TOPIC:

From Highland Brigade Battlefield to Typhoid Epidemic - Walter Allen, RAMC

9441 Pte Walter Allen, Royal Army Medical Corps
QSA - Cape Colony, Paardeberg, Dreifontein
Roll Number : WO-100-222_02 p.63

Topics: RAMC / Highland Brigade / Paardeberg / Typhoid Epidemic / Army Medical Service Reform

Read time : 12 Mins

I do hope the following submission is enjoyable and informative for Forum members.

1/ Early Life

Whitechapel, East London, in 1873 was a densely-packed, grimy district teeming with life, labour, and hardship. Its population, largely working-class and impoverished, lived in overcrowded slums. The area’s main industries included sweated tailoring, dock work, butchery, and jobs tied to the nearby Spitalfields Market and London Docks.

Crime, alcoholism, and disease were rampant, exacerbated by a lack of sanitation. It had a high immigrant population from across the empire. Amid this bleakness, there was vibrancy—street markets buzzed, radical political ideas flourished, and charitable missions brought relief.


Whitechapel 1890


Into this environment Walter Allen was born on March 4, 1873. His father, also Walter, was a railway servant from Norwich and his mother, Mary Ann, was from Devon. He appears in the 1881 census living in Rochester Bldgs, Whitechapel where he was one of 3 siblings. In 1888, as Walter turned 15, Whitechapel became the scene of the murders perpetrated by Jack the Ripper. By 1891 the family have moved around 5 miles west to St John's Westminster.

In 1891, at the age of 18, Walter enlists into the Army Medical Service.

Listing himself as a Porter, he stands 5 feet 5 inches tall, weighing 142 lbs. Enlistment into the medical services is an interesting choice for that time, influenced perhaps by ambition and the growing importance of military medicine , alongside the more commonly seen motivations of security, adventure and travel that could have been accessed through any unit. It may be that his early life in Whitechapel influenced this choice.

The first 2 years of his career were spent on Home service, followed by Egypt in 1894, then Cyprus from 1895 where, on 17 April 1897, age 24, he marries a Cypriot, Olymbias Christofi. Their first child, Malta, is born 8 months later.

A second period of service in Egypt in 1898 coincided with the restoration of civil administration in Khartoum by Kitchener following the Sudan Mahdist war.

A return to home service in November 1898 is followed by the birth of their second child, Ada Louise, in April 1899.

2/ To South Africa

Walter is mobilised for South Africa arriving 24 October 1899, two weeks after the declaration of war. He is assigned to No 3 Company RAMC staffing the Highland Brigade Field Hospital. The Highland Brigade, under Major General Wauchope (and later General Hector MacDonald) moves to relieve the besieged town of Kimberley, about 450 miles North of Cape town.

The Highland Brigade Field Hospital provided reception, triage and immediate surgery at the battle of Magersfontein on 11 December 1899, notorious as one of the three 'Black Week' British defeats which shook the public's confidence in British forces superiority, brought home the reality of emerging twentieth century warfare and can be seen on war memorials across Scotland today.

The Highland Brigade's casualty figures of 935 (205 killed, 690 wounded and 40 missing) out of a brigade strength of 3500 (26%) constitutes the highest casualty rate for any British brigade in a single engagement during the entire war. It would have tested the skills and determination of any medical unit.


3 Company, 3rd (Highland Brigade) field hospital. Source : www.britisharmyancestors.co.uk/blog/no-3...gade-field-hospital/

Though working in the Highland Brigade Field Hospital on the series of engagements leading to the relief of Kimberley on 15 February 1900 would have proven a strong test of Walter's skills and training, it is the actions following Kimberley, the race to the Boer capitals and Walter's later transfer to No 9 General Hospital in May 1900 that place him at the heart of the most significant medical challenge posed to British forces by the Anglo Boer war (ABW) and that will be the focus of this piece - Typhoid.

