by Professor J.C. de Villiers, MD FRCS
BRITISH MILITARY ORGANIZATION
On the British side, the magnitude of the entire military operation was underestimated from the outset so that the medical arrangements were totally inadequate. This gave rise to immense problems; practical, emotional and political.
The R.A.M.C. (Royal Army Medical Corps) had only been established in 1898 and lacked efficiency, not having been tried in a major conflict. Conditions of service in the Corps and particularly the low salaries which it offered, were such that they failed to attract to a career in it the kind of person who might lend it status and find personal satisfaction therein. In an attempt to compensate for these defects, a large number of civilian surgeons were appointed as consultants to the military medical units for service in South Africa.(1)
There was a tremendous emotional reaction in Great Britain, especially after 'Black Week' when it became obvious that the war in South Africa would not be over in a few weeks as was initially predicted. This serious military setback which Britain, the major power in the world, had suffered induced her population to close ranks and forced even the anti-war sympathisers to feel that the war had to be brought to a rapid and satisfactory conclusion. Many privately endowed hospitals, ambulances, ambulance trains and hospital ships were provided to assist in the war effort and individuals volunteered for the military medical and nursing service in large numbers.
The medical organisation in the British Army although fairly standardised, was to be tried out for the first time on a large scale under the most adverse conditions. The vast distances over which the campaign in South Africa was fought soon strained the British transport arrangements to the utmost. Indeed many of the problems experienced in South Africa were associated with transport.
Each soldier was issued with a first field dressing - the first war in which this happened. The medical personnel attached to each company were one medical N.C.O. and two stretcher bearers whose task it was to take the wounded to the battalion aid post where they were attended to by a Medical Officer assisted by a medical N.C.O. From the battalion aid post casualties were then taken by stretcher bearers, from the bearer company under the care of a M.O. and two medical N.C.O.s, to a collecting station from where they were transported by ambulance to a field hospital.
The R.A.M.C. hospital arrangements were, broadly, as follows:-
These arrangements had to be adapted to changing needs and attracted a great deal of both constructive and adverse criticism.(2)
In addition to the Army Hospitals there were a number of privately endowed hospitals such as, amongst others, the Imperial Yeomanry, the Portland, the Edinburgh and East of Scotland, the Welsh, the Irish, the Van Alen and the Princess Christian Hospitals.
The Princess Christian hospital train departing from Durban for the Natal Front, 1900.
Most of the privately endowed hospitals were adequately and sometimes even lavishly equipped. They rendered excellent service as a result not only of the quality of the materials available to them, but particularly of the high standard of medical and nursing care provided by their selected staff. All of these establishments ceased to function independently when the R.A.M.C., being fully in command of the situation, was able to take them over.(3)
There were several of these. Four worked from Cape Town, two in Natal and one from East London. One of them, donated by Princess Christian, and named after her, was the first train to enter Ladysmith after the Relief. It was lavishly equipped and highly spoken of by everyone who worked in it. The Red Cross Society financed an ambulance train which was built and equipped in the East London railway yards.
Ten ships were specially converted for the transport of patients from Durban to Cape Town or from Cape Town and Durban to England. Some served as temporary hospitals in Durban harbour. The most famous of these was the Maine, which was financed by Americans who sympathised with the British cause, under the direction of Lady Randolph Churchill who was soon to become Mrs Cornwallis-West.(4)
About 500 civilian surgeons were appointed consultants to the army, a considerable number of whom served in South Africa and were later to become famous in various surgical fields. Among the latter were Sir Anthony Bowlby, Sir George Makins, Sir Lenthal Cheatle, Watson-Cheyne, Cuthbert Wallace, Sir William McCormack and Sir Frederick Treves. Sir Arthur Conan Doyle established a reputation for himself not only as a doctor but as a writer and the creator of the fictional character Sherlock Holmes. Fortunately, many of these men committed their experiences to paper so that an accurate record of the British Medical Services exists as a result of their books and papers.
The medical organisation of the British Army would have been effective, had it not been for a major difficulty which arose fairly early in the campaign in the form of typhoid fever. After the battle of Magersfontein, there was a long period during which troops were static at Modder River and, later, at Paardeberg. The situation in which vast numbers of troops were massed using a contaminated water supply, created ideal conditions for a massive outbreak of typhoid fever. The army was already stricken with this disease when it had to march on to Kimberley and Bloemfontein in LordRoberts' flanking movement away from the Orange River and the Kimberley railway line.(6)
The manoeuvre demanded the use of every available form of transport that could be obtained. Transport for supplies, including that for the sick and wounded was kept to a minimum.(7) When it entered Bloemfontein, the British Army became paralysed by typhoid. Within a month 4 000 - 6 000 troops had succumbed to the disease. The hospitals that had moved apace with the army were field hospitals, which were only supplied with ground sheets and blankets, and a few stationary hospitals which were only supplied with stretchers.(8) One can imagine what would happen if 4 000 patients with typhoid were to be precipitated on Bloemfontein today!
