A PAINFUL sensation was caused on June 27th, by disclosures in "The Times" about the lack of medical comforts and skill in South Africa. " The Times" correspondent, Mr. Burdett-Coutts, signed his name because of the gravity of the statements he made. He wrote from Cape Town under date May 29th, and began thus: "A long time has elapsed since the despatch of the last preceding letter. During that period the growing scenes of neglect and inhumanity, of suffering and death, which have been the lot of the British soldier in the closing chapters of this war have made up a picture which it is impossible any longer to conceal from the eyes of the British public,"

The real charge contained in the correspondent's letter was that, whatever success may have attended preparations for dealing with men wounded in battle, there was no adequate, or approximately adequate, provision for dealing with the far more numerous class of men stricken down by disease.

" The Times" correspondent went to Bloemfontein, the chief headquarters of the Commander-in-Chief for seven weeks, and he told what he saw after the occupation had lasted a month, and when there had been ample time to obtain necessary appliances if such appliances existed. Typhoid was rampant in Bloemfontein. There was uninterrupted railway communication to the sea, and there was more than ample time to get everything needed from Cape Town, or, for that matter, even from England. Yet there were neither beds, nor linen, nor stretchers, nor nurses, nor proper ambulances, nor any of the well-understood necessaries for the treatment of typhoid.

The correspondent drew a painful picture of the condition of affairs. There were some 1,500 in field hospitals. Field hospitals had no beds, because, in theory, they follow an army on the march, so for seven weeks men ill of typhoid fever lay on the ground. But this was not the worst. The fever cases increased, but the accommodation, poor as it was, did not. The field hospital overflowed into bell tents constructed to hold six healthy men who are out in the open air all day. Into these were huddled ten typhoid patients who had to lie there day and night on the hard ground, or, when it rained, in three inches of mud.

" One night (he says) hundreds of men to my knowledge were lying in the worst stages of typhoid, with only a blanket and a thin waterproof sheet (not even the latter for many of them) between their aching bodies and the hard ground, with no milk and hardly any medicines, without beds, stretchers, or mattresses, without pillows, without linen of any kind, without a single nurse amongst them, with only a few ordinary private soldiers to act as 'orderlies,' rough and utterly untrained to nursing, and with only three doctors to attend on 350 patients. There were none of the conditions of a forced march about this. It was a mile from Bloemfontein. There was a line of railway to two seaports, along which thousands of troops and countless trainloads of stores and equipment of all kinds, and for every one except the sick, had been moving up during the whole of that leisurely halting time.

" Besides other deficiencies which cannot be described there were no sheets or pillow-cases or pretence of bed linen of any kind; only the coarse rug grated against the sensitive skin burning with fever. The heat of these tents in the midday sun was overpowering, their odours sickening. Men lay with their faces covered with flies in black clusters, too weak to raise a hand to brush them off, trying in vain to dislodge them by painful twitching of the features. There was no one to do it for them. At night there were not enough to prevent those in the delirious stage from getting up and wandering about the camp half naked in the bitter cold. In one tent, where some slept and others lay with eyes open and staring, a case of 'perforation' was groaning out his life huddled-against his neighbour on the ground. Men had not only to see, but often to feel, others die.

" With one more incident graver than all the rest the dark history of a field hospital at Bloemfontein must close. On the occasion of my last visit, the hospital had been mostly emptied, as it was to move on to the front. In the course of this process 20 of the worst cases were removed to a more permanent hospital a mile and a half off. How were they taken? They were lifted out of their tents and put into rough ox-waggons—all typhoids and many of them dangerously ill—and then jolted across the veldt, which in this place is much broken by spruits and gullies. One case was in a state of ' hemorrhage' when moved."

The correspondent, among many other questions asked: " Was the medical service at Jacobsdal and Paardeberg included in the sweeping eulogy of the eminent surgeons in London? The horrors of those scenes, the tortures suffered by our wounded there owing entirely to shortcomings of medical equipment, staff, and transport, were a by-word in every mouth before that first chapter ' closed."

It must be remembered these events occured at Bloemfontein. No practical man (the writer says) will question the prior claim of military exigency over humanity where the interests of the two are irreconcilable; but whenever the former is not really endangered by the latter humanity cannot, and must not, be entirely neglected.

