Mr. Burdett-Coutts's Charges
- in The Times (6 july 1900 [UK]) as Mr. Burdett-Coutts's Charges
- in The British Medical Journal (7 july 1900 [UK]) as The Epidemic of Enteric Fever at Bloemfontein
- extracts in chapter XI. Bloemfontein of From Aldershot to Pretoria, by W. E. Sellers (september 1900, The Religious Tract Society [UK])
The Epidemic of Enteric Fever at Bloemfontein
Sir, — You were good enough to suggest when I left England that I should send you some notes upon any points which might strike me. The pressure of work has prevented me from complying with your request, and even now I feel that you will find these comments of a very scrappy character.
When the nation sums up its debt of gratitude to the men who have spent themselves in this war I fear that they will almost certainly ignore those who have done the hardest and the most essential work. There are three classes, as it seems to me, who have put in more solid and unremitting toil than any others. They are the commissariat, the railway men, and the medical orderlies. Of the three, the first two are the most essential, since the war cannot proceed without food and without railways. But the third is the most laborious, and infinitely the most dangerous.
The outbreak of enteric among the troops in South Africa was a calamity the magnitude of which had not been foreseen, and which even now is imperfectly appreciated. We naturally did not dwell too much upon it while the war was in progress. But it was appalling in its severity, both in quantity and quality. I know of no instance of such an epidemic in modern warfare. I have not had access to any official figures, but I believe that in one month there were from 10,000 to 12,000 men down with this, the most debilitating and lingering of continued fevers. I know that in one month 600 men were laid in the Bloemfontein Cemetery. A single day in this one town saw 40 deaths. These facts would have stiffened the resistance at Pretoria if they had been generally known. It is only now, when the worst is past, that they can be talked of.
How was this unforeseen and unprecedented crisis grappled with? Entirely by the efforts of the medical men and by the devotion of the orderlies. When a department is confronted by a task which demands four times more men than it has, the only way of meeting it is for each man to work four times as hard. This is exactly what occurred, and the crisis was met. In some of the general hospitals orderlies were on duty for thirty-six hours in forty-eight, and what their duties were — how sordid and obscene — let those who have been through such an epidemic tell.
He is not a picturesque figure, the orderly, as we know him. We have not the trim, well-nourished army man, but we have recruited from the St. John Ambulance men, who are drawn, in this particular instance, from the mill hands of a northern town. They were not very strong to start with, and the poor fellows are ghastly now. There is none of the dash and glory of war about the sallow, tired men in the dingy khaki suits — which, for the sake of the public health, we will hope may never see England again. And yet they are patriots, these men; for many of them have accepted a smaller wage in order to take on these arduous duties, and they are facing danger for twelve hours of the twenty-four, just as real and much more repulsive than the scout who rides up to the strange kopje or the gunner who stands to his gun with a pom-pom quacking from the hill.
Let our personnel speak for themselves; and we make no claim to be more long-suffering than our neighbours. We have 3 on the staff (Mr Gibbs, Mr. Scharlieb, and myself). Four started, but one left us early in the proceedings. We have had 6 nurses, 5 dressers, 1 wardmaster, 1 washerman, and 18 orderlies, or 32 in all, who actually came in contact with the sick. Out of the 6 nurses, 1 has died and 3 others have had enteric. Of the 5 dressers, 2 have had severe enteric. The wardmaster has spent a fortnight in bed with veld sores. The washerman has enteric. Of the 18 orderlies, 1 is dead, and 8 others are down with enteric. So that out of a total of 34 we have 17 severe casualties — 50 per cent. - in nine weeks. Two are dead, and the rest incapacitated for the campaign, since a man whose heart has been cooked by a temperature over 103° is not likely to do hard work for another three months. If the war lasts nine more weeks, it will be interesting to see how many are left of the original personnel. When the scouts and the Lancers and the other picturesque people ride in procession through London, have a thought for the sallow orderly, who has also given of his best for his country. He is not a fancy man — you do not find them in enteric wards — but for solid work and quiet courage you will not heat turn in all that gallant army.
