It started off as a Boys’ Own adventure both for the troops and for the young doctors seeing active service in the early days of the Boer War that broke out in October 1899. The young newly qualified medic was urged to seize his ‘chance of seeing actual fighting, and, maybe, of proving himself to be something more than a non-combatant’ and was reminded that ‘a chance such as this does not often come of widening one’s view of life, of foreign travel, of active service and of good pay into the bargain.’1 What no one at the time could know was that the new century so soon to dawn was to be a century of total war in which health and medicine were to assume great importance for good and ill, nor that this colonial adventure straddling the ‘Century’s corpse outleant’2 was to prefigure the relationship between medicine and warfare in the years to come. For the time being though, a recruit could happily claim that ‘we live in tents, comfortable enough, though everything is covered with dust’ and complacently boast of ‘what a brotherhood our profession is! Although I know none of the men here, almost all of us have mutual acquaintances’.3 This spirit of supreme confidence of a quick victory by an efficient modern army against a weak force of Boer farmers shared by army doctors and soldiers alike was soon to meet its nemesis in the form of three British defeats in the aptly christened ‘Black Week’ of December 1899. Few could have foreseen that it would be another two and a half years before the might of the British Empire, represented by over 400,000 British troops, could prevail over a seemingly insignificant enemy.4 Wars in the coming twentieth century were rarely to go according to predictions either in duration or outcome.
Despite initial appearances to the contrary, the Boer commandos were actually better armed in many ways than the British Army at first. They could call upon an impressive arsenal of modern Mauser 0.276 rifles, Krupp cannons and French Creusot siege-guns, not to mention a stock of more ammunition than they could hope to use. Moreover, ‘these hard-bitten farmers with their ancient theology and their inconveniently modern rifles’ turned out to be unsurpassed as horsemen and even more superb as marksmen, easily able to pick off British officers at 1200yds.5 The resultant gunshot wounds were clean and it was soon found best to leave them to heal themselves as far as possible. Vincent Warren Low, tending over 300 wounded in a small field hospital in one week from the Battles of Paardeburg and Driefontein in February 1900, noted that ‘the most striking feature of the ordinary modern bullet wound is its asepticity’ and that ‘assuming no complication existed, both [entrance and exit wounds] healed in the course of a few days under a scab, and, as a rule, gave rise to no inconvenience, though occasionally a little pain and stiffness existed in the course of the track of the bullet’.6 A Canadian Scout had been wounded by a Mauser bullet a week before reporting sick and this ‘had not prevented him riding some 20–30 miles daily’. Low ascribed this to the shape, structure and size of the bullet, although many of his fellow surgeons were more inclined to put it down to ‘the dryness and asepticity of the South African atmosphere’ despite the fact that shell wounds invariably suppurated and shrapnel wounds tended to drive small pieces of shirt or khaki uniform into the wound which also caused infection whereas ‘the wedge-like modern bullet made as clean a perforation of the clothes as it did the skin’.7
That it was possible to wait for a wound to be treated by a doctor for sometimes considerable periods was partly owing to the fact that each soldier now carried a ‘first field dressing’ for immediate use at the height of battle. These packages contained a couple of sterile dressings in waterproof covers, comprising gauze pads stitched to a bandage, together with a safety pin. The Prussian Army had been the first to use such dressings and they were an item of standard issue to British troops from 1884.8 Soldiers in the Boer War and subsequent wars of the twentieth century were able to apply the dressings to themselves if they were not too badly wounded or to their comrades to stave off infection. Yet many soldiers would be seen ‘with their dressings a long way from their wounds’.9 Nevertheless the field dressing also allowed regimental medical officers in the midst of battle to collect ‘their wounded in the nearest sheltered positions they could find, which owing to the hilly nature of the ground was usually close to the fighting line; here they were dressed and attended to, and no attempt was, or could be, made to move them further to the rear until the fighting had ceased’.10
It was perhaps just as well that the majority of the wounds could be left undressed for some time as the rapid pace of many of the battles on the veldt meant that the sudden evacuation of a casualty clearing station or field hospital might become necessary at short notice. Lieutenant Wingate was giving chloroform to a wounded officer being operated upon during the Battle of Paardeburg when the Boers began to shell the hospital tents and ‘two bullets whistled through the operating tent over our heads’. With barely time to finish operating upon their patient, the doctors had to abandon their tented hospital, load their wagons with the wounded under fire and travel two miles before it was safe to stop and ‘dead beat, with all our wounded except two poor fellows who died en route, we camped or rather laid down on the veldt and slept’. For the exhausted and wounded soldiers there lay ahead a night of intense thirst since the enemy had control of the nearby river and had captured the hospital’s water carts.11
Frederick Treves, surgeon to Queen Victoria and now in charge of the No. 4 Field Hospital, was shocked by the sight of the casualties from the Battle of Colenso on 15 December 1899, men whom a few hours earlier he had witnessed marching off with a devil-may-care attitude only to return ‘burnt a brown red by the sun, their faces … covered with dust and sweat … blistered by the heat’ and their ‘blue army shirts … stiff with blood.’ All of them ‘seemed dazed, weary and depressed’.12 Although he was an experienced surgeon, the horrors of war still turned his stomach as he surveyed the men lying on stretchers covered with tarpaulin as slight protection against the rain that had now started to pour down; one man paralysed by a bullet in his spine was trying vainly to move his limbs, other men were kicking around deliriously on the wet grass to which they had fallen from their stretchers, and the piles of discarded bullet-riddled helmets and blood-soaked uniforms littered the ground. For him, there lay a ceaseless round of amputation ahead.
There was not even time to remove the dead and, during one hectic operating session, Treves noticed what seemed to be a corpse lying below the operating table. The man had been shot through the face and his ‘features were obliterated by dust and blood’, leaving only his blood-clotted moustache visible. Treves was taken aback to see ‘this apparently inanimate figure’ raise his head and open his eyes to see what was happening when an amputated limb fell onto him. For most of the casualties there was not to be such a happy ending even if they actually reached the operating theatre in good time.13
Transport was a major problem bedevilling the British Army during the war in South Africa, but it was perhaps at its most grievous in its effects on the care of the sick and wounded. Liaison between stretcher-bearer companies and the field hospitals was often poor, with bearer companies simply dumping the wounded at the short-staffed field hospitals where they might be left waiting a long time for treatment. There was no simple line of command to link these two units responsible for battlefield medicine. Moreover, many of the stretcher-bearers were not specially trained orderlies but were ‘the outlaws, who are useless for regimental work, and handed over to the M[edical] O[fficer] to carry his bags about’. Such ‘useless ignorant fellows’ could kill their patients ‘by the clumsy jerky way’ they carried the stretcher. One medical officer who saw a soldier who had been wounded in the abdomen die on a stretcher lamented that he ‘could not make the men, who were untrained, understand the stretcher was to be carried absolutely level and not jerked’.14 It was felt throughout the army and even into the corridors of the War Office that ‘probably nothing has come more prominently under the notice of army medical officers in this campaign than the necessity of combining the field hospital and the bearer company into one unit under one commanding officer’.15 A model for this was the New South Wales Ambulance, which comprised a unified field hospital and bearer company, ‘everything necessary for the performance of its special duties’, and had proved itself to be efficient.
However, little could be done to make the ox-drawn ambulance wagons without springs comfortable for the men travelling in them. William Burdett-Coutts, war correspondent for The Times, complained in April 1900 that ‘many of the wounded were sent back to Kimberley in bullock wagons, and we can well imagine the excruciating suffering caused by such a method of conveyance’.16 It was remarkable that there were very few accidents involving them on the march from the Modder River to Pretoria following the British reverses of the aptly named ‘Black Week’ of December 1899, although there were doubts about their true value when their weight and the number of animals they required to pull them was compared with the relatively few sick and wounded they could carry.17 Indeed General Buller considered them so unsuitable for the stony terrain of the veldt that he recruited a team of some 2000 volunteer stretcher-bearers as a substitute for them, mainly from British-born Uitlander refugees from the Boer Republics.18 With them were 800 volunteers from the Indian community of Natal led by a twenty-eight-year-old barrister Mohandras K. Gandhi, keen to show loyalty to the British Empire in the non-belligerent role of stretcher-bearer.19 The medical horrors of war and seemingly needless death were to reinforce Gandhi’s innate pacifism.
