TOPIC:

From Newington to Norvalspont
An Edinburgh Medical Student with the Edinburgh South African Hospital / VMSC / RAMC - Alfred Brown
Roll number : WO-100-225 03 p.31

I've recently researched the life narrative of one individual delivering medical services in the Anglo Boer war. I hope this forum enjoys this account.

Alfred Brown was born on a Sunday, in Edinburgh.

This particular Sunday, the 16th Nov 1879, was in a year marked by exceptionally cold weather all across Europe where rivers froze, people died of cold, agricultural production struggled and evergreen trees perished. It was described as a year of two winters and no spring or summer. Two weeks later an eye-watering minus 31c was recorded in nearby Berwickshire.

Alfred's parents, John Brown, a Paper Merchant and Printer, and Caroline Patience Bailey Brown, both aged 42, must have worried, and focused on keeping him warm in the early weeks of his life.

The family lived at 17 Lutton Place, Newington, Edinburgh in the 1881 census - a spacious Victorian building overlooking St Peters church. By 1886, aged 7, he had been enrolled at the Royal High School, Edinburgh - a fee-paying, boys school near Calton Hill - a brisk 30 min walk from Lutton Place over North Bridge and Waverley station.

Over the years of his school commute, he would have seen the redevelopment of Waverley station (in 1892) and would have passed the spot where, a decade later, the South African War memorial to the Kings Own Scottish Borderers would stand without knowing this would play a part in his future.




(Lutton Place, Edinburgh Street view; Royal High School 1892 and view from Newington towards Salisbury crags 1893)

To Edinburgh University Medical School - 1895

We know Alfred was diligent and intelligent, as the University of Edinburgh Historical Alumni site shows him obtaining a place studying Medicine, commencing 1895, aged 16.

Then, as now, Edinburgh's global reputation in medicine meant winning a place was exceptionally competitive. Entry was on the basis of academic achievement, financial resources, and social connection. Prospective students needed proficiency in classics, Latin and Greek, alongside an understanding of science and maths. Fees were £150 (at time when junior solicitors earned £150 pa, Bank managers £300 pa and doctors £200-500 pa).

The Medical School's reputation attracted influential figures including: Joseph Lister, who pioneered antiseptic techniques in Surgery ; James Young Simpson, who introduced chloroform as an anaesthetic; and Charles Darwin, who theorised evolution by natural selection. Arthur Conan Doyle attended, encountering surgeon Joseph Bell whose use of deduction in medicine inspired the character of Sherlock Holmes. Bell continued teaching until 1900, so its possible that Alfred may have attended one of Bell's lectures.

The Royal Infirmary, where Alfred studied, was built in 1879 and was an early adopter of aseptic surgical techniques that would significantly improve survival rates in the Anglo Boer war and beyond. Alfred was studying at a heady, experimental time - were for every advance in medicine, such as the discovery of Roentgen (X) rays (1895) or blood typing (1897), parallel developments in global communication, engineering and weaponry were underway. The modern world was being brought into being.



(Edinburgh Royal Infirmary : View from the Meadows in 1890s; A Ward; Entrance in 2024).

Edinburgh Volunteer Medical Staff Corps

The British Volunteer Corps was a civilian reserve force established in the 1850s to recruit and train volunteers who could defend Britain in times of emergency.

A medical component, the Medical Staff Corps, raised in June 1855, was to provide orderlies for the care of the injured in General Military Hospitals. Allegations of neglect during the 1882 Egyptian Campaign led to the creation in September 1884 of the Volunteer Medical Staff Corps (VMSC) staffed by University Medical students. By December 1884 the Glasgow Herald reported the establishment of a VMSC at Edinburgh, Aberdeen, Glasgow and St Andrew's Universities.



(Source : Glasgow Herald, Dec 1885 and Aug 1897 ; VMSC Marching Uniform Wikimedia commons)

We know that Alfred, as a medical student at Edinburgh, had joined the VMSC between 1895 and 1900 and that the Edinburgh VMSC were held in high regard. Training included an annual camp. In August 1897 this tragically included an accidental drowning of an Edinburgh VMSC member near Southend.

