS by midnight, but it was not until the early hours of the 24th that the ambulances were able to get through to the battalion RAPs and clear the wounded, who were by then accumulating. The task of the ambulance car drivers was most difficult; the desert tracks between the ADS and the several RAPs, though lit in parts, were ill-defined and difficult to follow, and were congested with armour, particularly in the narrow gaps leading through the minefields. Tanks moving up prevented the ambulances from making their way through, and by the time they were able to reach the RAPs and set out on the return journey, the enemy, reviving somewhat after the initial stunning shock, was beginning to hit back. Returning amid bursting shells and whining shrapnel, the ambulances relayed their wounded back to the ADS, and the little dressing station became a bustle of activity.
With a clearer passage for the ambulances, the wounded began to pour into 6 ADS, which for a time was taxed to cope with the flood of casualties. Medical officers and orderlies were dressing wounds in a frantic rush, bandaging, splinting, and administering drugs, giving blood transfusions to those whose condition was low, and even performing some minor surgery where it was deemed urgently necessary. But still the number of men awaiting attention accumulated—they lay on stretchers on every available square foot of space. In the holding wards, too, men who had received attention lay everywhere awaiting evacuation to the MDS, for it was impossible to get them away before first light; armour in a densely packed mass was moving up past the ADS during the early hours of the morning, and ambulances could not find a passage through the congestion.page 232
By 6 a.m. it was possible to send the first of the wounded down the desert track to 5 MDS, under Lt-Col McQuilkin, and all vehicles that could be used, ambulances and three-tonners, were despatched fully loaded with wounded. To clear the congested treatment tent for those awaiting attention, the wounded were loaded on the ambulances direct from the reception centre at first, and soon some semblance of order was restored in the dressing centre. By midday six extra ambulance cars were secured to assist the evacuation and the dressing station had returned to smooth-running routine.
All day the ADS worked steadily. That night the barrage opened again and there was a further heavy flood of casualties, but a continuous relay of ambulance cars plying from RAP to ADS, from ADS to MDS, created a smooth-running chain of evacuation, and the capacity of the ADS was not again overtaxed. With tank engagements on the 25th, 6 ADS was receiving casualties mostly from the British armoured units; a light dressing station from 166 British Field Ambulance joined the ADS to assist in treating these casualties.
Fortunately for 5 ADS the enemy did not reply to the opening artillery barrage. Had he done so, the ADS, just forward of our own guns, would probably have been in an untenable position. A steadily increasing number of casualties poured in, and the medical officers and men of the company worked without a break during the night and all the next day. It was fortunate that additional ambulance cars were available to take the casualties back quickly to 5 MDS, then some eight miles way. In a period of 26 hours the ADS admitted and evacuated approximately 460 casualties.
One medical officer, assisted by orderlies, dealt with walking wounded only at the small German tent. A second medical officer, with the most skilled nursing orderlies, treated the serious cases and applied Thomas splints whenever lower limb fractures were involved. A third medical officer, with less skilled assistants, dealt with the miscellaneous wounded. As far as possible the orderlies and stretcher-bearers worked in rotational shifts. This ensured some rest for all from their very arduous and trying duties. Next day, 25 October, fewer casualties were received, the total admissions numbering 94. One ambulance car, en route from the ADS to the page 233 rear, ran over a mine and was damaged. During attempts to salvage the vehicle, it struck another mine and was so damaged that it had to be abandoned.
At the Main Dressing Station
At 5 MDS very full preparations had been made. At 11 p.m. on 23 October the first casualties began to arrive. During the early hours of the 24th, Major McKenzie's1 1 General Hospital surgical team began performing urgent major surgery; it continued to work without a halt for 16 hours. All through the early morning a steady stream of stretcher casualties poured in, and at mid-morning twelve three-ton trucks filled with walking wounded returned from the ADSs. The MDS was exceptionally busy, and a request was sent to the ADMS for an additional surgical team. To clear the MDS of patients, extra transport was pressed into service, as the ten MDS ambulance cars could not cope with the numbers waiting to be evacuated. After midday, casualties began to arrive at a terrific rate, many of these being from 51 Highland Division. From 1 South African Division's forward medical units, considerable numbers of chest, head, and abdomen cases were also received. The accommodation of the MDS was completely overtaxed, and at 3 p.m. 250 lying cases surrounded the area without any form of protection from sun and dust. The staff of the unit worked continuously, and the ASC drivers, when not driving their ambulances, assisted in general duties. At this time the supply of stretchers was exhausted and it was impossible to procure more. The supply of blood and plasma was adequate, and during the day nearly ninety transfusions were given.
About 6 p.m., through the efforts of ADMS 2 NZ Division (Col Ardagh), 30 vehicles arrived, and within an hour a great number of casualties was evacuated, leaving with the MDS only those who had recently come from the operating theatre. Considerable relief was afforded the overworked medical officers when Maj S. L. Wilson, with his additional surgical team from 1 NZ CCS, began operating during the afternoon. Both surgical teams operated without a halt for many hours. The evacuation arrangements worked more page 234 smoothly as the day progressed, and an adequate number of three-tonners was available to clear the MDS. On an average it took three hours for a vehicle to do the round trip from MDS to CCS.