3/ Typhoid's impact in the ABW and state of Medical Knowledge

Typhoid's impact was significant. British casualty figures show twice as many troops died of disease than of battlefield injury.

Disease ~16,000 63% of total deaths
Combat ~7,000 27%
Accident ~2,000 10%

Of these figures 11,000 were as a result of typhoid, and 2400 of dysentery. Gabriel and Metz (1992) estimate that 74,000 experienced typhoid over the total campaign out of a total force of c 500,000.

The causative organism of Typhoid, Salmonella Typhi bacteria, had been isolated in1880 by Eberth. Transmitted via contaminated food and water, symptoms include headache, fatigue, abdominal pain and constipation or diarrhoea. By 1896 a test to detect it was available and inoculation had been developed by Wright of the Army Medical School (and Pfieffer in Germany).

For Walter and RAMC members inoculation was voluntary and not universally applied, though we can speculate Walter was inoculated as, like other RAMC members trained at Netley, he would have participated in deployment briefing on infectious disease prevention. Dale (2015) outlines that less than 4% of the British Army were inoculated.

Though the epidemiology was not fully understood, Army sanitary officers were aware of the four measures needed to control its spread: Boiling or treating water to kill bacteria; Proper sanitation; Good hand hygiene and Safe food handling.

In 1896 the medical office of Cape Colony reported Typhoid was endemic in the colony and was known to be seasonal, increasing up until May every year.
The conditions of conflict along the western theatre provide all the conditions for typhoid.

4.1 / Conditions for Typhoid Part 1 : Static at Modder River

Methuen's forces of around 40,000 (including the Highland Brigade and Walter) moved north from Cape Town, crossing the Orange river on 22 November 1899 and then fighting a series of engagements with precious little progress. Forces were encamped alongside a slow-flowing, contaminated stream for a period of two and a half months creating opportunity to contamination.

Untreated water from the river was pumped to tanks for use with trains which provided troops with easy access to the contaminated water. By January, 97 cases of typhoid were reported, rising to 156 by 6 February. Wells providing cleaner water were completed on 9 Feb, but the army moved north on 11 Feb, finally relieving Kimberley on 15 Feb 1900.

Kimberley was contending with its own outbreak after months of seige, exacerbated by overcrowding, shortages of food and medicines.



The Drive to Bloemfontein via Kimberley. Source : samilitaryhistory.org/vo092swa.pdf


4.2 / Conditions for Typhoid Part 2 : The Drive to Bloemfontein

Chasing the Boer Forces retreating east from Kimberley to Bloemfontein was a hard couple of days march. Cromb in the Highland Brigade (1902) writes of "waggons, dead horses and bullocks marking too plainly the path of the Boer army". The Boer commander, De Wet, had captured 180 transport wagons, resulting in British forces carrying their own 30kg kit, marching c25-30 miles a day in February's average temperatures of 26c whilst being reduced to half rations.

De Villiers (2008) outlines the army were warned to drink only boiled water but that this ignored the reality of overwhelming thirst, a parched landscape, insufficient fuel, no boilers, and officers unconcerned with hygiene.

In with Methuen to Modder (1901), the war correspondent Alfred Kinnear, accompanying the Guards Brigade on this route describes seeing :

"...what at first sight might have been mistaken for a mirage. The vision of water turned out on approach to consist of a series of spacious ponds, the water of which, unfortunately, became too muddy to drink with comfort. Nevertheless, drunk it was.

I have, in common with officers and men, tasted worse; indeed, the water at Orange River was repulsive alike to sight and to taste. It was of the colour of the contents of a chambermaid's bucket; and at another place, the flavour was distinctly of castor oil.

These ponds quickly ran dry, and there remained now nothing drinkable - I use the word in its most extensive and exhaustive form - nearer than Modder River; "muddy river," an ill-omened name. " (p.111)





"Does this water look alright to you?" Water replenishment on the route to Blemfontein

4.3 / Conditions for Typhoid Part 3 : The Paardeberg Shambles

The chase east was punctuated by the battle of Paardeberg which commenced 18 February 1900, lasted 10 days and pitted 32,000 British against 4,000 of Cronje's encircled army, until his surrender on the 27th February.