There is one mistake which we have made, and it is one which will not, I think, be repeated in any subsequent campaign. Inoculation for enteric was not made compulsory. If it had been so I believe that we should (and, what is more important, the army would) have escaped from most of its troubles. No doubt the matter will be fully threshed out in statistics, but our strong impression, from our own experience, is that although it is by no means an absolute preventive it certainly modifies the course of the disease very materially. We have had no death yet (absit omen) from among the inoculated, and more than once we have diagnosed the inoculation from the temperature chart before being informed of it. Of our own personnel only one inoculated man has had it, and his case was certainly modified very favourably by the inoculation.
Of the courage and patience of the soldiers in hospital it is impossible to speak too highly. We have had 500 cases pass through our hand can speak now from a fairly large experience. I had always imagined that in every large army there must be a minority ofskulkers and shirkers, but they are singularly absent in the South African Field Force. I have not had more than two or three cases in my wards which bore a suspicion of malingering, and my colleagues say the same. They are uniformly patient, docile, and cheerful, with an inextinguishable hope of "getting to Pretoria." There is a gallantry even about their delirium, for their delusion continually is that they have won the Victoria Cross. One patient, whom I found the other day rummaging under his pillow, informed me that he was looking for "his two Victoria Crosses." Very touching also is their care of each other. The bond which unites two soldier pals is one of the most sacred kind. One man shot in three places was being carried into Mr. Gibbs's ward. I lent an arm to his friend, shot through the leg, who limped behind him. "I want to be next Jim, 'cos I'm lookin' after him," said he. That he needed looking after himself seemed never to have occurred to him.
I do not think that any men have ever expended money better than those who fitted out the private hospitals. The officers of the Army Medical Department freely admit that they do not know what they would have done without their aid. They arrived out here at the very moment when the sickness was becoming alarming, and they took their share of the strain when the epidemic was at its height. The large general hospitals found it difficult to get to work on account of the pressure on the line which prevented them from getting up their bulky equipment, but the private hospitals, more compact and mobile, got to work almost at once after their arrival. The pressure was severe. Our own hospital, with equipment and personnel for 100 cases, had 150 cases, most of them virulent Paardeburg enterics, shot upon them, and had to cope with them as best they might. But the men had come out to work, and the orderlies, though untrained, never once grumbled at the great exertions which were called for. Without the Yeomanry, the Portland, the Irish, the Scotch, the Welsh, and the other hospitals fitted up by private effort, and manned by volunteers, it is difficult to see how the epidemic could have been met.
There is sure to be some adverse criticism of the Army Medical Department after the war, because they have had to meet so difficult a situation with such inadequate resources that it is impossible that there should not be particular instances where the machinery has broken down. A captious critic could quote cases of an overfilled, undermanned hospital without medical necessities in one place or of hardships endured by the sick and wounded in another. How can it be otherwise, when a Department which is sufficient for the needs of two army corps has to provide for the wants of 200,000 men with typhoid raging among them? Taking it on the whole, the Department has been well organised and well worked, and has met an unforeseen and exceptional state of things With remarkable success.
The statistics of the campaign are likely to be vitiated by the employment of the vague and unscientific term, "simple continued fever," so largely used in the army returns. A great number of cases were classified under this head, and such forms as "veld fever," "camp fever," etc., were freely used. I think that nearly all medical men have come to the conclusion that all, or at least most of these cases were really enteric of varying types and degrees of severity. Our senior surgeon, Mr. Gibbs, performed post-mortems on several cases which presented abnormal features, but never without finding the characteristic ulcers.
A. CONAN DOYLE, M.D.
The Langman Hospital, South African Field Force, Bloemfontein, June 5th, 1900
Mr. Burdett-Coutts's Charges