Every available space was used for typhoid hospitals, including the Raadzaal, churches and school buildings. This was the chaotic situation which confronted a visiting British Parliamentarian, Mr Burdett-Coutts, who reported on it emotionally in letters to The Times. In addition to statements which he made about the situation which were factually correct, he also made unwarranted accusations against the R.A.M.C. which started the so-called 'Hospitals Scandal' in South Africa.(8) It was alleged that Britain had sent out the best of her men to fight for the Empire who, when they were in need of basic care were denied it. This resulted in the appointment of a Commission of Inquiry under the Chairmanship of Lord Romer which heard evidence before the war was concluded and published an extensive report which led to considerable improvements in British military medical organisation. (10)
A history of the war, either from a medical or any other point of view, would be incomplete without due consideration being given to the effect of typhoid fever which proved to be its greatest killer. It wreaked havoc on the British side in particular because of the fact that so many men were massed in a slow moving army in which the risks of contamination of food and water supplies were great. It is interesting that typhoid was a far greater menace on the western front than it was in Natal (except for Ladysmith). The Boer Commandos which were constantly on the move were relatively little affected by the disease and it was only at Modder River and Paardeberg that it was a real problem.
The official figures reveal that of the British Force of 556 653 men who served in the Anglo-Boer War, 57 684 contracted typhoid, 8 225 of whom died, while 7 582 were killed in action.(11) As had been the experience in America, the disease was found to be one which occurred in static camps.
In concluding the story of typhoid in this war it is necessary to mention the development of active immunisation against it with which the name Almroth Wright is inseparably linked. Wright was Professor of Bacteriology at the Military School at Netley and commenced his work on this subject in 1896. In 1901 he reviewed the results of immunisation in a number of army units in various places, including some from the Anglo-Boer War. His conclusions were that, 'in every case, there was at least a two-fold reduction in cases of typhoid fever in the inoculated. In certain cases there was a reduction varying from six-fold to twenty-eight-fold.' There was also a striking diminution in case mortality. (12)
With the refinement of immunisation techniques and the preparation of the vaccine, the effect of active immunization became far more evident. The benefit from immunisation was only appreciated during the 1914-18 war, much of the pioneer work however was done during the Anglo-Boer War.
As the war in South Africa progressed and conditions stabilised, there was a decline in the incidence of typhoid but the war ended with another medical near-disaster. Plague broke out, particularly in the harbour cities, and claimed the lives of many civilians. Many doctors discharged from their military duties were appointed Plague Officers and emergency Plague Hospitals such as the one at Uitvlugt (the present day Pinelands) in Cape Town had to be opened.(13)
NURSING DURING THE WAR
The war saw the beginning of an organised military nursing service along the lines that it is known today. At the outbreak of the war, the Army Nursing Service consisted of a Lady Superintendent, 18 Superintendent Sisters and 56 Sisters to serve the principal military hospitals in Britain and abroad. The ambulance trains and railheads were however the nearest that nurses were allowed to the battle zone(14) where orderlies had to do the nursing in their stead. Some foreign ambulances were staffed by male nurses only, as the work was not considered to be of the kind that a young woman ought to do.
The Princess of Wales organised a group of nurses from the London Hospital to work in South Africa and the idea gradually developed that nursing at base hospitals should be done by trained nursing sisters. As a result, a permanent military nursing service was founded in 1902 - Queen Alexandra's Imperial Military Nursing Service (Q.A.I.M.N.S.).(15)
The nursing sisters attached to the foreign ambulances worked nearer to the fighting line and were exposed to hardship, although for a short period of time. Voluntary nursing assistants on both sides were a mixed blessing. The Boer side was at least spared the dubious benefit of the 'Lady hindrance', the term used to describe a group of female 'do-gooders' whose members literally killed with kindness as a result of their complete lack of insight which could be excused perhaps in the light of their unbridled enthusiasm.(16)
The St John's Ambulance Brigade and Society rendered sterling service by providing trained men to serve as orderlies in the British Army. (17)
RADIOLOGY DURING THE ANGLO-BOER WAR
It is perhaps surprizing to learn that a mere five years after its discovery radiology had already been accepted and was being practised during a war, in a remote outpost of civilisation at the end of the 19th Century. On the Boer side there were at least five sets of apparatus being used extensively at Jacobsdal, Springfontein, Krugersdorp, Johannesburg and Pretoria. On the British side, there were about ten, including those on the hospital ships. A few of the units warrant mention in the light of the interesting personalities who operated them and the circumstances attached to their use.
The unit in Jacobsdal was under Dr H. Küttner who, following his experience in the use of this apparatus in the Greco-Turk War of 1897, had already published a book on the application of Roentgenology to war surgery.(18) How he managed to provide power for his machine is a story in itself and a credit to his assistant, one Van Alphen. He requisitioned a petrol engine from a mine on the Rand and had it railed to Bloemfontein from where it was transported to Jacobsdal by wagon. This engine supplied power not only for the radiology apparatus but also for electric lighting.
Dr Hall Edwards, who became the father of British radiology, was in charge of the apparatus used first at Deelfontein and later in Pretoria, in the Imperial Yeomanry Hospital. He tragically lost his fingers from irradiation necrosis as a result of his pioneer work.(19) Both of these authors as well as Fessler in Krugersdorp, told of the difficulties involved in their radiological endeavours not least of which were the summer heat which softened the emulsion on the plates to which sand then adhered and the lack of an adequate dark-room for developing. It was impossible to acquire the necessary darkness in a tent in the intensely bright sunlight, consequently, all developing had to be done at night. Problems in finding running water for washing plates in most parts ot the country and difficulties in obtaining good pictures with exposure times of several minutes, were continual. Despite these vicissitudes radiology proved its worth particularly in locating retained missiles.
From a medical point of view, despite many disasters and false starts, much that was good resulted from the war. The reorganization of the British Army Medical and Nursing Services, the establishment of principles to deal with new kinds of war wound, the use of radiology, the re-introduction of strict military sanitary arrangements and vaccination against typhoid serve as examples.
The Operating Theatre at No. 4 General Hospital, Mooi River.
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