Altogether some 22,000 British troops were to die during the war and more than five times that number were to be wounded or incapacitated by disease. However, of those soldiers who died, two thirds of them were the victims not of wounds inflicted in battle but of infectious disease.20 Above all, it was typhoid that proved the greatest killer in this war rather than the armed warrior. War and typhoid, often known as enteric fever, were old companions. In the Spanish American War of 1898, one fifth of the United States armed forces had contracted it and six times the number of soldiers who died in combat died from the fever. Out of 107,973 soldiers, there were 20,738 cases of typhoid with 1,580 deaths. In the majority of the volunteer regiments involved, the disease tended to break out within two months of the men going into camp and was the result of poor sanitation, flies carrying the contagion and dusty conditions.21 This pattern was to be all too familiar during the war in South Africa where the disease also struck standing camps rather than troops constantly on the move. The infection was also spread by the ‘plagues of flies’ so common on the veldt ‘for it was a most difficult task to prevent them from settling on the sore lips and gums of men, and then inoculating any food or drink they might come into contact with’.22 Of the 557,653 officers and men serving, 57,684 caught enteric fever. There were 8,225 deaths from it compared with the 7,582 men who died of wounds.23
Typhoid victims are often infected by eating food or drinking water contaminated by the bacillus Salmonella typhi, which had only been identified as recently as 1880 by Carl Eberth and Edwin Klebs. Once the bacillus reaches the small intestine, it multiplies and enters the bloodstream. After some ten to fourteen days the symptoms begin to manifest themselves, often starting off with a fever, headaches and pains in the muscles and joints that make rest difficult if not impossible. Constipation in the early stages of the illness may be followed by watery green or bloody diarrhoea. By the second week of the infection, the patient is often too weak and dizzy to get out of bed when stricken with diarrhoea, with the result that the bedclothes are frequently soiled. Meanwhile, the fever, accompanied by fits of shivering, increases until it reaches 104°F or even higher. The skin is hot and dry, the lips scab-encrusted and the tongue blackened. Not surprisingly, the patient often begins to ramble mentally. In many cases the intestine wall is perforated and there is massive gastrointestinal haemorrhaging, the major causes of death from typhoid. In 1896 Ferdinand Widal had devised a blood test for the diagnosis of typhoid fever but there was to be no effective treatment for the dreaded disease until the discovery of the antibiotic chloramphenicol in 1948. For the late nineteenth-century patient the infection meant great suffering with no hope of any effective treatment; for the doctor of the age it represented a failure in the therapeutic tools at his command.24 William Osler, the great doyen of medical humanism, was in no doubt that ‘typhoid fever has been one of the great scourges of armies, and kills and maims more than powder and shot’. Writing in 1914, on the eve of a conflict in which this was to change, he despaired that ‘the story of recent wars forms a sad chapter in human inefficiency’.25
The Hospital Field Service in South Africa soon found it impossible to cope with the horrors of an outbreak of typhoid that shocked the public at home already reeling from news of military setbacks and heavy battlefield casualties. An epidemic spread through besieged Ladysmith, the hot, dusty railway junction walled in by a ridge of hills in which around 13,500 British troops were trapped. Three field hospitals were set up within the town and an isolation hospital for typhoid cases set up in a no man’s land at Intombi, beyond the perimeters of the town to which typhoid cases were sent. Out of a garrison of 13, 500 these hospitals treated 10,688 cases of sickness between November 1899 and February 1900, during which four months 393 people died of the disease. At first, when Sir George White and his men had flocked into Ladysmith at the end of October, the hospitals had seen mainly battle casualties. One nurse, Miss Charleson found those early days heady ones as ‘trembling from want of rest, strangely excited at the thought of seeing – for the first time – the wounded from a field of battle … by the dim light of many lanterns, I traced a moving mass of ambulances carrying the wounded and the dead’ from the Battle of Modderspruit. An improvised hospital was set up in the town hall and the nurses handed out warming cups of hot Bovril to the wounded. Meanwhile in the operating theatre, surgeons operated on hopeless case after hopeless case: ‘alas for the brave Gordons, many of them with their heads shattered by shells, or with hair matted with gore, and faces grey with suffering’.26 Such horrific injuries did not stop this nursing sister from taking a romantic view of the dying wounded hero, the death of Commander Egerton of HMS Powerful, prompting her to write in her diary on 2 November 1899 that ‘his face was pale and peaceful, a tender heroic smile was on his lips, and his eyes had no pain in them, only a look of satisfaction for having done his duty, and a glory in dying for his country’.27 She had a more realistic view of wounded privates, noting that ‘always Tommy was very anxious to get his bullet for the missus’.28 As the siege went on and typhoid raged, her romanticised view of war was to be greatly modified.
The hospital at Intombi Sprut had been established for the isolation of typhoid and dysentery sufferers. By agreement with the Boer General Piet Joubert, hospital trains bearing a white flag were allowed to transport patients there each day. Once there, they were forbidden to return to Ladysmith. Intombi was a ‘dismal spot’ and when it rained the camp became a swamp. Nurse Charleson was ‘obliged to wade from one marquee to another in a very short dress, shod with long gun boots and with a waterproof bag on my head’ when tending her patients.29 It was no better in dry conditions when the heat of the sun made conditions in the tents unbearable. The patients were deliberately deprived of what medicines and comforts were available in Ladysmith by the military authorities in charge in order to save them for the defenders within the besieged town. Nurse Charleson’s diary recorded her despair about being ‘shut up in that hollow with so many sick and wounded, surrounded by high mountains in which our enemies were seated with their long-reaching guns; we were indeed to be pitied’. She noted that ‘daily the camp was becoming more unhealthy, and the food rationings decreasing. Nothing but a good, sound constitution could have possibly overcome these obstacles’.30
It was little wonder that sick men tried to stay in one of the hospitals in Ladysmith rather than be sent to such a hellhole. In order to prevent journalists from seeing what was happening out there, any press correspondent stricken with enteric fever was allowed to stay in the town though it was compulsory for all other sufferers to be sent to the isolation of Intombi.31 George Steevens, the dashing war correspondent for the Daily Mail, had complained soon after the beginning of the siege that there was nothing to do other than eat, drink and sleep and that unless Ladysmith were to be relieved soon, ‘we die of dullness’, but was destined himself to die a horrible death from typhoid shortly before Christmas 1899 in one of the insalubrious Ladysmith hospitals.32
Conditions in the hospitals were bad enough at the height of the typhoid epidemic but were made worse by the actions of Colonel Exham, the Principal Medical Officer who, desirous of being able to present a neat list of supplies at the end of the siege, had forbidden the issue of such meagre comforts as sago, arrowroot and brandy to the sick whilst ensuring that these were diverted for the use of journalists, civilians and senior officers.33 At the same time Exham was obsessed with the tidiness of the field hospitals, prompting Major Donegan, who was in charge of the 18th Field Hospital, to complain ‘God almighty! We have four doctors for 120 patients scattered over three churches and thirty-six tents, and the P[rincipal] M[edical] O[fficer] only worries whether the men’s clothes are neatly folded, or if their boots are in line.’34
Bad as the ravage of typhoid was at Ladysmith with its grim average of ten deaths a day, it was to be far worse at Bloemfontein after its occupation by General Roberts in March 1900. Almost 1,000 troops were to die in the epidemic which had been partly caused by many of Roberts’s troops drinking water from the Modder River, heavily polluted by the corpses of men and horses killed in the recent Battle of Paardeburg fought there. Neglect of elementary hygiene compounded the problem. Where attention was paid to adequate sanitation, it was possible to control typhoid. At 6th General Hospital, Naauwpoort, a simple and effective sewage system had been devised by the Royal Engineers who had also provided pumps for an adequate water supply. Moreover, the hospital staff had incinerated all soiled dressings and the excreta of typhoid patients, thereby ensuring that ‘up to date we have passed over 2000 patients through No. 6 General Hospital, and there is not a case of enteric fever to be traced to the surroundings of the hospital’.35 Less care was taken at Bloemfontein. Soon there were funeral processions through the dusty streets of the town every afternoon mocking the recent triumphal entry of the army that was now burying its dead with the minimum of ceremony.