Over a period of 24 hours (23-24 October) the MDS handled a record number of 838 patients, of whom more than 500 were New Zealanders. The surgical teams, as well as the field ambulance surgeons, were fully engaged with either major or minor surgery. The resuscitation department was always abreast of blood transfusion requirements. The day's intake on 25 October was much lighter (about 300), and every feature of the work in the MDS, including evacuation, went most smoothly. The special surgical teams attached to the MDS worked under a rotational scheme of duty, and this gave the surgeons an opportunity for rest.
Amongst the casualties received at the MDS were also many enemy prisoners, but their own captured medical personnel were able to look after them. Considerable air activity in that sector and heavy bombing in nearby areas interrupted rest and sleep. During the day there were several air battles overhead. On the night of 25-26 October things became relatively quiet, and as many of the staff as possible took the opportunity to rest.
At the CCS
The Battle of Alamein provided 1 NZ CCS at Gharbanyat with the busiest period of its life, but the unit rose to the occasion. Surgeons, doctors, sisters, medical orderlies, stretcher-bearers, and cooks all gave of their best.
The CCS and the adjacent ⅔ Australian CCS and 10 British CCS received patients in rotation. The unit started receiving at 5 p.m. on 24 October, and within three hours over 300 cases had been admitted, most being seriously wounded. At half past eight a special evacuation by road to Alexandria cleared some of the wards and the unit was able to admit a further 70 casualties. No member of the staff will ever forget that first night. Every department was working at top pressure, all wards and annexes were congested, stretcher cases were everywhere. Special attention could be given only to the very seriously wounded, while for the others there was time only to see that they were as comfortable as possible and well covered with blankets. More than anything else, the wounded appreciated hot drinks, and the Padre ensured that all of them page 235 received Red Cross cigarettes and chocolate. Morphia gave relief to those in pain but shock and exhaustion brought instant sleep to most.
The next day, Sunday, a blockage on the railway line upset the evacuation of wounded, and patients had to be taken by road to the train at Ikingi Maryut. This caused a shortage of ambulances for a while and casualties accumulated. A further 300 cases came in during the day, so that by night the hospital was again full to capacity. Overnight a heavy rainstorm brought further problems when some of the tents leaked. No one had time to stop and make repairs. Next morning a strong wind quickly dried the ground, but then there was dust to contend with.
And so the busy period continued day after day. Admissions for the ensuing week averaged over 200 daily. Extra tentage had now been erected, bringing the number of wards to ten. All the staff worked long hours. Some of the sisters and orderlies were often on duty over eighteen hours a day. The sisters were proud to be attending to battle casualties in the forward area. After such long hours on duty it was a great relief to get out of one's department and enjoy the fresh air while walking across for a quick meal at the cookhouse.
Volunteers freely offered their services for extra tasks such as stretcher-bearing. The ASC drivers and general duties teams, though not at all accustomed to nursing, were willing assistants in the wards, and by attending to routine jobs enabled the orderlies to employ their skill where it was most needed. A number of men had roving commissions and lent a hand where necessary. Considerable assistance was given by a team of Mauritians who arrived at the hospital each morning. Two or three were attached to each department and proved first-class workers. Although they spoke French only, they were quick to see what was required and were keen to learn.
Much could be written about the work of the operating theatre and of the trials and difficulties that the number of serious cases brought its staff. Naturally the most important, it was by far the busiest section of the whole unit, working non-stop for ten days and nights. The CCS had only one theatre at this time. It was an EPIP tent, and in it two operating tables were set up. Working in this very confined space, two surgical teams, under Maj T. W. page 236 Harrison and Capt A. W. Douglas,2 operated almost continuously for 72 hours in eight-hour shifts. All the operations were major ones. Then, when the work was at its peak, Capt Douglas had to go off duty with a septic finger. Col T. D. M. Stout and Maj W. M. Brown3 were attached at this time and it was possible to form three operating teams. After an eight-hour shift in the theatre, the orderlies of each team had to spend a further eight hours sterilising and cleaning up. With endless major operations, the cramped space and the heat, and with but a few hours' sleep daily, these surgical teams required extreme patience and endurance. They did a grand job and saved many lives.
When it was seen that the main theatre could not possibly cope with all the cases requiring surgical treatment, the MI tent was equipped with surgical and anæsthetic equipment and used as a small operating theatre. Maj Brown, and later Lt-Col Hunter, performed the surgery here, with the assistance of a theatre team. Long hours were worked in this small department, too, and many patients were handled. Most of the wounds treated were slight, requiring only surgical cleaning, dusting with sulphanilamide powder, and dressing with vaseline gauze.
With the ambulance convoys arriving unheralded at all hours of the day and night, and famished drivers and wounded all in need of a meal, the hospital cookhouse was almost as important as the theatre. The cooks kept up a 24-hour service and ensured that the large numbers passing through the unit were able to have a meal. Food was kept in special hot-boxes and cocoa or coffee was always available. Walking patients ate at the cookhouse, but the wards' staffs had to collect meals for stretcher cases.