The Highland Brigade directly assaulted the Boer positions resulting in 70 killed and 250 wounded with the Field Hospital and Walter again providing medical support.

Sanitation and clean water were limited for both sides over the 10 days. Death and putrefaction would have added to the stink of defecation of tens of thousands confined to a small area. The conditions for the rapid spread of both dysentery and typhoid were approaching perfection.

Murray Cosby Jackson (1913) of the Hampshire Regt shares "The last night or so heavy firing was kept up from the laager, and at daybreak on Majuba day a crowd of white flags went up. I didn't see Cronje; but the laager was in an awful state: dead horses and cattle and half buried dead men; the stink was fearful".

I will write a piece on medical support at Paardeberg in future.



Paarderberg aftermath - possibly sanitised photo as no evidence of bodies Source : Canadian


5 / The Result : The Bloemfontein Outbreak

Following Cronje's surrender at Paardeberg, the British forces, including Walter, marched the 80 miles to Bloemfontein arriving 'fatigued, ragged, hungry, sick and short of supplies' on the 13 March 1900.

Jackson (1913) described 'a good deal of sickness amongst us at this time, owing probably to the bad water at Paardeberg (we had to drink from the river in which the Boers had thrown dead horses, cattle, and even men), and I think I had a narrow escape.

Though I say it myself, I had never in my soldiering fallen out on a march, either at home (where the manoeuvres are no joke) or out here in the marching already mentioned; but about two days before Bloemfontein I began to feel queer in the afternoon on the march. I got worse and worse, till at last I couldn't keep up at all, so asked leave from my company officer (Mr.Ashby - who was very sick too with dysentery) to fall out.'

The 32,000 troops swamped a city of 3,000 inhabitants. Food and resources were sparse and relied entirely on a single track railway stretching the 650 miles from Cape Town. The 2 weeks march between Paardeberg and Bloemfontein neatly matched the 8-14 day incubation period of Typhoid.

Two thousand troops reported sick immediately on arriving in Bloemfontein.

Every available public space was converted into a temporary hospital including a nunnery, the lunatic asylum and parliament hall. There was a shortage of beds, bedding, medical supplies with a downward spiral of insufficient resources and staff adding to the unsanitary conditions and sick figures. Conan Doyle (1902) serving at the Langman Field Hospital in Bloemfontein throughout the epidemic states 'there can be no doubt that the severe outbreak in Bloemfontein had its origins in the Paardeberg water.'


Bloemfontein Town hall converted to accommodate the sick.

The threat from nearby Boer Forces meant that priority was given to military supplies over medical.

De Villiers (2008) reports 'The army in Bloemfontein required about 550 tons of stores and supplies a day, and in preparation for the advance to Pretoria needed about another 470 tons per day for the time they remained in Bloemfontein'.

At a later commission into the circumstances Lord Roberts admitted that for the first fortnight, he was completely cut off from his base, his 'prime concern was whether he would be able to feed his army and at no stage did he have supplies for more than a day in reserve. He was aware of the needs of the sick, but could do nothing about that; indeed, he could do very little for the healthy.'

To make matters more complex the water treatment facility at Sannah's Post was briefly captured by Boer forces cutting off clean water to the town.

In April 1900, Surgeon General Wilson wrote 'I regret to say that our sick list, principally enteric, is still on the increase, and I am daily receiving demands for assistance. My great want continues to be Royal Army Medical Corps, both officers and men. Those at present in Africa are seriously overworked, and I fear their breakdown.'


6/ The Arrival of Hospitals

The first hospital arrived at the end of March - though as a field hospital, it did not have beds, but groundsheets.