Arthur Conan Doyle working in a voluntary hospital at Bloemfontein saw the outbreak of enteric fever at Bloemfontein as ‘a calamity the magnitude of which had not been foreseen and which even now is not fully appreciated’. In one month alone, 10–12,000 men had gone down with ‘the most debilitating and lingering of continued fevers’ and over half of the doctors, nurses and medical orderlies attending the sick had themselves caught the disease.36 William Burdett-Coutts, a journalist and Unionist MP, denounced in the columns of The Times the scandal of the failure of the Hospital Field Service:
hundreds of men to my knowledge were lying in the worst stages of typhoid, with only a blanket and a thin waterproof sheet … between their aching bodies and the hard ground, with no milk and hardly any medicines, without beds, stretchers or mattresses, without linen of any kind, without a single nurse amongst them, with only a few soldiers to act as orderlies and with only three doctors to attend on 350 patients.37
Yet despite it being ‘obvious that for many years the department of healing has not advanced pari passu with the department of maiming’,38 the Army Medical Department was unwilling to co-operate with civilian volunteer hospitals notwithstanding it being recognised that such hospitals as the Portland Hospital offered superior standards of care and accommodation to anything provided by the Royal Army Medical Corps.39 Perhaps co-operation was not as great as it may have been because of a feeling that the private hospitals were getting in the way of the army organisation and that ‘they should not be allowed to force themselves up towards the Front in the place of organised military hospitals’.40 Jurisdictional rivalries only worsened the lot of the sick and dying.
All these deaths from typhoid could so easily have been prevented had the troops been vaccinated. Only a few years before the outbreak of the war a vaccine against typhoid fever had been developed by Almroth Wright, professor of pathology at the Army Medical School at the Royal Victoria Hospital at Netley overlooking Southampton Water. Yet, despite it coming from an army medical establishment that was gaining a reputation for its research, the military authorities were suspicious of the new vaccine and even more so of the man who had produced it. Wright was an abrasive, acrimonious figure made for controversy who made no concessions to his critics however much he may have antagonised them and biased them against his ideas. There had been resentment against his appointment to the post at Netley in 1892 when this relatively unknown thirty-one-year-old civilian with as yet little experience in the field of pathology had been given the job in preference to older, more experienced army officers.41 By this time, despite having followed an erratic career path that had veered from the humanities to the sciences and from law to medicine before he finally chose to concentrate on medical research, he was already acutely conscious of his own ability and impatient of anyone who disagreed with him. It was an attitude that was later to earn him the nicknames of ‘Sir Almost Right’ and ‘Sir Always Wrong’ from his many opponents who did not share his own extremely high opinion of himself.42 He was not averse to telling the president of one military tribunal to which he was giving evidence that ‘I have given you the facts, I can’t give you the brains.’43
At Netley, he had developed a diagnostic test for Malta Fever and a vaccine against this prolonged, relapsing illness. So confident was he that this vaccine would work that he tried it out on himself and then injected himself with live organisms only to find that the vaccine did not work after all.44 When he had recovered from a long and distressing bout of Malta Fever, he turned his attention in 1896 to the problem of producing a vaccine against the much more serious typhoid fever. It had taken great personal courage for Wright to test his vaccine against Malta Fever on himself, yet there were even greater dangers in injecting a human being with this virulent organism, the typhoid bacillus, in however attenuated a form. Still firm in his belief in the principle of vaccination and encouraged by the success of Waldemar Haffkine in using heat-killed bacteria in an anti-cholera vaccine, he developed a heat-killed vaccine which he tested on himself, his colleague David Semple and sixteen trainee medical officers. These young officers were accustomed to military discipline and to obeying orders but were also inspired by their charismatic chief’s confidence in what he was asking them to do. The initial effects were alarming. The officers concerned soon felt faint and suffered from vomiting and a loss of appetite. The worst affected of them remained weak and ‘looked somewhat shaken in health for some three weeks after’.45 Wright, having learned his lesson with Malta Fever, decided against infecting himself with typhoid to see whether the vaccine did actually work, but injected one intrepid young man with live typhoid bacilli with no ill effects. More extended clinical trials following a typhoid outbreak at Maidstone Insane Asylum in 1897 and with the Indian Army in 1898 also gave encouraging results but were too sketchy and incomplete to confirm Wright’s faith in his vaccine.46 The outbreak of the Boer War offered just the opportunity he needed to try out his vaccine in wartime conditions and give him the chance he craved to make a difference to the health of the troops.
Unfortunately, the new vaccine was not received by serving military medical officers with the same enthusiasm Wright had shown for it. Only 14,628 soldiers actually volunteered to be inoculated, which amounted to no more than four per cent of the total. There was little support and much suspicion from the army doctors. There was a general history of popular hostility to compulsory vaccination, which had raged ever since Edward Jenner had first developed his smallpox vaccine at the end of the eighteenth century with many doctors opposed to the very idea of inoculation.47 Moreover many of them actually believed that anti-typhoid inoculation caused the fever in the first place; and the severity of the reactions to it, which could leave a man unfit for duty for several days, only reinforced military hostility to inoculation.48 Wright explained such adverse reactions as representing a ‘negative phase’ in the treatment, a period immediately after inoculation when immunity was diminished before it could be enhanced. Since this made men more vulnerable to infection in the short term, it meant that inoculation must take place before they were exposed to infection and made it potentially dangerous during an epidemic. Wright also recommended a second booster injection to increase protection, but this advice made it even more of a deterrent to the adoption of the vaccine. Some wooden cases containing supplies of the vaccine were even dumped over the sides of troopships leaving Southampton Water within sight of Wright at Netley to be returned to him by the coastguards.49
Those doctors who actually inoculated soldiers during the voyage out to South Africa were to report adverse reactions made worse in some cases by seasickness. One civilian surgeon was able to round up 200 volunteers aboard SS Sicilian, but two of them fainted ‘with fright’ immediately after the needle was injected. Within ninety minutes, nearly all the men injected began to feel ill, some with cramp in the abdomen, others with nausea and violent vomiting or diarrhoea, and all with a rise in temperature. It was to be three days before any of them began to recover. The surgeon concerned was also inoculated and was soon ‘unable to move hand or foot without assistance’ while the ‘two glands in my groin were swollen to the size of pigeon’s eggs’.50 Such strong reactions, though actually very common, were put down by some doctors to the sera being too strong.51 It was no wonder that many men did not volunteer, even if their regimental medical officers recommended the injections, when they saw the effects on their comrades.