The New Zealand CCS was not, of course, in the field to deal with New Zealand sick and wounded alone. Medical services were pooled and the unit was under Corps control, admitting troops from all the Allied formations that constituted Eighth Army—cheery Australians, often too long for their stretchers; South Africans, who page 237 could always be told by their solid weight; staunch Scots from the Highland Division; and English Tommies, always to be admired for their patience and philosophical acceptance of suffering. Someone could always be found to interpret for the Fighting French, but Greeks, Indians, and Italian and German wounded prisoners of war presented difficulties, particularly when their medical documents were written in their own language.
Patients did not remain long at the CCS during this busy period. All who were fit to travel went on as soon as possible, some remaining for only an hour or so. Most of the wounded were sent by train from Gharbanyat station to hospitals in the Delta area, but some went by road to Alexandria. Air evacuation had been instituted just before the battle began, and cases urgently needing specialised treatment went by hospital plane to Cairo. The landing ground was about three-quarters of an hour by road from the CCS and the air journey from there took just over an hour.
In the first three days of the offensive, Eighth Army drove a big salient into the enemy's defences. The fighting was bitter and the objectives were gained at great cost. But to the enemy the cost was much greater, and in men, armour, and materials he had been heavily depleted. Since daybreak on 24 October the Germans had been making a series of counter-attacks. These, together with a heavy armoured counter-attack on the 27th, were all repulsed. The ADSs treated and cleared to the MDS a large number of wounded from the fighting.
October the 26th was the quietest day experienced at 5 ADS since the action began, and only 70 casualties were brought in. Seventeen of these had resulted from enemy bombing of front-line positions near the ADS and the artillery positions sited just behind it. The ADS was fortunate to escape being hit as considerable numbers of enemy aircraft were in action over the sector. These same gun positions were again bombed on 27 October and further casualties suffered. The enemy also began to shell the area, and the resulting casualties were brought back to the ADS by ambulances of the American Field Service.
On the night of 26-27 October 6 Brigade made an attack which gained more depth in front of Miteiriya Ridge, and during next page 238 morning 6 ADS was busy clearing the casualties. Eighth Army was then regrouped, and the next night the whole of 2 NZ Division, except the artillery, was relieved by 1 South African Division and moved back to a rear area to reorganise.
While the Division was resting, 9 Australian Division, fighting magnificently, succeeded in penetrating far into the enemy's defences. This threat to cut off his coastal forces drew the enemy's main concentration to the north, while farther south Eighth Army resumed its attack. For this attack 2 NZ Division, with two British infantry brigades4 under command, was brought back into action on 1 November to conduct a further assault and enable the mobile 10 Corps to break through.
A Company, 6 Field Ambulance, dug in its ADS that night in the salient driven into the German lines. Its position was almost on the railway line, some distance beyond the El Alamein station. Nearby were come uncleared minefields, and a little to the north was the main road, north of which the Australians had been fighting. With the help of bulldozers borrowed from the Engineers, areas for the tents had been dug out during the afternoon, and the men set up and sandbagged their tentage, completing the erection of at least a partially protected dressing station. 6 ADS was opened at last light.
It was five o'clock next morning (2 November) before casualties reached the dressing station from the attack, most of them from 152 Brigade and armoured units. Wounded flowed in steadily, and the ADS continued working through the day, on through the night, and during the following day. As the wounded were sent back, 5 MDS, the CCS, and the hospitals were busy in turn.
This attack, relentlessly pressed by 9 British Armoured Brigade, burst through the enemy's anti-tank gun screen which had so far successfully barred the way to the armour. In the morning of 4 November it was found that this screen of guns had withdrawn to the north-west. The way was clear. Rommel was retreating and the chase was on.
1 Maj D. D. McKenzie; born Australia, 9 Sep 1902; Surgeon, Auckland; Surgeon 2 Gen Hosp Jun 1940-Dec 1941; 1 Gen Hosp Dec 1941-Sep 1942; OC 2 NZ Fd Surg Team Sep 1942-Mar 1943; OC 1 British Neurosurgical Unit Feb-Sep 1943; Surgeon HS Maunganui Nov 1943-Mar 1944.
2 Maj A. W. Douglas; born Napier, 23 Oct 1910; Surgeon, England; Surgeon 1 Mob CCS Jan 1942-Apr 1943; OC NZ Surg Team Apr-Jun 1943; 1 Gen Hosp Jun-Oct 1943; OC 1 Fd Surg Unit Oct 1943-Aug 1944; 1 Gen Hosp Aug 1944-1945.
3 Maj W. M. Brown, m.i.d.; born Lyttelton, 8 Jul 1895; Gynæcologist, Christchurch; Surg Sub Lt RNVR 1918; Asst SMO Burnham Camp Jun-Oct 1941; Medical Officer Maadi Camp Hosp Jan-Oct 1942; 1 Mob CCS Oct 1942-Dec 1943; 1 Gen Hosp Dec 1943-Apr 1944.
4 151 Inf Bde (from 50 Division) and 152 Inf Bde (from 51 Highland Division).