No. 9 General Hospital arrived in Port Elizabeth on 1 April 1900 and was operational in Bloemfontein by 20 April. At least 6 General Hospitals and 6 Field Hospitals were in operation by May 1900 operating 2000 beds - a figure still inadequate for the scale of the epidemic.

Two weeks later, on 8th May 1900, Walter is re-deployed from the Highland Brigade Field Hospital to No.9 General Hospital. His deployment is part of Army medical services response to the evolving threat, from war fighting, to fighting an epidemic.

7/ Conditions in Hospital during the epidemic

Staff in No.9 General Hospital had to work 36 hours out of 48 for weeks on end.

There was a lack of bed utensils, blankets, commodes, any change of hospital clothing, and latrines were improperly cleaned or disinfected. There was a deficiency of fresh milk and meals were served irregularly from a kitchen designed for 520 patients supplying the 1277 daily average patients in May (Watt, 1992).

Nursing care in contemporary textbooks indicated the need for 24-hour care for Typhoid with staff required to monitor temperature precisely and hourly, as temperature was indicative of haemorrhage.

Those suffering from diarrhoea would have required careful monitoring of pressure areas and regular changes of bed linen. Contemporary accounts stated typhoid patients often defecated up to seventeen or eighteen times a day.

Conditions must have been brutal for Walter and the medical staff involved. Though separated by 120 of years scientific advancement, the Covid epidemic of 2020 may offer a recent glimpse of the impact on medical staff (and their patients) of struggle against overwhelming odds, combined with flawed availability of medical supplies.


No 9 General Hospital Stereoview image. Caption reads 'Bloemfontein, South Africa, c 1900. Medical staff and nurses of no. 9 general hospital. British forces lost heavily here when typhoid broke out among the troops'. (Source: Underwood and Underwood.)

'For more than two months the hospitals were choked with sick. One general hospital with five hundred beds held seventeen hundred sick, nearly all with enteric. A half field hospital with fifty beds held three hundred and seventy cases.

The total number of cases could not have been less than six or seven thousand - and this is not an evanescent and easily treated complaint, but of the most persistent and debilitating continued fevers, the one too which requires the most assiduous attention and careful nursing. How great was the strain only those who had to meet it can tell.'

Edith Hancock, a nurse in Bloemfontein describes the town as a ‘death trap’ and that, ‘one cannot grasp the amount of Enteric that is amongst our troops … The medical work to be done out here is tremendous, but they are all sick. Every available place has been taken up with the sick and the beds and mattresses were divided up so as to make them go further but a great many are still on the floor with one blanket & an overcoat. I have not seen any wounded yet.’

One correspondent wrote 'A sickening smell came from the stricken town ... you could smell Bloemfontein before you could see it.'

Conan Doyle (1902) asks 'How was this unforeseen and unprecedented crisis grappled with? Entirely by the efforts of the medical men and by the devotion of the orderlies. When a department is confronted by a task which demands four times more men than it has, the only way of meeting it is for each man to work four times as hard. This is exactly what occurred, and the crisis was met. In some of the general hospitals orderlies were on duty for thirty-six hours in forty-eight, and what their duties were-how sordid and obscene-let those who have been through such an epidemic tell.'

De Villiers (2009) records in three months, there were 6369 admissions due to typhoid and of these 1370 died - a mortality of 21%. For context, the first 3 months of Covid globally saw hospital mortality rates of 17%.


The epidemic forced a 6 week halt in Bloemfontein before Lord Roberts was able to resume the march to the Transvaal capital of Pretoria 300 miles to the north. De Villiers (2008) writes of the army being 'prevented from marching to Pretoria, not so much by the Boers as by a malicious bacterial assault from within'.

Walter was to remain on the staff of no 9 General hospital which remained in Bloemfontein for the duration of the war.

Typhoid continued to circle the British forces before rapidly reducing with the onset of the southern hemisphere winter.