As a result of the low number of troops inoculated, it was impossible to perform any accurate statistical analysis of the results of using the vaccine. Wright, who was sceptical about statistics at the best of times, had no doubt about its value and advocated the compulsory vaccination of troops against typhoid. His many enemies in the military hierarchy, headed by David Bruce, discoverer of the cause of Malta Fever and one of the disappointed candidates for Wright’s chair in pathology, were hostile to any form of inoculation let alone any involving compulsion. As a result, the army board advising the War Office on scientific issues recommended that voluntary inoculation be suspended and that it should only be resumed if Wright prepared a detailed proposal ‘showing exactly on what lines and with what precautions he would propose that the system should be carried out’.52
An Army Medical Services committee on anti-typhoid inoculation was established in 1904 after Wright had mobilised medical and scientific support against this decision; it concluded that ‘the practice of anti-typhoid inoculations in the army has resulted in a substantial reduction in the incidence and death rate from enteric fever among the inoculated’ and recommended resumption of voluntary vaccination for troops.53 However, the critics of vaccination enlisted the support of the statistician Karl Pearson, who attacked the rigour of Wright’s methods of analysis.54 Wright, who had left the Army Medical Service in 1902, was to spend the next decade fighting for official recognition of the value of vaccination that he believed could have saved so many lives in South Africa.55 It was only once William Leishman, Wright’s successor at the Royal Army Medical School now based at Millbank, London, had undertaken further research into the effects of anti-typhoid sera that vaccination was reintroduced on a voluntary basis in 1912.56
However, it was not only among the British armed forces that the inadequate response to the treatment of infectious disease was to provoke a scandal.57 Boer women and children incarcerated in the first concentration camps of the twentieth century were to suffer from the ravages of epidemics just as much as the men who were fighting, although measles rather than typhoid was to be the bigger killer. These camps were General Kitchener’s response to the Boer guerrilla warfare that characterised the last phases of the conflict. They were established as refuges for Boer women and children made homeless by the burning of farms thought to be harbouring the commandos. It was a policy which freed the Boer men from the distraction of looking after their families and added to the determination of the ‘bitter enders’ to carry on what was by now a hopeless struggle. Those families who tried to stay in their farms seemed to be ‘very badly off’ and were short of sugar, salt and matches. If they left home to seek refuge in a camp, their homesteads were burned in line with the policy ‘to destroy everything likely to be of material use to the enemy’ if it had not been purloined by British soldiers, with ‘a most brilliant reputation for looting’, first. Even many an army doctor ‘became somewhat of an adept at fowl-snatching’.58 For some Boer families the camps were at first refuges as much as prisons, but not for long.
Soon death from malnutrition and disease swept through these badly sited, unhygienic camps. At the camp at Mafeking women were washing clothes in excrement-fouled water, the latrines were not properly disinfected and slop water was just emptied next to the tents. There was no mortuary despite a rising death rate. Fresh meat and vegetables were not available as part of the rations, even though they could easily have been bought from the nearby town. However, it was not just the negligence of the British Army that was to blame for creating such unsanitary conditions.59 The Boer women were also blamed by observers for having ‘a horror of ventilation’ which directly caused ‘the pestilential atmosphere of the tents’ which could best be described as ‘stinking’.60 Farming families accustomed to leading healthy if isolated lives had not built up resistance to infectious diseases. By the end of the war, well over 20,000 women and children had died in the camps, a quarter of all women and children from the Boer Republics.61
Conditions at Heilbron were made even worse when the army interned a group of Boer families infected with measles in a camp unable to cope with the influx of the sick, many of whom were housed in ‘miserable sheds or stables, and one hovel was one surely meant for a pig or some poor native and yet a young girl, dangerously ill lay in it’.62 Such a policy outraged the suffragette Millicent Fawcett, the leader of an all-women committee appointed by the British government to enquire into conditions in the camps: ‘There is barely language too strong to express our opinion of the sending of a mass of disease to a healthy camp; but the cemetery at Heilbron tells the price paid in lives for the terrible mistake.’63
Conditions in the camps had first been exposed by the Quaker Emily Hobhouse who had been horrified at what she had witnessed during her visit to them between December 1900 and May 1901:
I began to compare a parish I had known at home of 2,000 people where a funeral was an event – and usually of an old person. Here some twenty to twenty-five were carried away daily … it was a death rate that had not been known except in the times of the Great Plagues … the whole talk was of deaths – who died yesterday, who lay dying today, who would be dead tomorrow.64
Alfred Milner, British High Commissioner for South Africa, although privately blaming the scandal on military mismanagement, was so angered by Hobhouse’s rhetorical mission to publicise the scandal, that he arranged for her to be arrested and deported when she attempted to return to South Africa in October 1901.65
However, by that time Mrs Fawcett’s Ladies’ Committee had been sent out by the War Office to investigate the conditions in the camps. Unlike Hobhouse, who was often dismissed as hysterical in her response to the camps, all of these practical and down-to-earth women, including two doctors and a nurse, believed that the war was just and that in wartime unpleasant measures might have to be taken against enemy civilians. Yet, they were appalled by what they saw and recommended relief measures including the provision of trained nurses in the camps, improved rations and proper equipment for the sterilization of the linen used by typhoid patients, though their interest did not extend to the native Africans who had also been interned.66
Just as Hobhouse and the Fawcett Commission’s reports had galvanised action to improve conditions in the camps, it was Burdett-Coutts’s revelations of ‘the growing scenes of neglect and inhumanity, of suffering and death, which have been the lot of the British soldier in the closing chapter of this war’67 that provoked the usual governmental response to any official scandal, the appointment of a royal commission ‘to consider and report upon the care and treatment of the sick and wounded during the South African Campaign’ under the chairmanship of Sir Robert Romer. Evidence was taken from officers of the Royal Army Medical Corps (RAMC), civilian surgeons and the sick and wounded themselves. The commission found that the scale of the war had taken the authorities by surprise and that the RAMC had come under great pressure and had neglected sanitation in the field, but its conclusion that in general the Corps had generally overcome its own very considerable shortcomings was certainly a whitewash that bore little relationship to the reality of what had actually happened.68 The evidence pointed towards a breakdown of the army medical organisation especially with regard to sanitation, transport, the response to infectious diseases, and manpower, however brave and dedicated individual officers may have been. The whole question of the failure to introduce inoculation against typhoid was ignored.
Yet the outcome of this commission should have come as no surprise to anyone, for there was a feeling within the RAMC that ‘this war is the first occasion on which the existing medical organisation has been tested, and in spite of the reduced scale, it has stood the test remarkably well’.69 E.W. Herrington, a doctor at Bloemfontein, had no doubts after a visit from the Hospital Commission that:
I do not think that the RAMC will come badly out of the enquiry but will, in the future, have their hands greatly strengthened. They were not able to do impossibilities and did their best with what material they could seize upon, whilst no one could foresee that there would be such a terrible outbreak of enteric after Paardeburg, or that the disease would be of such virulent a type.70
Nonetheless, the RAMC had come very close to breaking down under the pressure of war. When the war broke out, the Corps was only one year old, having been formed as recently as June 1898 from an amalgamation of the Medical Staff Corps, made up of medically trained soldiers, and the doctors of the Medical Staff. Up to this time the Staff Corps, men of ‘regular, steady habits and good temper … possessed of a kindly disposition’, had had no officers while the Medical Staff of the Army Medical Department were all officers without any men to command.71 Only with the formation of the RAMC were medical officers given the same status and rank as other officers within the British Army but they still continued to be looked down upon as inferior by both the army and their fellow civilian doctors to whom medical military service was seen as a last resort for medical men unable to afford a footing in general practice or even to find a paid appointment with the poor law authorities. Recruitment to the Corps was also deterred by the inferior terms of service offered to army doctors within the armed forces even if they enjoyed officer status. Whereas an eighteen-year-old cavalry subaltern was paid £400 a year in allowances to enable him to maintain two servants, two horses and stabling, the £200 salary and £70 allowances paid to an older, medically qualified RAMC subaltern was not enough for him ‘to keep up a smart civilian and military kit and subscribe freely to everything that is going on’.72 If better doctors were to be recruited, the army had to offer them more attractive conditions of service and more authority in enforcing health and sanitary regulations. It was little wonder that on the outbreak of the Boer War the new Corps was still undermanned and its inadequacies had been only too visible, but the experience had offered salutary lessons which were to be heeded over the next few years.