The despatch from Mr. Burdett-Coutts to Lord Wolseley was as follows:

Capetown, June 1.—Just returned from front. Terrible pressure sickness. Breakdown in medical arrangements. Doctors, nurses, equipment, miserably insufficient. Pitiable scenes here entirely falsify reports sent home.

(Signed) Coutts.

The sensation created by the publication of Mr. Burdett-Coutts's denunciation of the South African war hospitals and their organisation was transferred to the House of Commons on the 28th of June, when several questions were asked of the Government on the subject.

Mr. Balfour, in reply to Sir Henry Campbell-Banner-man, said nothing had come to the notice of the Government to suggest that any suffering of the sick and wounded in South Africa was due to the insufficient supply of medical comforts sent from this country. The question was rather as to organisation in South Africa. A certain amount of correspondence had passed between Lord Roberts and the Secretary of State on the subject. It would be in the hands of members later in the day. However, the House felt so keenly on the subject that he would read some extracts.

The first intimation which reached the Government was a telegram from Mr. Burdett-Coutts on June 4th. Lord Lansdowne at once telegraphed to Lord Roberts, who replied on the 7th.

Lord Roberts' reply: " The very existence of my force depended upon supplies coming up by train along a line of railway nearly goo miles long, every bridge of which for the last 128 miles had been destroyed by the enemy. Notwithstanding this, I ordered that the requirements of the sick were to be first taken in hand, as soon as the railroad had been repaired. The principal medical officer proceeded with the first train to Kroonstad, with surgeons and nurses. No. 3 General and Scotch Hospital had been held in readiness at Bloemfontein to be sent to Kroonstad directly the line was open. This was done, and they received 180 patients within twenty-four hours of arrival.

" I repeatedly visited the hospitals during the time I was at Kroonstad, and impressed upon the principal medical officer to do all that was possible' to remedy matters. A few days afterwards I received a report from the medical officer that the medical arrangements were good, and Lord Methuen has since informed me that the medical arrangements were perfectly satisfactory. i

" I was deeply distressed at being unable to make more perfect arrangements on first arrival at Kroonstad. But it was inevitable that in the rapid advance of our great army when the railway had been destroyed the suffering would have been enormously increased had it not been for the prompt manner in which the medical authorities made use of the scanty accommodation available at a place little larger than an ordinary English village."

Subsequently, continued Mr. Balfour, a further communication was addressed by Lord Lansdowne to the Commander-in-Chief in South Africa, and he wired on June 25th:—

" As regards the hospital at base I personally satisfied myself that all arrangements were working satisfactorily, and I have not heard any complaint about them. When we first arrived at Bloemfontein we had an abnormal number of sick, due no doubt mainly to the peculiarly exhausting conditions of the march; but also to the terribly insanitary conditions of the camp at Paardeberg. We also had a considerable number of wounded from the fight of March 10th, and hastily to improvise accommodation at Bloemfontein for such a large number —increased before I left up to 2,000—was not an easy task.

" Owing to the rapidity of the march no huts were available until railway communication with Capetown had been restored. As soon as I could arrange for such a supply of tents as was necessary for the very existence of the forces I ordered more nurses, more doctors, and more hospitals.

"Bloemfontein is not a large town, but all suitable public buildings, schools, etc., were made into hospitals.

I constantly visited these, and after a very short time they were, I consider, in good order and not overcrowded.

" I can quite understand that people who have no practical experience of such matters are much concerned to hear of the hardships which sick and wounded soldiers have to undergo in times of war, especially when they are not aware of the many difficulties which have to be contended with in alleviating suffering. Such difficulties are sufficiently great in countries where there are large towns and villages and easy communication by road and rail, but they have been immeasurably increased in South Africa by the local conditions to which I have referred.

" I have no wish to evade responsibility in the matter, or to screen any shortcomings which may be proved against the Royal Army Medical Staff. You state you have been told that reports of Sir William MacCormac and Mr. Treves are optimistic, and that conditions have changed since they were here.

" It is true that neither of those gentlemen took part in any long or difficult march, but two consulting surgeons who are now on the road to England have been with this force from the Modder River to Pretoria, and I would ask that their opinions on the subject might be ascertained.

" I would further suggest that some committee, say of two medical men of recognised ability and some man of sound common sense, should proceed to South Africa in order to furnish a full report on the working of the medical arrangements throughout the war. I will guarantee that they shall have the fullest assistance; and if their visit should result in any amelioration of the condition of our sick and wounded soldiers during war no one would be more grateful than myself."