No. 9 General Hospital Stereoview image - possibly taken post epidemic (Source: Underwood and Underwood.)

8/ Reaction to Reform

Conan Doyle (1901) was one of many that expressed increasing outrage at the experience endured by the British forces with Typhoid.

He indicated 'doctors had the utmost difficulty in getting tents, medicines, and other essentials for their work. They were overwhelmed with cases at the very moment that their means for treating them were at their lowest, and unhappily enteric is of all diseases, the one which needs careful nursing, special nourishment and constant attention. At the root of the problem of insufficient supplies being available there had undoubtedly also been inadequate preparation and creation of reserves prior to the outbreak of war.'

'The outbreak of enteric among the troops in South Africa was a calamity the magnitude of which had not been foreseen, and which even now is imperfectly appreciated. We naturally did not dwell too much upon it while the war was in progress. But it was appalling in its severity, both in quantity and quality. I know of no instance of such an epidemic in modern warfare. I have ,not had access to any official figures, but I believe that in one month there were from 10,000 to 12,000 men down with this, the most debilitating and lingering of continued fevers. I know that in one month 600 men were laid in the Bloemfontein Cemetery.'

A Royal commission was instigated and reported that much of the blame fell on the military hierarchy for not heeding ample warning prior to the war and for not having prepared the army adequately to conduct a war of the magnitude required. The Commission found no evidence or proof of a scandal, of wilful neglect, disregard for suffering of patients or incompetence of the medical or nursing staff. Problems experienced by the RAMC were highlighted but the medical and nursing staff and the orderlies were praised for the high standard of care provided under difficult circumstances.

According to Surgeon General Jameson, 'if sanitation had been understood not alone by our own officers, by the rank and file, and the military officers, commanding officers, I think it would have saved thousands of lives'.

This was a hard fact to admit but Surgeon General Wilson stated the need for reform in his report: 'The Committee are of the opinion that no satisfactory system of camp sanitation can be carried out without the intelligent co-operation of company and commanding officers, and consider that in future all Officers should receive periodic instruction in elementary hygiene, as applied to barracks and camps.'

9/ Walter's Later Service and Life

Walter's service continued in South Africa until June 1902.

After seeing losses of Magersfontein and experiencing first hand a typhoid epidemic, its saddening to see tragedy also dogged his family life with Olymbias.
After a period of Home service where a son, Thomas, was born in 1903, his daughter, Alexandria was born in 1904, but was to die by the age of 2.

Walter is then in Malta in 1905-6 and Egypt again in 1906-10, age 37.

Their next child, George Henry, is born 1907 living for only 4 months. Ethel is born in 1908, living only for 3 weeks before a final child, Dorothy is born in 1912 in Canterbury and survives.

The Journal of the Royal Army Medical Corps reports 9441 Cpl W. Allen disembarking from Egypt in 1910 and the following year where in August 1911 he is discharged in August, age 38, after 18 years service having qualified for the Long Service and Good conduct medal and an annuity.

After long service he may have looked forwards to a different life. This was not to be.

His considerable battlefield and epidemic experience is put to use once again in WW1 when on 1st October 1914 he reenlists, age 41, serving with 38 Field ambulance in France between May 1915 and January 1917. He would have been present with 38 Field Ambulance at the battles of Loos in 1915 and the Somme in 1916.

His final demobilisation was in March 1919, age 46, as 45509 Staff Sgt W. Allen. His extended service and commitment is recognised by George VI (whose accession in Dec 1936 would make Walter 58 years old) when he is awarded the Meritorious Service Medal. Only 100 recipients can possess this at one time. Typically awarded to long-serving senior NCOs and including an annuity of £20 p.a it recognises efficiency, discipline, leadership and service.

His wife Olymbias lives until 1946, age 68.
Walter lives until Feb 1953 where he dies in Hackney, London, age 79.

Why is Walter's narrative important ?