The years between the end of the Boer War and the outbreak of war in 1914 were ones of reform for the army medical services just as they marked a period of army reform in general under the War Secretary Lord Haldane. The status of the military doctor was regularised and it was suggested that candidates for the RAMC should be ‘British subjects of unmixed European blood, not more than 28 years of age, and shall possess a recognizable qualification to practice’. The medical officers were given responsibility for all medical and sanitary services in their area. Salaries and the status of army medical officers were raised and provision made for study leave.73 In 1904 the director-general of the Army Medical Department was raised to a rank immediately below that of an adjutant-general, which ensured that his voice would be heard when it came to military planning. The Royal Army Medical College was transferred from Netley to London in 1907 ensuring that it was more in touch with wider developments in the medical world of the capital and was no longer regarded as a seaside holiday for men taking courses there. The veteran bacteriologist Alexander Ogston was very concerned that there was no provision ‘for the formation of a Sanitary Corps, consisting of officers specially charged with the duty of carrying out proper sanitary measures in peace and war, and a staff of men trained to ensure the requisite measures being carried into effect’.74 In 1906 a school of sanitation was opened at Aldershot for the training of regimental officers and non commissioned officers that could form the nucleus of hygiene detachments. Military hygiene courses also became a regular part of the syllabus for army doctors. Field ambulances replaced the old stretcher-bearer companies. Research was commissioned into water filters and water sterilizing carts.75 The need for a medical reserve to cope with greater needs in the event of war was met by the formation of a territorial army unit modelled on the RAMC. This reorganisation under the aegis of the director-general Alfred Keogh was to shape the RAMC into a much more effective medical service, one that was at last prepared to fight the Boer War so recently over. Sir Frederick Treves gave his approval to the removal of ‘the grave defects brought to light in the Report of the South African Hospital Committee’ and predicted that ‘it will be the finest service in the world in time’.76
Army nursing did not escape rationalization in the rush to repair the deficiencies revealed by the war. An Army Nursing Service had been formed in 1881 and this had been supplemented by Princess Christian’s Army Nursing Service Reserve from 1887, but women still lacked any status as regular members of the armed forces and were not supposed to nurse close to the battle zones. The Boer War demonstrated the need for the employment ‘of nurses in fixed hospitals for the care of the wounded and of fever and dysenteric patients, and such others as can properly be nursed by females’.77 A committee under the chairmanship of St John Broderick recommended the amalgamation of the army and Indian Nursing Services to form Queen Alexandra’s Imperial Military Nursing Service ‘under the immediate control of Her Majesty Queen Alexandra as President’.78 However, Queen Alexandra was determined to be consulted and have her way on everything, from the size of buttons on the uniform to the role of the Lady Superintendent or Matron-in-Chief.79 The Queen’s interest was often counter-productive and a trial to any one who opposed her well-meaning but always regal interference. Lord Haldane as Secretary of State for War was not the only person to consider her a nuisance when he came up against her in replacing Princess Christian’s Army Nursing Reserve with the rationalized Queen Alexandra’s Imperial Military Nursing Service Reserve and establishing the Territorial Army Nursing Service in 1908. Exasperated by his dealings with the Queen, Haldane complained that ‘she is about the stupidest woman in England’.80 However, there was nothing he could do to counter royal influence in army nursing.81
Military medical and nursing reform was part of a wider obsession with ‘National Efficiency’ which reverses in the Boer War had brought to the fore, though their origins lay in an underlying unease that economically and militarily Britain was being overtaken by an armed, vigorous and prosperous German Empire. The fear was that if the mighty British forces could be brought to the verge of defeat by simple South African farmers, they would stand no chance against a well-disciplined, well-equipped and well-trained German Army. If Britain was to survive it had to modernise itself. Linked in with such fears of national decline were the revelations of the deplorable physical condition of many of the men volunteering for service in South Africa. Over a quarter of volunteers at some recruiting depots were rejected as unfit for military service. The journalist Arnold White revealed that at Manchester three out of five recruits failed to meet the low physical standards of a minimum height of 5ft 3in, a chest measurement of 33in and a weight of 115lb. At York, Leeds and Sheffield, forty-seven per cent of recruits failed to meet these standards and twenty-six per cent were additionally rejected on account of defective vision or hearing, decayed teeth, ill-health or ‘dull intellect’.82 Major-General Sir John Frederick Maurice argued that such statistics suggested that the environmental conditions in which the working classes lived were seriously depleting the reserve of fit men from which the soldiers were recruited.83 All of this was to influence debate on social policy for many years to come.84
In the short term, an interdepartmental committee of enquiry into physical deterioration was set up to consider the important question of whether the British race was in terminal decline and unable to bear the Imperial burden. As the Boer War was the first time since the Crimean War that large numbers of the adult male population had been weighed, measured and tested for physical weakness, no one could be sure whether the conditions that had been reported were the result of progressive racial degeneracy or merely of an unhealthy urban environment. The report, as would be expected from a commission made up exclusively of civil servants, was reassuring in its findings that there was no clear evidence of inherited physical degeneracy. However, evidence given to it confirmed White’s charge about the physical condition of recruits and suggested that dirt, ill-nourishment and neglect were responsible for much of the ill-health uncovered, but that this could be remedied if the conditions producing it were improved. A clear connection was made between the evils of the slums and national security: an unhealthy citizenry meant a declining national power and physical weakness directly corresponded to military weakness. Yet, these evils could be overcome since ‘those inferior bodily characters which are the result of poverty (and not vice, such as syphilis and alcoholism), and are therefore acquired during the lifetime of the individual, are not transmissible from one generation to another. To restore, therefore, the classes in which this inferiority exists to the mean standard of national physique, all that is required is to improve the conditions of living, and in one or two generations all the ground that has been lost will be recovered’.85 The recommendations of the report were conventional ones that social reformers had been urging for about twenty years, including the medical inspection of school children, school meals for the needy, physical education in schools, the education of girls about child care and cookery, and more rigorous enforcement of the existing sanitary regulations. They were given more cogency by their importance for the future of Britain as a world power and Sir William Taylor, Director-General of the Army Medical Services expressed the hope that ‘the inquiry might end in suggestions that will lead to the institution of measures which will result in bringing about a marked improvement of the physique of the classes from which our recruits are at present drawn’.86
Although the medical profession and many social reformers welcomed the report, others were less convinced that physical deterioration was not a reality and were concerned about the differential birth rate, whereby the unhealthiest stock among the poorest working classes were having more children than the healthier middle classes. The statistician Karl Pearson was concerned that a quarter of the population would produce half of the next generation and that as the best stocks, as he considered the professional classes to be, were dying out, the worst stocks, the dysgenic poor, were multiplying. The racial fitness of the population would determine its survival chances and Britain’s differential birth rate could be seen as foreshadowing the collapse of the British Empire.87 This war-induced panic created an atmosphere congenial to the launch of the eugenics movement with its schemes of race improvement through encouraging breeding among the better classes and discouraging it among the unfit.