Mr. Balfour continued that it was the opinion of the Government that some such independent inquiry as Lord Roberts suggested should be placed at his disposal. He was aware that the subject was one in which a great deal of public feeling had been excited; and he considered it desirable that they should have an opportunity of discussing it.

A " Daily Mail" correspondent bore out the allegations:—I am able to bear out much of the worst that Mr. Burdett-Coutts has written about the treatment of the sick and wounded in South Africa, but as I took no notice, and made no study of the matter, I can only tell of chance observations and impressions.

All, however, tend to confirm the results of his experience. In Bloemfontein the nurses at the Volks Hospital told me that they would consider it a lasting disgrace if they lost a single enteric patient, so light is the form of that disease prevalent there. The Army statistics will show that this was equally true of the situation with regard to the soldiers sick in and around Bloemfontein.

There were 2,500 enteric patients when I left them, and they were out of all proportion. Left to lie on the ground and be nursed by ignorant and slovenly "Tommy" attendants, the sanitary arrangements were such that at least in some hospitals they had to leave their blankets at the risk of death.

At the Volks Hospital it was realised that the army under Lord Roberts had long been on short rations, and that the men were hungry and weakened. Therefore, a " building-up" treatment, with nourishing food, was adopted and relied on, with satisfactory results.

In the army hospitals (I had it from the lips of the officer in charge) at least one base hospital staff was trying upon these sick and famished patients a new German method rightly called "the starvation treatment." All the time I was at Bloemfontein I was haunted by the horror of the neglect and cruelty to the sick.

When I was at Kimberley some of the local physicians were similarly horror-stricken by the condition in which wounded came to them—trundled over the bad roads all the way from Paardeberg in ox-waggons. Reaching Kimberley, they were put on the bare floors of the buildings which the philanthropic Mr. Rhodes placed at the army's disposal, and they secured beds only at the hands of a Colonial dispenser of charity funds. Yet— and Dr. Treves may make a note of this—there is no more reason why even "flying hospitals" cannot carry the new fold-up American beds than there was reason why we correspondents should do without them. Yet we all carried these or inferior beds, which were light, small, and portable. Five to seven hundred American camp beds could be carried in one ox-waggon.

Those who had the dispensing of the funds of such charities as the Red Cross and other societies, and who had expected only to provide delicacies and extra comforts, can help the cause of reform by repeating to the public what they told me on the field of the demands made upon them by the Army Medical Corps for the primary essentials of hospital outfitting, such as you and I and everyone would have supposed the Government had supplied.

As to the amount of skill that enters into the surgical and medical treatment of the sick and wounded, I, of my own knowledge, know more than is to be seen in the criminal adoption of the starvation method at Bloemfontein. But one of the greatest English surgeons told me that the average army medical man is a tyro, and must be so because of the failure of the War Office to allow the doctors to prosecute their studies in the great capitals of the world in times of peace.

He said that the doctors should be either sent or allowed to go to Paris, Berlin, and New York for two or three months either in their holidays or in extension thereof, but that the practice in the army is to discourage and to forbid this advantage to its doctors. The result is that only those who have been stationed in or near London have had a chance to walk the metropolitan hospitals, and the rest are experienced only, if at all, in the treatment of the commonest wounds and maladies. This matter of the training of the doctors in the hospitals is apart from Mr. Burdett Coutts's complaint, yet it is quite as important as any defect he mentions.

When we confine ourselves to the care received by the sick and wounded in other respects we must be deeply grateful to the enterprise and humanity of those colonies and rich men at home who sent to Africa the only well-equipped field hospitals there. The managers at these outside and private charities did not have to beg of civilians for thermometers, measuring glasses, sheets, beds, pillow cases, and instruments as the army men did.

So extravagant and grotesque was the unpreparedness and helplessness of some army hospitals that I actually heard of the indisputable case of a private citizen supplying bandages to a hospital in Capetown. He found it lacking in these simplest necessaries, and in an hour purchased a Cape carload of bandages to present them to the hospital. He had some difficulty in getting through the red tape which prevents the military receiving from civilians, yet this humiliation could have been avoided early by the proper outfitting of the hospital in the first place, or the purchase of bandages by the hospital in the second place.

