Source: 'The War in South Africa' by Maj Gen F Maurice.
APPENDIX 7
THE Medical Department of the Army was less affected than others by the
change which at the end of 1900 was occurring in the character of the war.
Up to then the maintenance in efficiency of the medical field units and the
establishment of hospitals behind the central force advancing towards
Pretoria had been of equal importance. With the occupation of Johannesburg
and Pretoria, and the establishment of large hospitals in those places, the
further advance to the east and the irregular movements which took place
both in the Transvaal and the Orange River Colony had little effect on the
hospital arrangements. The main centres were already established, and the
changes which took place in them were a mere development of their resources.
But inasmuch as the number of columns was now increased while their
individual strength was reduced, so additional but smaller medical field
units were required. Moreover, as it was impossible to say when and where
concentrations of troops might take place, all the hospitals in the Colonies
had to be maintained almost at their maximum accommodation, so as to provide
for sudden demands for beds consequent on the arrival of a large body of
troops. This resulted in local excesses of permanent accommodation, and a
dispersion of personnel, where, had the circumstances been different, a
concentration both of beds and staff would have been economical.
As the campaign continued, certain districts became quieter, and it was
possible to reduce some hospitals in order to enable others to be opened at
a distance from the trunk lines, so that the latter might be in touch with
the troops as these gradually pushed further into the field and came less
frequently to the railway; and finally the development of the system of
lines of blockhouses enabled hospitals to be maintained and relieved of
their sick by convoy.
The subjoined tables will show the places at which hospitals existed, and
the dates on which they were opened and closed. [For this information,
click here]
In November, 1900, cases of plague occurred among natives near King Williams
Town, and the Principal Medical Officers of the lines of communication and
the base were warned to watch for suspicious cases, and to take precautions.
In January, 1901, plague appeared at Cape Town at the docks, and thence
spread to the native, and later to the European, population of the city.
This was a serious complication, for Cape Town was the principal port for
disembarkation of troops and for the discharge of foodstuffs. The preventive
measures put in force were the following : (1) Cape Town, as far as
possible, ceased to be a port of discharge for supplies. A complete stoppage
could not be effected owing to the needs of the western line, and of the
troops in Cape Colony itself, but every precaution was taken in the supply
depots to limit the possibility of infection being conveyed by foodstuffs,
forage, etc. (2) Cape Town was evacuated as far as possible, particularly
Greenpoint Camp, which was close to the docks, and provided the largest
number of cases. (3) Movements of troops from Cape Town could not entirely
cease, but arrangements were made for the inspection of troops passing up
country at the various stations at which the trains halted. In April a
conference was held at Cape Town to arrange for common action upon the above
lines by the military and civil authorities, and a special plague hospital
was established at Maitland, with a bacteriological laboratory. The
precautions taken against the conveyance of plague by the moving troops were
successful. Of some 900 cases of plague which occurred, only twenty-four
belonged to the Imperial forces. One only occurred outside Cape Colony, at
Mafeking; there was one near Wellington, another at Port Elizabeth, both of
which places were in frequent communication with Cape Town. One case also
occurred on board ship, between Cape Town and Durban. Of the remaining
twenty cases, eleven occurred at Greenpoint, five in Cape Town itself, and
four at Maitland.
Owing to the multiplication of small columns, the medical field units
were reorganised. It was no longer possible to maintain the field hospitals
as distinct from the bearer companies. A unit to fulfil both functions was
therefore formed by adding ambulance transport to the field hospitals, or by
sending additional equipment to the bearer companies. The total strength and
equipment of the combined unit was thus reduced, resulting in greater
mobility. Tongas were found to be useful, or, in their place, Cape carts or
the four-wheeled " spiders."
In the operations in Cape Colony the nature of the country made it
impossible for wheeled ambulance transport to keep in touch with the troops,
and in these conditions, as formerly in Natal and the Eastern Transvaal, the
Indian bearers, with dhoolies from the Indian field hospitals, were of
service. These men were collected from the various hospitals, and a number
of dhoolies were sent down to the colony.
The use of small medical units was only rendered possible by the fact
that a column was never long away from its advanced base, and that
casualties were limited, while the actual distance to some point on the line
of communications was never great. At first columns came to the line to
refit; later they obtained supplies from advanced bases pushed forward into
the veld, and here the advanced hospitals were posted, from which the sick
left by the columns were conveyed to the hospitals on the line of
communications.
When " drives " took place, the hospitals on the line of communications
where the " drive " was destined to end, were evacuated so as to make room
for the incoming sick, and hospital trains were moved to convenient points
so as to meet the columns on their arrival.