The quality of future good citizens mattered as much as the quantity, a concern which encouraged eugenicists to ally with social reformers, unconvinced of there being any evidence of hereditary racial degeneration, in order to improve conditions for the next generation upon whom national survival might depend. Infant welfare was at the heart of public health concerns. Even before the war, there had been concern about the dangers to mothers and babies from untrained midwives, but, despite attempts to regulate the profession through unsuccessful bills in 1890 and 1899, it was not until 1902 that the Midwives’ Act banned unregistered midwives from practising. One midwife instructor, Emilia Kanthack, linked training in midwifery with the creation of little imperial assets and the fight against race-deterioration in 1907, stating that ‘we want not only to keep babies alive, but we want them to be healthy young animals’.88 Mothers were urged to breastfeed their babies because of a belief among medical experts that the use of dirty feeding bottles, contaminated milk or tinned, sweetened, skimmed milk was causing a high infant mortality rate from diarrhoea. Maternity and child welfare clinics were also established all over the country, following the opening of the St Pancras School for Mothers in 1907, where mothers could be given advice on feeding, and the babies could be weighed. Health visitors were also employed by many of the more progressive local authorities.89 Meanwhile, mothercraft and domestic science lessons for girls became more prominent in schools, a preparation for their future responsibilities and roles in the home.90 The Fabian Society called for ‘the endowment of motherhood’, which involved a combination of family allowances and publicly financed infant welfare centres, in order to encourage ‘fit parenthood’.91
It was not just the role of the mother that was being emphasised as a solution to the problems exposed by wartime recruitment. If Britain was to maintain the Empire, it was important to ensure the physical health and nourishment of a new generation of schoolchildren who would represent the future imperial army. Imperial rivals were already making such provision. Japan made provision for the medical inspection of schoolchildren and Germany provided baths, food and medical services in its schools, both nations being very much in advance of Britain in welfare matters. In 1905 free school meals were introduced for needy schoolchildren. School medical inspections followed in 1907, primarily to provide an accurate anthropometrical survey of school-age children that would help to establish whether physical deterioration was indeed a reality, and also reveal the true extent of preventable disease. Once these inspections had revealed a picture of widespread ill health, the way was open for the establishment of a school medical service staffed by nurses.
School clinics were set up when it proved too costly and difficult to refer cases to local hospitals. The first clinic was established by Margaret McMillan in London in 1908, and by the end of 1913 there were 260 school clinics in 139 local education authorities around the country. Dental treatment was offered, though in the days of foot-operated drills it was often distressing for the child. By 1914 free eye-tests were widely available although the parents had to pay towards the costs of the spectacle frames. Perhaps the most visible results of the service were the reduction in the number of children carrying lice or ringworm.92 Nevertheless in 1913 more than fifty per cent of schoolchildren still had bad teeth, ten per cent were carrying vermin, ten per cent had seriously defective vision and five per cent had defective hearing.93 A healthier people could not be created overnight, especially without more investment from the State and less continued reliance on voluntary action, but the aftermath of the Boer War had been a great impetus to social advance by focusing on already existing concerns as matters of urgency.
Physical training and sport were more immediate ways of improving the fitness of young people. It was a matter of contemporary concern that by the age of seventeen many young working class men had passed their peak of fitness and their bodies were taking the toll of a passion for gambling and stimulants such as alcohol and tobacco, varied with a poor diet of bread, tea and salt fish. As a result, ‘the lack of self-improvement which they have exhibited is bound up with their physical condition. At seventeen they become street loafers – practically the only available source of recruiting for the army’.94 The Majority Report of the 1909 Royal Commission on the Poor Laws recommended that ‘with a view to the improvement of physique, a continuous system of physical training should be instituted, which might be commenced during school life and be continued afterwards’.95 It was widely accepted that the armed forces were effective in improving the bodily fitness of their men and that through army drill the bodies of these recruits were ‘re-formed into more manly shapes’.96 Military drill for boys had been introduced in elementary schools from 1871 and was supplemented by a Swedish drill for girls from 1881. The whole question of physical education in schools was brought into focus by the Boer War and forced the War Office and Board of Education to take concerted action. In 1901 the Physical Training Committee made provision for regular inspection of physical classes in schools to ensure that drill was being correctly taught and in line with military thought on the subject.97
Both the army and Board of Education adopted the gymnastic exercises of Swedish drill, with its emphasis on the toning of the stomach, ensuring that physical training in elementary schools mirrored that of army training camps. This represented a move away from German drill, which used Indian clubs, dumb-bells, horizontal and parallel bars, rings and vaulting horses for muscular development of the biceps and shoulders. However, there was less emphasis on organised games such as football, rugby or cricket except as supplements to drill, despite the emphasis on sports in promoting manliness in public schools. It was left to such organisations as cadet forces, university settlements, the Church Lads’ Brigade, the Boys’ Brigade and the Boy Scouts to use sports to improve the physique of working-class boys by physical exercise in the open air, and to improve their character through imbuing them with the code of the gentleman.98 The influence of the young middle-class men who introduced the working-class boys to sports in this way was often immense when it came to encouraging them to keep fit and healthy. Arthur Bullock, a young London medical student, was an inspiration to the boys of the Pauline Mission at King’s Cross, established by St Paul’s School, and ‘attracted them by his skill in athletics’ and the lessons he gave them in gymnastics so that ‘many of them still practice the exercises he taught them in order to increase their chest measurements and thus pass the test and get into Khaki’.99 It was one answer to the question of how to raise the standards of recruits.
Whereas the Boer War had brought into the spotlight the inadequacies of the British army preparedness for the medical aspects of modern warfare, the Russo-Japanese War of 1904–5 offered a model of how it should be done. No less an authority than Sir William Osler approved of the efficiency of the Japanese medical services and noted that ‘no great war has ever been conducted with such forethought for the preservation of the fighting unit, and in consequence the mortality from typhoid fever and dysentery was exceptionally low’.100 Part of the success of the Japanese forces in preventing disease was owing to their medical officers having status within the army. Not only were their roles well defined but they had the same status as other officers of similar rank and the authority to issue instructions on sanitary matters. Moreover, the Japanese medical officer ‘is proud of his profession which is considered by the whole army to be a highly honourable one’.101
The medical organisation of the Japanese forces was based on that of the German Army but lines of command were ‘much shorter, less detailed and less cumbersome’ and had ‘proved as perfect a machinery for the purposes of this war, at any rate, as can well be devised’.102 There were clear lines of responsibility from the principal medical officer of the field forces down to the principal medical officers of depot divisions and the regiments, and thence to the medical services with the military units. Each battalion had two medical officers attached to it who would set up regimental ‘sick rooms’ or infirmaries in standing camps, and aid stations and temporary dressing stations in the field. Crucially, these medical officers had complete control over sanitary matters in the area in which they were stationed.103 This emphasis on sanitation as the province of the army doctor was seen as essential for the control of infectious diseases.
There was also a separate department dealing with the transport of the sick and wounded which had no counterpart in European medical regiments of the time but which proved extraordinarily efficient in evacuating the wounded from field hospitals down the line to trains and ships.104 Yet, the Japanese stretcher-bearers did not have an easy time of it. After the Battle of Sha Ho in October 1904 they had to go backwards and forwards over a distance of ten miles to transport 342 wounded soldiers from the battlefield to a dressing station. Chinese coolies and carts were employed to supplement the work of the stretcher-bearers and also ‘one might see a long straggling line of wounded marching from the dressing station to field hospital’.105 The operating tables were improvised from solid Chinese cupboards salvaged from houses and operations were performed by the light of sperm candles since the Japanese were reluctant to use ‘any lights that would indicate any of their positions to the enemy’.106
Western observers especially praised the fact that not only did the Japanese medical service work efficiently in conditions of modern warfare but ‘there is an entire absence of that sentiment, which, in Western nations, is apt to exaggerate those defects into so-called medical scandals’ because ‘the Japanese soldier who is wounded considers his sufferings as nothing compared with the hardships and dangers of his comrades who are left in the fighting’.107 It was a cultural difference which was even more marked, though less appealing to Europeans, in the Japanese practice of not treating wounded soldiers on the battlefields, especially in cases of ‘severe wounds of the brain, in which the skull was shattered and the brain substance protruding’, because of the Japanese belief that it was ‘a special honour to be killed outright in battle … and not considered inhumane to leave on the field a case so hopelessly injured that death is likely to occur within an hour or two’.108 Despite the apparent modernity of Japan, older cultural traditions made its people act differently from what would be considered humane in Europe.