With respect to the latter expedient, a civilian who spent hundreds upon hundreds of pounds in buying common necessaries for the field hospitals told me that he was informed the army medical men could not purchase a thermometer except at the risk of personal pecuniary loss. It wanted three months, he said, for a field hospital to observe the formula for getting supplies which he used to buy at an hour's notice.

I have no hesitation in saying that I consider the treatment of the sick and wounded (especially after the main advance from Modder River) primitive, cruel, and almost barbaric, as well as needless and inexcusable.

Julian Ralph.

The “ British Medical Journal “ printed a report from Mr. Anthony A. Bowlby, F.R.C.S., who was at Bloemfontein with the Portland Hospital. The letter, dated May 31, stated that when the hospital arrived at Bloemfontein the health of the troops was bad.

They had been without proper tents or shelter, and the nights had often been pouring wet. The ground in many places was a swamp, and much of it had been fouled. Within a few days of the occupation of Bloemfontein enteric fever broke out in many camps, and spread rapidly. It appeared to have been brought in by the men in many cases, but it is certain that in many other cases it was acquired through bad water or other local insanitary conditions, and various localities, such as Thaba N'chu, got a bad reputation, which was very well deserved.

At this time there were no general hospitals at Bloemfontein, and in spite of utilising buildings in the town the field hospitals speedily became overcrowded, so that they had to accommodate three or four times the numbers for which they were equipped, and it became impossible tQ nurse or treat the patients satisfactorily,

The " British Medical Journal" stated that Mr. Alfred Fripp, the chief surgeon of the Imperial Yeomanry Hospital, in a letter dated June 4th, wrote that there were at that time over 5,000 sick at Bloemfontein, most of whom were suffering from enteric, while at Kroonstad three hotels, the town hall, and the churches had been converted into hospitals.

A Birmingham soldier, who had been invalided home from Bloemfontein, said that while in the hospital he frequently saw naked men in a delirious state wandering about on freezing cold nights. He had several times to wait seven or eight hours before he could get a drink of water.

Although he was in hospital twenty-one days he never saw a nurse. The major portion of the men had to lie on the ground. The stench in the tents was terrible. On one occasion after a thunderstorm he lay in a pool of water for almost an hour and no one came to him.

An invalid member of the Army Service Corps, who was attached to the 9th Divisional Field Hospital outside Bloemfontein, and who arrived in England June 26th, wrote to the " Daily Mail," stating that on April 3rd, when suffering from enteric, he was put into a small marquee with fifteen other men suffering from various complaints, and there lay on the ground with just one blanket under him for three weeks. He and other men had no change of garments, and were smothered with vermin. On some days the doctor never came near them. He was finally sent down with a train-load of men to Wynberg. The journey took two and a half days, but rations for one day only were served out.

A private just home from Green Point Hospital, Capetown, wrote to the same paper that the patients in convalescent wards were not nearly so well off for comforts as the men in the camp.

A soldier's wife sent a letter from her sick husband at Bloemfontein, in which he stated that the sufferings of the enteric patients were horrible in the extreme. Thousands of patients were in a frightful state, even the barest necessities being unobtainable.

Lord Wantage, V.C., who is chairman of the English Red Cross Society, was interviewed by a newspaper representative on the subject of the allegations against the South African war hospital authorities.

" The Central Red Cross Committee sits in London twice a week," said Lord Wantage, " to receive and consider reports from our commissioners in South Africa, and we have had no such complaints as those of Mr. Burdett-Coutts.

" That gentleman attended a sitting of our committee before he went out to South Africa and offered to act as our commissioner out there, but as he was only making a flying visit we did not accept his offer. He has been out there observing all these things, but has never let us know of the deficiencies of which he now complains. Had he reported them to us we should have remedied anything needing it. We have the means to do it."

" The principle of the field hospital," continued his lordship, " is that it should be kept as light as possible and should not be hampered with beds and other appliances.

"The regulations of the service specially preclude them. If they attempted to carry these things about with them they would lose the very object for which they are instituted, and yet Mr. Burdett-Coutts complains of their not having these things. The chief thing to remember is that a war, with its varying fortunes, cannot be carried out with the smoothness of a garden party."

"As a matter of fact," added the veteran soldier, "the reports from Sir John Furley, who is our head commissioner in South Africa, have shown us that the arrangements for tending the sick and wounded in this campaign have been as good as the ups and downs will allow.

" But the Red Cross Society is not the subject of this criticism, and I have no doubt the medical department of the War Office will supply its own defence should any defence be needed."