Local emergencies in various districts often necessitated the sudden
formation and despatch, at short notice, of fresh columns, so that at any
time an unforeseen demand for a medical unit might arise. One or two units
were generally available to meet such demands. Columns were being constantly
broken up, leaving a medical unit unattached. An opportunity would thus
arise of bringing it into some central position whence it could be railed to
the latest point of concentration. It was not, however, always possible to
obtain such early intimation of impending movements as would enable medical
units to be sent to join new columns. Such personnel, equipment, and
transport as were available in the neighbourhood were in these cases hastily
concentrated, and an improvised field unit would be formed from them.
Continuous movements pressed heavily on the personnel of the medical
field units. Many were incessantly in the field during the whole period,
except for short delays whilst the columns to which they were attached were
refitting. The wastage in personnel was therefore large, and it was often
difficult to keep units up to strength.
The nucleus was formed of Royal Army Medical Corps N. C. Officers and men,
but the rest of the personnel was made up principally of the specially
enlisted men of the Royal Army Medical Corps, Cape Medical Staff Corps, and
a similar body enlisted under the general term of South African Irregulars,
with, for a time, some of the Imperial Hospital and the Imperial Bearer
Corps.
The part played by the Natal hospitals should be mentioned. From the end of
1900 to the close of the war the medical arrangements in Natal remained
unchanged. These hospitals were of much importance, for, as already noted,
they received the overflow from the hospitals in the Transvaal. A regular
system of evacuation was maintained through Natal, via Durban, to England.
Invalids, collected in the hospitals in Pretoria, Johannesburg, and
Elandsfontein, from the eastern, northern, and western lines, were
transferred by hospital train to the Natal hospitals at Newcastle,
Charlestown, Howick, Pietermaritzburg and Pinetown. There, many of the cases
recovered, and the rest were sent home by hospital ship or sick transport.
From the time when traffic on the line between Elandsfontein and Charlestown
had become regular, all the invalids from the Transvaal passed through the
Natal hospitals, while all the invalids south of the Vaal passed through
Cape Town. The invalids from Harrismith were also sent through Natal, and
the hospitals in that colony were thus steadily employed till the end of the
war. Both in Natal and Cape Colony hospital camps were established for the
reception of officers and men needing rest and change during convalescence,
or in the state of exhaustion which induces disease. The chief of these were
at Mooi River in Natal, at Wynberg in Cape Colony. The benefits derived were
most marked. Many potential invalids were re-equipped for the field, both
physically and mentally, by the interlude of quiet thus afforded, whilst
many extraordinary recoveries from actual disease were recorded. It is
probable that in the future, campaigns of long duration will inevitably
demand the institution of such rest camps for the reinvigoration of those
whose organisation has temporarily succumbed to the exhausting tension of
modern warfare.
It had been foreseen that the establishment of officers of the Royal Army
Medical Corps would not be sufficient for the needs of the field force, and
from the first civil surgeons formed a large proportion of the staff of the
general hospitals despatched from England.
Later, civil surgeons sent by the War Office, or engaged locally, were
employed in every capacity—-in medical charge of regiments, with field
medical units, in ambulance trains, in the smaller hospitals, and in charge
of posts on the line, as well as in the general and stationary hospitals.
Up to the end of 1901, of the total number of medical officers employed,
about forty-two per cent, only, were officers of the Royal Army Medical
Corps. Of the remainder, about four per cent, were Militia, Volunteer, and
Colonial officers, while the remaining fifty-four per cent, were civil
surgeons, of whom about forty per cent, were engaged by the War Office. In
1902 the officers of the Royal Army Medical Corps numbered about forty per
cent., the War Office civil surgeons about forty-six per cent., and those
locally engaged about ten per cent.