On June 1st 1899 The Scotsman newspaper outlined plans for that summer's camp, commencing 22 July at Dunbar Common in East Lothian, with the Edinburgh VMSC working alongside the Royal Scots, Gordon Highlanders, Argyll and Sutherland Highlanders and Kings Own Scottish Borderers.

Whilst Alfred, aged 19, received notification of that summer's training plans, that same week, 8000 miles away at the Bloemfontein Conference, the British High Commissioner and Boer representatives failed to reach an agreement on the franchise for British subjects in the Transvaal, with the president of the Transvaal immediately placing orders for weapons and ammunition from overseas in anticipation of a looming conflict with Britain.

By July 27th, as the Dunbar camp came to a close in the unusually warm weather, Alfred may have read news of Britain issuing a warning to the Transvaal, stating that failure to grant political reforms would have serious consequence. The Boers dismissed this ultimatum.

The training in the fields around Dunbar would soon be tested in reality for Alfred, and all others at that camp.

The Edinburgh and East of Scotland Hospital

War was declared in October 1899 and the British soon suffered setbacks, including three successive defeats in one week in December 1899. The Medical services, including the newly formed Royal Army Medical corps (RAMC) founded in 1898, were soon beyond capacity. The British public and wealthy individuals stepped in to fill the gap in medical provision, proposing a series of private hospitals, mirroring the public provision of medical services with private enterprise of today.

By February 1900 the Glasgow Herald reported a meeting called by the Lord Provost of Edinburgh to establish a hospital of 100 beds for the sick and wounded. By 9 February £12,000 was collected for what was to be the Edinburgh and East of Scotland hospital and Prof John Chiene, a Professor of Surgery at Edinburgh University, and Major Sir James Clark Bart of the RAMC were appointed to lead it.

On the 13th February the Glasgow Herald reported 17 members of the Edinburgh VMSC had volunteered, been passed fit and had been attested into the RAMC. Alfred, aged 20, would have been amongst them. He demonstrates leadership potential as, of the 40 orderlies, he is made Corporal.

Staffing included Doctors, radiological specialists, seven nursing staff and 40 additional staff including 1st class orderlies (students in the the Edinburgh VMSC) and 2nd class orderlies with St Andrew ambulance certificates who were also skilled artisans, joiners, and engineers, able to assist in the building of huts for the hospital.

On the 22nd March the company paraded in the Edinburgh University old college quad before leaving. The unit embarked at Southampton on the Union Castle S.S. Briton on Saturday, 24th March 1900 along with 193 tons of equipment and stores arriving in Cape Town on 10 April 1900 before proceeding to Port Elizabeth.


(Source : Glasgow Herald 23 March 1900 & Report of the Edinburgh and East of Scotland Hospital, 1901)

As a side note the school's global pre-eminence in the medical field meant that the Edinburgh VMSC were not the only students or faculty active in South Africa. Edinburgh Medical students from South Africa volunteered to staff the Sivewright ambulance, providing medical services to the Boer forces from Dec 1899.

Indeed, Edinburgh's influence is such that, of the 133 names of the most notable medical practitioners (excluding unqualified individuals) listed in De Villiers seminal work on Boer war military medicine, 23 (17%) of these had taught at, or been trained in Edinburgh.

Challenges at Norvalspont

By April 1900 the British had overcome the earlier setbacks and were driving northwards to the Boer capitals.

Prioritisation of supplies for the advance on Pretoria along the single track railway meant Alfred and the staff of the Edinburgh hospital had to wait until 21 April 1900 to move to the proposed hospital site at Norvalspont, 225 miles northwards on the Cape and Orange Free State border. The train journey took 36 hours with staff arriving at 2am and sleeping on the ground.

Surgeon-in-charge David Wallace later referred to this site as "the most god-forsaken country any man could put his foot in" notwithstanding "that for people from the dull sky and constant rain of Scotland we had the advantage of having blue sky".

There the hospital encountered challenges - an unsuitable and unsanitary site, the single track railway requiring a siding be constructed, non-standard huts and missing materials requiring purchase of equipment from Cape town.



