The enemy lurking beneath the surface

Contaminated water, long sieges, unhygienic conditions and the scorching heat in South Africa became an epic calamity for the British forces during the Anglo-Boer War.

The Anglo-Boer War highlighted the importance of medical care for the British army. The medical services treated 22,000 wounded and a staggering 74,000 for dysentery and typhoid fever alone.

The advice of the new hygiene officers was ignored, and as a result the consequences were fatal; water purification was defective, sanitation deplorable and rations inadequate.

Typhoid fever, which emerged fairly early in the campaign, casted a shadow over the troops and their operations. The Royal Army Medical Corps was formed by Royal Warrant on 23rd June 1898, with the formation of the RAMC. Only one year after its formation, the RAMC was fully committed to the Anglo-Boer War.

Because the RAMC doctors were part of the British army, they had to obey orders, even if they negatively impacted their medical responsibilities.

After the battle of Magersfontein, troops were static for a long period at the Modder River and, later, at Paardeberg. The situation in which vast numbers of troops were massed using a contaminated water supply created ideal conditions for a massive outbreak of typhoid fever, a situation that could have been prevented, wrote Professor J.C. de Villiers, an expert in the medical aspects of the Anglo-Boer War.

Unfortunately, the army was already grappling with this disease when it had to march on to Kimberley (which was besieged for weeks) and Bloemfontein, during Lord Frederick Robert’s massive flanking movements, away from the Orange River. The outbreak of typhoid fever significantly hampered their movement and added to the already mounting challenges.

During the siege of Kimberley, overcrowding and contamination of water sources escalated the typhoid cases. The Boers blocked the railways to Kimberley, and they had a large laager upstream from the British on the banks of the Modder River, which was already contaminated.

When troops entered Bloemfontein, the British Army became paralysed by typhoid. Within a month, 4,000—6,000 soldiers had succumbed to the disease. Thousands were sick. This created chaos in the relatively small town. Sanitary arrangements were inadequate for the influx of people, and the disease spread quickly through personal contact, flies, dust, milk, food, and water.

It wreaked havoc on the British side, particularly because so many men were massed in a slow-moving army, and the risks of contamination of food and water supplies were significant.

The Boer Commandos, who were constantly on the move, were relatively little affected by the disease, apart from the usual endemic cases. They also knew the landscape well and where and how to get fresh drinking water.

But foreign doctors of the Red Cross visited the Boer laagers. They commented on their inappropriate placement, that they had not considered the drainage of the soil, the nature of the water supply or the primitive slaughtering methods with improper handling of offal, and the consequent plague of flies.

John Boje, the author of An Imperfect Occupation: Enduring the South African War (University of Illinois Press, Urbana, 2015), wrote in an article that the British opposed the voluntarism fundamental to the Red Cross movement and that all British medical personnel in the field were subservient to the military establishment.

In the British camps at Paardeberg, the sick and wounded lay on the ground, exposed to the elements, but an army doctor, Wilson Cheyne, later made light of it, saying that their hardships were of little consequence.

When Roberts entered Bloemfontein on 13 March 1900, he had 200 sick and wounded; by 1st June, there were close to 4,000 patients, and without the personnel and resources to cope, men died in appalling dirt and distress.

A British soldier wrote: "All the stuff that has been written about the military hospitals and the care given of the sick and wounded is lies. As for Tommy Atkins, no one cares a straw whether he lives or dies".

A civilian doctor confirmed this, Albert Morison: "Believe everything you hear as to mismanagement and even incapacity and wilful neglect. You would be surprised how the 'Tommies' cringe from me because of the R.A.M.C. badges on my shoulder.”

This resulted in the appointment of a Commission of Inquiry under the Chairmanship of Lord Romer, which heard evidence before the war was concluded. An extensive report, which included an overview of the hospitals, was published, leading to considerable improvements in the British military medical organisation.

Tragically many more British and Colonial soldiers died of disease than of war wounds or in battle. (5,774 killed in battle; 2,108 died of wounds; 14,210 died of disease.)

Sources:

· https://www.museumofmilitarymedicine.org.uk/galleries/history-of-the-royal-army-medical-corps

· BOJE, John. The doctors' dilemmas: Medical practice in the Free State during the South African War. Historia [online]. 2018, vol.63, n.1 [cited 2024-08-19], pp.45-71

https://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0018-229X2018000100003

Military History Journal Vol 6 No 3 - June 1984 The Medical Aspect of the Anglo-Boer War, 1899-1902 Part II, JC. De Villiers. http://samilitaryhistory.org/vol063jc.html

· De Villiers, JC. Healers, Helpers, and Hospitals. Vol II. Protea. 2008.