Before the outbreak of the war there were a number of medical men, who
had been in practice in the Transvaal, in the larger towns of the English
colonies, especially in Cape Town and Pietermaritz-burg. Many of these,
being without employment, at once offered themselves for service as civil
surgeons, and were engaged. As the war continued more medical men became
available. Some were driven from their practices as the result of the war,
others arrived in the country in the hope of obtaining employment. With
certain exceptions, practically every medical man who offered himself
locally was engaged. In addition to the civil surgeons engaged locally for
general service it was always convenient to utilise the services of medical
men in practice in many of the smaller towns (especially in the Orange River
Colony and Cape Colony), to look after the smaller bodies of troops
stationed there, or parties of sick and wounded dropped by the columns in
improvised hospitals. Many of these did good work and set free the general
service personnel for more urgent duties. The senior medical officer of a
column was thus enabled to arrange for the care and custody of the patients
whom he left behind. Most of these civil surgeons had considerable local
influence among the Boers, and so ensured better treatment for isolated
parties of sick than could have been obtained for them by a stranger to the
district. The Principal Medical Officer in South Africa recorded his opinion
that the civil surgeons sent out from England at the beginning of the war
were, on the whole, more efficient than the majority of those who came out
later, the latter being for the most part young men, fresh from the
hospitals ; and that, of the civil surgeons engaged in Africa, some were
exceptionally good men, whose local knowledge, and practical experience of
the country, were particularly valuable. In addition to the civil surgeons,
a certain small proportion of colonial medical officers were employed during
the war. Most of these belonged to certain units, e.g., the Canadian Field
Hospital, the New South Wales Ambulance, and the Cape Medical Staff Corps.
Brief mention must also be made of the work of the Nursing Sisters.
The authorised establishment of Sisters for a general hospital was one
lady superintendent and eight sisters. This number was found to be
insufficient, owing to the paucity of trained orderlies of the Royal Army
Medical Corps, and the staff of Sisters was increased to an average of five
for every hundred beds. This proportion was prescribed as the standard to be
maintained. The Nursing Sisters were obtained from four sources—the Army
Nursing Service, the Army Nursing Service Reserve, the Colonial Sisters, and
those locally engaged in South Africa. The following tabular statement shows
the approximate composition per cent, of the Nursing Service in South Africa
in the months given :—
| |
|
Army Nursing
Service |
Army Nursing
Service Reserve |
Colonial |
Locally
employed |
| |
June, 1900 |
9 |
57 |
1 |
32 |
| |
May, 1901 |
6 |
71 |
4 |
19 |
| |
May, 1902 |
8 |
74 |
4 |
14 |
In addition to the nurses employed in the hospitals in South Africa, a
large number were employed on the sick transports and hospital ships.
During the war 337 nurses were engaged at Cape Town, of whom 216 were for
duty in the homeward-bound transports, the remainder for duty in the
hospitals on shore. Mention must also be made of the Nursing Sisters from
the oversea colonies. They came from Queensland, Victoria, New South Wales,
South Australia, Western Australia, Tasmania, and New Zealand, while Canada
also sent others in November, 1899, and February, 1900, and again in 1901.
Most of these Sisters were originally sent free of expense to the Imperial
Government, their services having been engaged either by their respective
Governments or by private societies. Others came with recommendations from
their colonies, and were engaged immediately on their arrival in South
Africa. The Principal Medical Officer in South Africa placed on record his
opinion that by far the most efficient of the nurses obtained from all
outside sources were those who came from the staffs of the large hospitals
in the British Islands.
" Invaliding " was carried out in the army in South Africa much ' more
freely than has been usually considered necessary on foreign service. At
first the probable duration of the war was underestimated, and many were
invalided home in the belief that they would not again be fit for duty
before the end of the campaign. Later it became probable that a man might be
sent home and return in time to take part in the war for a second time. In
fact, many such invalids rejoined their units long before the cessation of
hostilities. A rapid rate of invaliding diminished the pressure on the
hospitals in South Africa, where the accommodation was often strained. The
hospital ships and sick transports provided early accommodation for all who
were fit to travel. It was unnecessary (as is the case in ordinary peace
conditions) that an invalid should wait a considerable time for a transport.
A sick man was therefore often sent home for recovery, when, under peace
conditions, he would have recovered and returned to duty before an
opportunity of embarking him occurred. It was actually more economical to
provide for cases on a returning transport than to accommodate them in
Africa. There were, however, certain conditions inherent in the Army in
South Africa (not shared by other British expeditionary forces) which tended
to raise unduly the percentage of invalids in its ranks; and these
conditions should severally be recorded. In addition to the Regulars, the
Army was composed of Militia, Volunteers and Yeomanry, as well as of various
corps of over-sea Colonials. The physique of the first Regular troops
(including a large proportion of the Reserves) was excellent. Afterwards,
the quality deteriorated, and reached its lowest level when the last drafts
arrived containing many immature lads of poor physique. The Militia were, in
general, physically inferior to the Regulars : a large proportion were only
eighteen years of age, whereas in the Regulars, Volunteers, and Imperial
Yeomanry the average was twenty years. The Volunteers were, generally, of
good physique, as were the first contingent of Imperial Yeomanry. The
succeeding contingents of Yeomanry were less satisfactory, while the last
contained many men and some officers who should never have been sent from
England.