(The Railway line and unloading the Hospital, Source : Report of the Edinburgh and East of Scotland Hospital, 1901)

The staff set to the task of "turning a lumber yard into a hospital" and Wallace talked of the medical students carrying out the "most uncongenial work with a whole-heartedness and enthusiasm which was every great credit to them" (Scotsman Newspaper, Nov 24 1900). It's in these trials that NCOs, such as Alfred, often provide the day to day motivation, leadership and energy to get the task done.


(The Hospital underway and inside one of the stores, Source : Report of the Edinburgh and East of Scotland Hospital, 1901)

The surgeon general sent ten tents to accelerate establishment of an outpatient facility/temporary wards. The main hospital was ready by 14 May 1900 with the first hospital train arriving on the 29 May with 96 patients. The facility was expanded in July to house 150 beds with an admin block, four hospital huts, surgical theatre, X-ray room, laboratory, mortuary, two cookhouses and stores, all lit by electricity.


(Stand By your beds - a completed ward, Source : Report of the Edinburgh and East of Scotland Hospital, 1901)


Surgical Impact

During its functioning the Edinburgh hospital treated 166 surgical cases, of which 75 were bullet or shell injuries (8 Head wounds, 8 Abdomen, 10 Thorax, 49 Extremities).

When we read historical casualty figures, we might prefer to focus on the number alone, yet each one contains a deal of pain, suffering and potentially life-altering injury that Alfred and the medical services tried to alleviate.

Two surgical cases are typical of the injuries dealt with.

• Private 6745 of 1st HLI had his lower jaw carried away by a pom-pom shell necessitating three rounds of extensive plastic surgery over 2 months. Though a traumatic injury the skill of the surgeons meant that he was able to "eat soft puddings; enjoy biscuits soaked in tea ; to speak fairly distinctly, and to enjoy a smoke and the usual bottle of beer or stout" (!) by the time of his leaving (Wallace & Boyd, 1901). He would, of course, carry significant deformity for life as a result.

• Private 1825 of 1st HLI was "lying down in the firing line, when he was shot in the hand by what he thought to be shrapnel. When retiring to get his hand dressed, he was shot in the back by a Mauser bullet : the bullet coming out in front. After being struck, he staggered for about 15 yards and then dropped". Surgery removed fragments from the hand and the chest wound healed before discharge 3 weeks later.

Wallace, the Chief Surgeon, describing the first war with high-velocity projectiles in a dry environment says the "majority of wounds due to rifle bullets do not become septic if properly dressed at the time of injury, and unless they strike a bone, joint, or some vital part, the patient as a rule escapes in a wonderful manner, and is often quite fit a fortnight or three weeks after" (Wallace &Boyd, 1901).

Enteric, the Risk to Staff and the use of X-Rays

The hospital also treated 156 enteric/typhoid cases (with heart-rending descriptions of the disease impact in the Report of the Edinburgh Hospital). Tantalisingly, one of these cases was listed as a staff member with initials A.B. No staff member other than Alfred had these initials.

This individual presented on 17th May with tongue dry and coated, abdomen distended and rose spots visible. The patient had a mild attack of enteric, modified by inoculation and temperature returned to normal by the twentieth fifth day. It's highly likely that this was Alfred, which demonstrates the risk staff were taking daily in dealing with typhoid patients. Though all 58 staff were inoculated, 9 staff contracted typhoid.

Wallace also states "X-rays were invaluable, not only in cases of bullet or shell wounds, but also in cases of fractures and as an aid in making a definite diagnosis in cases where fracture was doubtful". Ward & Boyd (1901) report "Fifty cases of gunshot wounds and fractures were photographed by means of the X-rays. In several of these, bullets were discovered, in many their absence was proved".

In total the hospital dealt with 507 cases and "upwards of 1000" outpatient cases up to 14 October 1900 when it was handed to the government as a free gift. Deaths were 13 of enteric and 1 of injuries. The surgeon general, initially critical of the speed of set-up, later acknowledged that it was well-equipped and run and was excellent, once established.

Return to Edinburgh

Alfred returned to Britain in mid-November having served 216 days overseas. The Scotsman Newspaper reports a dinner held by the Edinburgh VMSC for all hospital members on 23 November 1900 in the Imperial Hotel, Edinburgh.

