Hospitals - The Wounded & Disease

BLOEMFONTEIN & ENTERIC FEVER

Burying the dead at Bloemfontein

The enteric fever (now known as typhoid) at Bloemfontein cost the British Army more lives then the two severest battles of the war. Bloemfontein was occupied by Lord Roberts without opposition, but disease germs were deadlier than bullets. As many as fifty men died in one day. One hospital with 500 beds had 1,700 sick; another had 370. Some 6,000 soldiers came down with this severe and protracted fever. Sixty orderlies serving as nurses contracted the disease from the patients. in another hospital half the attendents came down with the fever. More than 1,000 soldiers' graves were added to the cemetery at Bloemfontein. It was all due to polluted water. The Boers had seized the water works supplying Bloemfontein. The troops were supplied from wayside pools or any other source. The precaution of boiling was omitted and the greatest army England ever put in the field had to halt till the bacilli were conquered.

Definition of enteric fever

Typhoid fever, also known as enteric fever, bilious fever or Yellow Jack, is an illness caused by the bacterium Salmonella enterica serovar Typhi. Common worldwide, it is transmitted by the ingestion of food or water contaminated with feces from an infected person. The bacteria then perforate through the intestinal wall and are phagocytosed by macrophages. Salmonella Typhi then alters its structure to resist destruction and allow them to exist within the macrophage. This renders them resistant to damage by PMN's, complement and the immune response. The organism is then spread via the lymphatics while inside the macrophages. This gives them access to the Reticulo-Endothelial System and then to the different organs throughout the body. [Source: Wikipedia - Typhoid fever]

ROYAL ARMY MEDICAL CORPS.

Extract taken from 'Our Regiments in South Africa' by John Stirling
published by Naval and Military Press Ltd

RAMC receiving station

IN his despatch of 2nd April 1901 Lord Roberts said "Under Surgeon-General Wilson this department has laboured indefatigably both in the field and in the hospitals. Some cases have been brought to my notice in which officers have proved unequal to the exceptional strain thrown upon them by the sudden expansion of hospitals, and in the earlier stages of the war the necessity of more ample preparations to meet disease were not quite fully apprehended. These cases have been fully reported on by the Royal Commission, and will no doubt receive the attention of his Majesty s Government. I am not, however, less conscious of the unremitting services of the great majority of the officers of the Royal Army Medical Corps. There are many instances, indeed, recorded of great gallantry having been displayed by the officers in carrying on their work of mercy under heavy fire, and in the face of exceptional difficulties their duty has been ably performed. My thanks are also due to the distinguished consulting surgeons who have come out to this country, and by their advice and experience materially aided the Royal Army Medical Corps. The services rendered by Sir William MacCormac, Mr G. H. Makins, Mr F Treves, the late Sir W Stokes, Mr Watson Cheyne, Mr G. Cheatle, Mr Kendal Franks, Mr John Chiene, and Sir Thomas Fitzgerald, were of incalculable value. The abnormal demand upon the R.A.M.C. necessitated the employment of a large number of civil surgeons, and to these gentlemen the army owes a debt of gratitude. The heavy strain on the Army Medical Department was further much relieved by the patriotic efforts of the several committees and individuals who raised, equipped, and sent out complete hospitals."

Lord Roberts also mentions the invaluable assistance by the British Red Cross Society, who equipped hospital trains, and he also speaks of the value of the hospital ships. As to the nursing sisters he says, “It is difficult to give expression to the deep feeling of gratitude with which the nursing sisterhood has inspired all ranks serving in South Africa."

The outcry raised at the time when the army was posted about Bloemfontein, and enteric was ravaging its ranks, may not have been entirely justified, in that it overlooked some insuperable difficulties, but, on the whole, it is fortunate that public attention was engrossed with a subject of such importance, and the agitation did good, in that it made the path of the reformers more easy That some reforms were necessary is beyond doubt, and that these have been undertaken is a matter of satisfaction.

Apart from all authorised or Red Book reforms, perhaps the most desirable consummation is that our fighting generals should realise that in a campaign of any duration their own power will greatly depend on the observance of sanitary rules. Medical officers should not be discouraged from urging and compelling the frequent changing of camping-grounds, and, in the selection of these, wholesome water-supplies must ever be a sine qua non (see ' A Doctor in Khaki,' by Dr Francis E. Freemantle Murray, 1901. The author was a civil surgeon, and his work is a very valuable contribution to the literature on the subject).

As to the bravery and self-sacrificing devotion of the immense majority of the Royal Army Medical Corps officers there is no possible doubt. The following gained the Victoria Cross

Major William Babtie, C.M.G., at Colenso, 15th December 1899

Lieutenant W H. S. Nikerson, Wakkerstroom, 22nd April 1900.

Lieutenant A. E. M. S. Douglas, D.S.O., Magersfontein, 11th December 1899.

Lieutenant E. T. Inkson, Natal, 24th February 1900.

Surgeon-Captain Crean of the Imperial Light Horse, and Surgeon-Major Howse of the Australian Field Hospital also gained the V C.

The following were, apart from honours bestowed, the mentions in the principal despatches, including officers attached from the Imperial Medical Staff, civilians, and civil nurses —

Orange River Hospital

Moving a wounded solider at Orange River Hospital

Last letter home, Orange River Hospital

Tugela River Field Hospital

Tending the wounded

Modder River Field Hospital

Unloading the wounded

Hospital Ships

Wounded aboard ship SS Pavonia

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.

[Source: The South African Military History Society]

Known hospital ships:

• HMHS Avoca
• HMHS Bavarian
• HMHS Dunera
• HMHS Egypt
• HMHS Formosa
• HMHS Lismore Castle
• HMHS Maine
• HMHS Montford
• HMHS Nubia
• HMHS Orcana
• HMHS Princess of Wales
• HMHS Simla
• HMHS Spartan
• HMHS St Andrew
• HMHS Trojan

Civil Surgeons

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.

[Source: The South African Military History Society]

Working in the field

Captain Dr. Wreford attending a wounded man