The Russian medical response to the war with Japan was less efficient. The Army Medical Department was supposed to make provision for all the sick and wounded but in practice depended heavily on back-up from the Red Cross, which provided most of the necessary drugs and modern appliances like X-rays. Many wealthy Russians vied with each other to provide Red Cross units and ‘the hope of social reward was sometimes partly the reason for their liberality’. One success was the work of the surgeon Princess Vera Gedroitz, who performed successful abdominal surgery from a well-equipped hospital train that she was able to bring close to the Front. Otherwise, the resultant medical arrangements were ‘on much too small a scale for modern great battles’ and suffered from poor co-operation between the Red Cross and army services.109
Within the Russian Army responsibilities were divided, doctors had no disciplinary or administrative powers and ‘the man who is responsible for the supply of medicines is not responsible for their use’.110 At Port Arthur, this administrative inefficiency resulted in some hospitals being oversupplied with drugs and equipment while others were in dire need.111 With doctors unable to enforce sanitary regulations it is little wonder that there was an outbreak of typhoid because the troops disliked the taste of boiled water.112 Yet, despite all this neglect, the Russian soldier remained in remarkably good health, better perhaps than that of his Japanese counterpart, which was put down to his being ‘of such good physique, and as a rule so inured to privation in his own home that he can … stand campaigning better than any other European soldier’.113
For western observers the lessons of the Russo-Japanese War were that scientific medicine was the key to military efficiency, with clear lines of command and sufficient attention paid to the important matters of sanitation and military hygiene. Japan, which seemed to have modernised its services and improved upon its Western models, was widely admired and offered a way forward in modern military medicine.114 Certainly, the conflict between Russia and Japan offered a contrast to British experience during the Boer War, but these first wars of the twentieth century were to seem like nothing when a much greater struggle broke out just when the lessons of the earlier wars seemed to have been learned, but were to prove less useful than anyone might have expected.
1 ‘Government Service’, St Mary’s Hospital Gazette, 5/8 (October 1899), 115–6.
2 Thomas Hardy, ‘The Darkling Thrush’, in H. Gardner (ed.), New Oxford Book of English Verse (1972), p. 757.
3 A.W. Sanders, ‘Civilian Surgery in South Africa’, St Mary’s Hospital Gazette, 6/3 (March 1900), 45.
4 G.R. Searle, A New England? (2004), p. 274.
5 A. Conan Doyle, The Great Boer War (1901), p. 1.
6 V. Warren Low, ‘Some Modern Bullet Wounds’, St Mary’s Hospital Gazette, 8/4 (April 1902), 54.
7 Ibid.
8 J. Laffin, Combat Surgeons (1999), p. 142.
9 V. Warren Low, ‘Some Modern Bullet Wounds’ (1902), 54.
10 TNA, WO 108/252, ‘Report on the Organisation and Equipment of Medical Units’, Pretoria, 1900, p. 8.
11 Lt. Wingate, letter, St Mary’s Hospital Gazette, 6/4 (May 1900), 47.
12 F. Treves, The Tale of a Field Hospital (1900), pp. 14–15.
13 Ibid., pp. 15–23.
14 Unattributed letter on ‘Army Medical Reform’, St Mary’s Hospital Gazette, 6/7 (September 1900), 96–7.
15 TNA, WO 108/252, ‘Report on the Organisation and Equipment of Medical Units’, Pretoria, 1900, p. 2.
16 The Times, 14 April 1900.
17 TNA, WO 108/252, ‘Report on the Organisation and Equipment of Medical Units’, Pretoria, 1900, p. 3.
18 F. Treves, The Tale of a Field Hospital (1900), pp. 74–6.
19 M.K. Gandhi, An Autobiography (1930), pp. 142–8.
20 G.R. Searle, A New England? (2004), p. 283; D. Low-Beer, M. Smallman-Raynor and A. Cliff, ‘Disease and Death in the South African War: Changing Disease Patterns from Soldiers to Refugees’, Social History of Medicine, 17/2 (2004), 223–45.
21 V.J. Cirillo, Bullets and Bacilli: the Spanish-American War and Military Medicine (2004), p. 139.
22 E.W. Herrington, ‘Further News from South Africa’, St Mary’s Hospital Gazette, 6/10 (December 1900), 149. See also V.J. Cirillo, ‘Winged Sponges: Houseflies as Carriers of Typhoid Fever in Nineteenth- and Early-Twentieth-Century Military Camps, Perspectives in Biology and Medicine, 49/1 (2006), 52–63.
23 W. Osler, The Principles and Practice of Medicine (1914), pp. 2–3; W.G. Macpherson, W.P. Herringham, T.R. Elliot and A. Balfour (ed.), History of the Great War: Medical Services (1922), vol. 1, p. 11.
24 K.F. Kiple (ed)., Cambridge Historical Dictionary of Disease (2003), pp. 345–9.
25 W. Osler, The Principles and Practice of Medicine (1914), p.2.
26 ‘Recollections of the Siege of Ladysmith from the Diary of Miss Charleson’, St Mary’s Hospital Gazette, 7/6 (June 1901), 91.
27 Ibid., 92.
28 Ibid., 91.
29 Ibid., 92–3.
30 Ibid., 7/7 (July 1901), 104.
31 H.W. Nevinson, Ladysmith: the Diary of a Siege (1900), pp. 285–90.
32 G.W. Steevens, From Cape Town to Ladysmith (1900), pp. 122–5.
33 T. Packenham, The Boer War (1992), pp. 353–4.
34 Quoted in ibid. p. 355.
35 Letter from J.A.H. Brinker, St Mary’s Hospital Gazette, 6/4 (May 1900), 56–7.
36 Letter to British Medical Journal, 7 July 1900.
37 The Times, 27 June 1900.
38 Ibid., 11 April 1900.
39 A.A. Bowlby, A Civilian War Hospital: Being an Account of the Work of the Portland Hospital and Experience of Wounds and Sickness in South Africa (1900).
40 TNA, WO 33/195, Recommendations of the Committee Directed to Consider Sir Thomas Gallwey’s Medical Report on the Campaign in Natal, 1899–1900, p. 2.
41 P. Hoare, Spike Island (2001), pp. 164–70.
42 L. Colebrook, Almroth Wright (1954), p. 123.
43 Ibid., p. 46.
44 A.E. Wright and F. Smith, ‘On the Application of the Serum Test to the Differential Diagnosis of Typhoid and Malta Fever’, The Lancet, 1 (1897), 656.
45 A.E. Wright, ‘On Vaccination against Typhoid Fever’, British Medical Journal, 1 (1897), 256.
46 ‘Notes from India’, The Lancet, 1 (1899), 929–34; ibid., 2, 182; A.E. Wright and W.B. Leishman, ‘Results Which Have Been Obtained by Anti-Typhoid Inoculations’, British Medical Journal, 1 (1900), 122–4; A.E. Wright, ‘On the Results Which Have Been Obtained by Anti-Typhoid Inoculation, The Lancet, 2 (1902), 652–3.
47 See N. Durbach, The Anti-Vaccination Movement in England, 1853–1907 (2005).
48 L. Colebrook, Almroth Wright (1954), p. 38.
49 L. Colebrook, ‘Obituary of Almroth Edward Wright’, The Lancet, 1(1947), 654.
50 ‘Letter from a Civilian Surgeon’, St Mary’s Hospital Gazette, 6/4 (May 1900), 54–5.
51 Letter from E.W. Herrington, No. 9 General Hospital, Bloemfontein, St Mary’s Hospital Gazette, 6/5 (July 1900), 82.
52 ‘Report of Advisory Board for Army Medical Services, 25 September 1902’, Journal of Royal Army Medical Corps, 5 (1905), 242.