I'd argue his narrative is important for three reasons :

• A reminder of the reality of conflict:

Through Walter's journey - from serving in the Highland Brigade Field Hospital treating battlefield injury to the epidemic gives us an insight into the nature of warfare. Beyond imperial adventuring and bravery we get a narrow glimpse of the stink and shambles and carnage, of the smell of human detritus in the 10 days encirclement of paardeberg, of marching 30 miles and the only water source being muddied and polluted, but having no alternative but to drink and hope for the best, of medical services and teams overwhelmed by 6,000 typhoid sufferers in makeshift hospitals with symptoms of diarrhoea, and the painfully slow arrival of supplies to treat the sick.

• Impetus for Army Medical Services reform:

[/b] We also see in Walter's experience some of the drivers for reform of the British Army Medical Services to address deficiencies exposed during the conflict. The RAMC was strengthened and better organised, medical infrastructure was upgraded, including enhanced field hospitals and faster evacuation systems. There was a strong focus on sanitation and disease prevention to reduce deaths from illness, alongside the adoption of antiseptics and vaccines. Supply chains were reorganised to ensure efficient distribution of medical resource and the establishment of the Queen Alexandra’s Imperial Military Nursing Service (QAIMNS) in 1902 to replace the small cohort of the Army Nursing Service.

• Emphasis on Sanitation and Counter Typhoid measures:

Surgeon General Jameson immediately after the Boer war reported 'The Committee are of the opinion that no satisfactory system of camp sanitation can be carried out without the intelligent co-operation of company and commanding officers, and consider that in future all Officers should receive periodic instruction in elementary hygiene, as applied to barracks and camps.'

Though the British army experienced typhoid outbreaks in the 20th century (Gallipoli in WW1, India and N Africa in WW2) they were minimal and localised - as direct result of lessons learned and experienced by Walter and others in Bloemfontein.

Compulsory typhoid (TAB) inoculation from 1914 onward, combined with better sanitation prevented typhoid being a limiting factor of deployments in the twentieth century (though the emergence of antibiotic-resistant strains poses additional challenges to treatment and control efforts in 21st century).


Walter's experiences in South Africa, across the treatment of wounded of the Highland Brigade at Magersfontein and through the western campaign, and then providing care in the largest typhoid epidemic in British military history, place him at a critical juncture between the nineteenth century and the modern world we have inherited, in its evolution of science, warfare techniques, medicine and mindset.

Finally and most importantly, thank you, Walter, for your service.



Entitled to:

Queens South Africa - Cape Colony / Paardeberg / Dreifontein (WO100/223_01 p.81)
Kings South Africa - SA1901/ SA1902 (WO-100-351_01 P.45)
1914-15 star
BWM
Victory Medal
Army LSGC Medal Geo V
MSM Geo VI

Select Bibliography

Doyle, A. C. (1900). The Great Boer War. London: Smith, Elder &Co
Cromb, J. (1902) The Highland Brigade: Its Battles & Its Heroes. Stirling
Dale, Charlotte (2015). Traversing the veldt with ‘Tommy Atkins’: The clinical challenges of nursing typhoid patients during the Second Anglo-Boer War 1899–1902. In One hundred years of wartime nursing practices, 1854–1953.
De Villiers, J.C. (2008). Healers, Helpers and Hospitals: A History of Military Medicine in the Anglo‑Boer War.
Gabriel, R. A. & Metz, K. S. (1992) A History of Military Medicine
Jackson, M. C. (1913) A Soldier’s Diary: South Africa 1899–1901 – The Experiences of a Non‑Commissioned Officer of the Hants Regiment and 7th Mounted Infantry during the Boer War.
Kinnear, A. (1900) To Modder River with Methuen: Briton, Boer, and Battle. London
Watt, S. (1992) The Anglo Boer war: the medical arrangements and implications thereof during the British occupation of Bloemfontein: march - august 1900 samilitaryhistory.org/vol092sw.html

Any corrections/builds or further information on Walter would be welcomed.