At that dinner Colonel Rooney, principal officer for Scotland of the RAMC, stated he was "under considerable obligation to the soldiers of the VMSC for their assistance". Surgeon Captain Hepburn described "one of the first wars of magnitude in which any serious attempt had been made to cope with the sick" and that "the Edinburgh company of the VMSC was one of the earliest to respond to the call to volunteer".

He hoped the “experience would be beneficial to them for the rest of their lives".

Later Life

We cannot know for certain what benefit Alfred took from his time in South Africa.

What is known is that Alfred returned to his studies attaining M.B. Ch.B. in 1901 before submitting his thesis, 'A statistical inquiry into the condition of the facial and other reflexes in general paralysis of the insane' in 1907 when he attained M.D status. This thesis sits in the Edinburgh University library today.


(Which one is our man ? - Edinburgh Medical School Postgraduate Cohort 1907 , Source : Edinburgh University Heritage Collections)

By 1908, aged 29, Alfred marries Gabrielle Stella Bell (b.1882) in Stratford on Avon, Warwickshire. By 1911 he was in practice and resident in the village of Minchinhampton in Gloucestershire. They would go on to have three children - Ronald Arden Brown (b.1913) ; Barbara Brown (b.1914); Alison S Brown (b.1919).

Glimpses of Alfred appear from time to time - still being a force for good. In 1916, he is chairing a special committee in Minchinhampton examining the 'advisability of not lighting the Street Lamps owing to the probable Air Raids by German Aircraft'. By 1918 he is instrumental in helping find premises for a local school, Beauderert Park. He is cited by the Local History group as being the first in the village to buy a car - perhaps a continuation of the atmosphere of experimentation he found in 1890s Edinburgh.

He practiced as the local Doctor until Nov 1946 - a full 35 years service devoted to the health of the village. The residents thought highly enough of him to name a road after him.

His death on 18 January 1951, aged 72, was reported in the British Medical Journal.

Dr Brown’s Road runs through the village to this day, a 1/3rd of a mile-long testament to Alfred's own road from Edinburgh childhood to medical school to South Africa to a lifetime's service as a village doctor.


(Queen's South Africa Medal & Guide to the Medical and Dental Professions book by Percival Turner (publ. 1895).

So What ?

So why is this narrative of one person's service in the Boer war important ? I'd argue there are 4 reasons.

1. It is a good illustration of key themes in British Medical service provision at the close of the Nineteenth century :
○ Edinburgh's global medical influence ;
○ the failure of the government/war office to provide appropriately scaled services for the task;
○ the response of private sector/charitable donations to cover the gap; and,
○ with the VMSC, a test of the emerging reserve forces model that would be fully realised in the 1907 creation of the Territorial Force that would meet the German Forces 7 years later.

2. It is a reminder that warfare, sadly, has often acted as an accelerant of medical and surgical practice. Here we see the creation of Typhoid inoculation in 1898 (under the auspices of the Army Medical services) and its first mass trial in the ABW, experimentation with X-rays and the development of surgical competence that would be documented and revised and put into further use 12 years later in ww1.

3. As historians this narrative serves to remind that sometimes a single, state clasp QSA can represent as significant a historical insight as multiple battlefield clasps, if we have the determination (& archival luck) to uncover it.

4. Personally I found this an example of how history allows us to take inspiration from the service and sacrifice of precedents and use this today.

The Royal Infirmary were Alfred studied also happens to be the place I attend as a post-graduate. Every time I visit the building I'm reminded that Alfred is one of example of many predecessors who saw the immediate challenges of their time and committed to sacrifice their time, effort and energy and to take risks in order to make a positive contribution to the world around them.

Any corrections/builds or further information on Alfred are always welcome.
Thank you for taking the time to read of his journey.

Jon

Select Bibliography

§ De Villiers, JC (2008) Healers, Helpers and Hospitals : A History of Military Medicine in the Boer war (2 Vols)
§ Ed Wallace, D and Boyd, F (1901) Report of the Edinburgh and East of Scotland South African Hospital
§ History of the Medical Staff corps - www.maltaramc.com/regmltgar/medstaffcp.html
§ History of the Medical Staff corps - militaryhealth.bmj.com/content/131/3/152

Special Thanks to the Minchinhampton Local History Society and especially to Stephen L at the University of Edinburgh Heritage Collection.