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.