The rate of invaliding in a composite army must always be greater than
among an equal number of men regularly enlisted. In the latter case, even
after the primary and stringent medical test, a process of elimination has
developed, causing the weaker to drop out during the early period of their
service, and leaving the fittest to survive. Amongst the auxiliary units in
the South African War this normal elimination was in process during the
whole campaign, and at an accelerated rate, owing to the conditions of
campaigning. The rate of invaliding in such an army is therefore not
comparable with that obtaining in one composed solely of regular troops.
Other causes contributed to increase the percentage of invalids. It has
been stated that as the campaign proceeded, the quality of the recruits
deteriorated. There was no doubt that much of this deterioration was due to
want of care in the medical examination of men for active service. At the
beginning of the war the examination was in the hands of the officers of the
Royal Army Medical Corps, who have a practical knowledge of what is required
of soldiers on service. But when the home stations were denuded of officers
of the Royal Army Medical Corps, the examinations were made by those who did
not possess this special knowledge—and were often not conducted with the
necessary care. The Militia showed a larger proportion of men who should not
have been sent out than either the Regular troops or the Volunteers, but the
last contingent of Imperial Yeomanry was by far the worst in this respect.
The oversea Colonials were of good physique, as were the earlier
regiments of South African Colonials ; but as the campaign continued the
proportion of unsuitable men enlisted in the South African irregular forces
increased till it became a serious question. They blocked the hospitals, and
were a source of needless expense. Recruiting for these corps was little
under control. Each had its own surgeon (locally engaged by the officer
commanding the corps), who examined the recruits obtained at the
headquarters of the corps, while other recruits were sent up from their base
depots. No other arrangement was possible, for officers of the Royal Army
Medical Corps could not be spared from their important duties.
Officers in the Transvaal were invalided by Boards in Pretoria and
Elandsfontein, under the Principal Medical Officer of the district. Similar
Boards officiated in Natal; in Cape Town a standing Medical Board was early
established for this purpose.
The hospital train service, as used during the campaign, may be
classified as follows :—
(i) Hospital trains, specially fitted, equipped, and staffed as such,
for " lying-down cases." They were usually composed of seven coaches,
and carried ninety-two patients and a staff averaging twenty-two.
(2) Improvised Hospital Trains.—These were, as a rule, first-class
corridor-carriage trains, with a kitchen-car attached, for the
conveyance of less severe cases and of convalescents. A medical officer
accompanied each convoy of sick, but there was no permanent staff.
(3) Ambulance Coaches.—These were specially fitted carriages placed at
convenient intervals on the railways. They were used to pick up small
parties of sick from the various posts along the lines, and were
attached to passing trains for conveyance to the nearest hospital. Many
had a regular service, usually twice a week up and down their own
stretch of line. As a rule one N.C. Officer and one orderly were
attached for duty to these carriages, and the medical officers along the
lines of communication attended to the wants of the sick as the
carriages passed the various posts.
During the period of the war 3,116 officers and 72,314 warrant and N. C.
Officers and men were shipped to England as invalids from South Africa.
Their transport by sea was carried out by hospital ships and sick
transports; smaller parties were despatched by the mail and " intermediate "
steamships from Cape Town and Durban.
The hospital ships were of two classes :—
(1) Those fitted and equipped in England.
(2) Those prepared in South Africa.
(1) Of those fitted and equipped in England, the Spartan, with
accommodation for 132 sick, and the Trojan, for 144 sick, were fitted out by
the Admiralty for the War Office.
In addition to these, the Red Cross Society fitted out and equipped the
Princess of Wales (accommodating 184 sick). The Maine, with accommodation
for 163 sick, was provided by a group of American ladies. The above ships
ceased to be employed a considerable time before the end of the war.
(2) The hospital ships prepared in South Africa were selected and
converted at Durban by the Naval Transport Department on requisition from
the Principal Medical Officer.
The ships were : Nubia (284 sick), Lismore Castle (214 sick), Orcana (209
sick), Simla (278 sick), Avoca (302 sick), and Dunera (284 sick). A regular
service was maintained by these vessels between Durban (and Cape Town) and
England, and was carried on to the end of the campaign.
Even this fleet was insufficient to cope with the number of sick and
wounded sent home, and full use was made of the large passenger ships which
arrived with troops and would have returned empty to England. These required
no structural alteration; the accommodation for invalids was ample and good
; and a suitable medical staff was placed on each vessel, with the necessary
stores and equipment.
