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''Mr. Burdett-Coutts's Charges'' is a letter written by [[Arthur Conan Doyle]] first published in [[The Times]] on 6 july 1900.

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== Editions ==

* 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 ==
[[File:the-british-medical-journal-1900-07-07-p49.jpg|thumb|300px|right|[[The British Medical Journal]] (7 july 1900, p. 49)]]

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 ==
[[File:The-Times-1900-07-06-burdett-coutts.jpg|thumb|250px|right|[[The Times]] (6 july 1900)]]

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* [[Sir Arthur Conan Doyle:Complete Works|Back to Complete Works]]
* [[Sir Arthur Conan Doyle|Back to Conan Doyle]]

Mr. Burdett-Coutts's Charges - Revision history

TCDE-Team at 12:49, 23 October 2019