53 Interim report of the Anti-Typhoid Inoculation Committee, Cd. 26989 July 1904.
54 K. Pearson, Letters to the Editor, British Medical Journal, 1 (1904), 1243, 1259, 1614, 1667.
55 See further L. Colebrook, Almroth Wright, Provocative Doctor (1954); V.Z. Cope, Almroth Wright, Founder of Modern Vaccine Therapy (1966); M. Dunnill, The Plato of Praed Street: the Life and Times of Almroth Wright (2000).
56 M. Worboys, ‘Almroth Wright at Netley: Modern Medicine and the Military in Britain, 1892–1902’ in R. Cooter, M. Harrison and S. Sturdy (ed.) Medicine and Modern Warfare (1999), pp. 77–97.
57 An outbreak of bubonic plague in Cape Town in 1901 also revealed a lack of collaboration between military and civilian authorities on account of the desire of army doctors to remain aloof from, and unimpeded by, their civilian counterparts, M. Sutphen, ‘Striving to be Separate? Civilian and Military Doctors in Cape Town During the Anglo-Boer War’ in R. Cooter, M. Harrison and S. Sturdy (ed.), War, Medicine and Modernity (1998), 48–64.
58 E. Lynn Jenkins, ‘Life in a Flying Column’, St Mary’s Hospital Gazette, 8/6 (June 1902), 86.
59 Report on the Concentration Camps in South Africa by the Committee of Ladies, Cd. 893, 1902 pp. 170, 174–9.
60 Ibid., 179.
61 R.J.S. Simpson, Medical History of the War in South Africa (1911), pp. 229–36.
62 Report on the Concentration Camps in South Africa by the Committee of Ladies, Cd. 893, 1902, p. 89.
63 Ibid, p. 93.
64 E. Hobhouse, Report of a Visit to the Camps of Women and Children in the Cape and Orange Rivers (1902), p. 135.
65 M. Hasian, ‘The Hysterical Emily Hobhouse and Boer War Concentration Camp Controversy’, Western Journal of Communication, 67/2 (2003), 138–63.
66 E. Hobhouse, Report of a Visit to the Camps of Women and Children in the Cape and Orange Rivers (1902), pp.9–13.
67 The Times, 27 June 1900.
68 Care and Treatment of the Sick and Wounded During the South African Campaign, Cd. 453, 1901.
69 TNA, WO 108/252, Report on the Organisation and Equipment of Medical Units, Pretoria, July 1900.
70 E.W. Herrington, ‘Further News from South Africa’, St Mary’s Hospital Gazette, 6/9 (November 1900), 126.
71 R. McLaughlin, The Royal Army Medical Corps (1972), p. 16.
72 Letter on Army Medical Reform, St Mary’s Hospital Gazette, 6/76 (September 1900), 96–7.
73 Report to Consider the Re-organization of the Army Medical Services, Cd. 791, 1901; TNA, WO 30/114, Discussion of War Office Committee on Reorganisation of the Army Medical and Army Nursing Services, 5 July 1901.
74 Ibid., p. 11.
75 TNA, WO 163/581, Minutes of Permanent Executive Committee of the War Office, 6 April 1902.
76 TNA, WO 30/114, Summary of reorganisation of various branches of the Army, including the RAMC, c. 1902.
77 Ibid., Extracts from the Report of the Royal Commission on the Care and Treatment of the Wounded in South Africa, 1901.
78 Ibid., Proposed scheme for the reorganisation of the Army and Indian Nursing Services, 19 July 1901.
79 TNA, WO 32/9338, comments of Queen Alexandra on reorganisation of Army and Indian Nursing Services, 1901–2. The motto of QAIMNS Sub Cruce Candida (‘Under the White Cross’) was adopted as a tribute to the Queen’s Danish birth and referred to the white cross on the flag of Denmark.
80 Quoted in F. Prochaska, Royal Bounty (1995), p. 126.
81 A. Summers, Angels into Citizens, (1988), p. 241.
82 B.S. Rowntree, Poverty: A Study of Town Life (1901), pp. 216–220.
83 J.F. Maurice, ‘Where to Get Men’, Contemporary Review, 81 (1902), 78–86; ‘National Health: A Soldiers’ Study’, Contemporary Review, 83 (1903), 41–56.
84 See G.R. Searle, Quest for National Efficiency (1971).
85 Report of the Inter-Departmental Committee on Physical Deterioration, Cd. 2175, 1904, p. 8, quoting Professor Cunningham.
86 Ibid., p. 8.
87 K. Pearson, The Groundwork of Eugenics (1912), pp. 27–30; Huxley Lecture, 1903, quoted in Report of the Inter-Departmental Committee on Physical Deterioration, Cd. 2175, 1904, p. 38.
88 Quoted in D. Dwork, War is Good for Babies and Other Young Children: A History of the Infant and Child Welfare Movement in England 1898–1918 (1987), p. 30.
89 J. Lewis, The Politics of Motherhood: Child and Maternal Welfare in England 1900–1939 (1980), p. 65.
90 Ibid., p.90.
91 H.D. Harben, The Endowment of Motherhood (1910).
92 B. Harris, The Health of the School Child: A History of the School Medical Service in England and Wales (1995), p. 64; J.D. Hirst, ‘The Growth of Treatment Through the School Medical Service, 1908–18’, Medical History, 33 (1989), 318–42.
93 P. Horn, The Victorian and Edwardian Schoolchild (1989), p. 90.
94 Report of the Inter-Departmental Committee on Physical Deterioration, Cd. 2175, 1904, pp. 5–6.
95 Report of the Royal Commission on the Poor Laws and Relief of Distress, Cd. 4499, 1909, p. 659.
96 E. Noble-Smith, Growing Children: Their Clothes and Deformity (1899), p. 7.
97 TNA, ED 24/37, Report of Physical Training Committee, 1901.
98 M. Girourad, The Return to Camelot: Chivalry and the English Gentleman (1981), pp. 250–8; see also K. Townsend, Manhood at Harvard (1996), pp. 102–4, for a consideration of the role of sport in promoting military qualities among American students at Harvard University.
99 Obituary, A.E. Bullock, St Mary’s Hospital Gazette, 21/8 (October 1915), 126.
100 W. Osler, The Principles and Practice of Medicine (1914), p. 3.
101 TNA, WO 106/6359, ‘Medical notes on the Japanese Army’ by Captain B. Vincent, 17 May 1905, p. 133.
102 Ibid.,’Medical and Sanitary Reports from Officers Attached to the Japanese Force in the Field’, 1906, p. 2.
103 Ibid., pp. 3–4.
104 Ibid., p. 7.
105 Ibid., ‘Medical Service of the Second Japanese Army During and After the Battle of the Sha Ho (10–16 October 1904)’, report by W.G. Macpherson, Manchuria, February 1905.
106 Ibid., pp. 176, 179.
107 Ibid, p. 190.
108 Ibid., ‘The Battle of Mukden’, report by W.G. Macpherson, July 1905, p. 219.
109 TNA, WO 106/6360,’Report on the Russian Medical Service’ by Colonel W.H.H. Waters, 1905, p. 539.
110 Ibid.,’ Report on Russian Medical Administration in the Field’ by Major J.M. Horne, 1905.
111 TNA, WO 106/6359, ‘Report on Condition of the Hospitals in Port Arthur After the Capitulation’ by W.G. Macpherson, April 1905, p. 268.
112 Ibid., p. 270.
113 TNA, WO 106/6360, ‘Report on the Health of the Russian Troops’ by Colonel W.H.H. Waters, 1905, p. 558.
114 C.Herrick, ‘The Conquest of the Silent Foe: British and American Military Medical Reform Rhetoric and the Russo Japanese War’ in R. Cooter, M. Harrison and S. Sturdy (ed.) Medicine and Modern Warfare (1999), pp. 99–129.