2. The Boer War of 1899–1901
In the war which England waged against the free states, Orange and Transvaal, and which lasted more than two years and necessitated the transportation, on the part of England, of more than 400,000 soldiers to South Africa, infectious diseases, particularly typhoid fever, played a very important rôle. The English army, which averaged 200,000 men, sustained the following losses:[[306]]
| Died of diseases. | Died in battle and of wounds. | Total. | |
|---|---|---|---|
| From Feb. 10, 1900, to the end of that year | 7,009 | 4,088 | 11,097 |
| In the year 1901 | 4,318 | 2,337 | 6,655 |
| Total | 11,327 | 6,425 | 17,752 |
Typhoid fever had always been prevalent in South Africa; the first cases in the English army were observed during the hurried march to Bloemfontein along the Modder River, on which the soldiers were dependent for drinking-water, despite the fact that typhoid fever was known to be raging in places further upstream. The Berkefeld and Pasteur filters yielded too little water, for the reason that they soon became clogged; the soldiers used boiled water with reluctance, for the reason that it took so long for it to cool. Another source of infection besides the water was the fine dust that was stirred up by daily wind-storms; this dust, being full of disease-germs, contributed greatly to the dissemination of typhoid fever. Furthermore, the crowding together of soldiers in tents caused many of them to contract the disease by direct communication.[[307]]
Jameson, the chief of the army’s medical staff, lamented the fact that sanitary officers (hygienists), originally appointed to accompany each division of troops, were dismissed. The regular doctors, who were then called upon to perform their functions, were fully occupied with taking care of the wounded, and were probably not well informed as to hygienic investigations and measures. The results obtained from preventive inoculation, which was practised on some of the soldiers, were in general satisfactory.
In other places the conditions were similar to those along the Modder River; in Paardeberg the available drinking-water was equally bad, and in Bloemfontein there was an explosion-like outbreak of fever. From the beginning of the campaign to the middle of the year 1900 there were 13,057 cases of disease in the army, and of those 3,174 terminated fatally; the total number of cases during the entire war was no less than 42,741.
The English troops that were shut up in Ladysmith from November 1, 1899, to February 27, 1900, were very severely attacked by typhoid fever. In the first part of November the English garrison had consisted of 13,496 men, and by March it had dwindled down to 10,164 men. The number of sick soldiers committed to the lazaret amounted to no less than 10,668, and of these 1,766 had typhoid fever and 1,857 had dysentery; 383 of the former and 117 of the latter died. When the Boers withdrew there were 1,996 patients in the hospital, 708 of them suffering from typhoid fever, 341 from dysentery, and 189 from wounds.[[308]]
In the Concentration Camps which the English established in the summer of the year 1900 for the accommodation of the women and children in the South African Republics, the pestilences soon gained the upper hand. Lord Roberts had made arrangements to concentrate the families of the Boers in camps; since the farms of the Boers were systematically burned, these camps were supposed to protect their wives and children against starvation, and at the same time the wives and children served as hostages for their husbands and fathers. When the location of these camps was decided upon, not sanitary, but military considerations were taken into account; it was necessary that they should be controlled from a near-by fortress. They soon became overcrowded, the supply of water was inadequate, and there was much uncleanliness. The inhabitants of the camps were mostly women, children, and old men; thus, for example, in October 1901, of the people living in the camps in the Orange Free State, 55 per cent were children under fifteen years of age, 31.9 per cent were women, and 13.1 per cent were men, mostly old men. According to the reports submitted to Parliament the condition of health in the Concentration Camps in Natal and in the Cape Colony was not unfavourable, but in those in Transvaal and Orange it was very bad. The following statistics, covering the time between June and September 1901, relate to the Concentration Camps in the Transvaal:[[309]]
| Number of Inhabitants. | ||||
|---|---|---|---|---|
| Month. | Men. | Women. | Children. | Total. |
| June | 8,576 | 16,078 | 19,811 | 44,465 |
| July | 9,665 | 20,012 | 24,462 | 54,139 |
| August | 10,496 | 22,036 | 25,983 | 58,515 |
| September | 10,581 | 22,226 | 26,599 | 59,406 |
| Average | 54,131 | |||
| Number of Deaths. | |||||
|---|---|---|---|---|---|
| Month. | Men. | Women. | Children. | Total. | Annual death-rate. |
| June | 26 | 48 | 310 | 384 | 103·6 |
| July | 51 | 118 | 748 | 917 | 203·2 |
| August | 32 | 185 | 1,014 | 1,231 | 252·5 |
| September | 75 | 165 | 1,014 | 1,254 | 253·3 |
| Average | 209·8 | ||||
In regard to the Orange Free State the following statistics, including the month of October, were compiled:
| Number of Inhabitants. | ||||
|---|---|---|---|---|
| Month. | Men. | Women. | Children. | Total. |
| June | 5,116 | 9,646 | 17,953 | 32,715 |
| July | 5,351 | 11,213 | 20,132 | 36,696 |
| August | 5,826 | 13,381 | 24,415 | 43,622 |
| September | 6,089 | 14,140 | 25,118 | 45,347 |
| October | 5,906 | 14,471 | 24,929 | 45,306 |
| Average | 40,737 | |||
| Number of Deaths. | |||||
|---|---|---|---|---|---|
| Month. | Men. | Women. | Children. | Total. | Annual death-rate. |
| June | 32 | 75 | 182 | 289 | 106·0 |
| July | 50 | 69 | 369 | 488 | 159·5 |
| August | 30 | 82 | 510 | 622 | 171·1 |
| September | 43 | 153 | 885 | 1,081 | 286·0 |
| October | 58 | 133 | 1,329 | 1,520 | 402·6 |
| Average | 235·6 | ||||
All told, no less than 19,600 persons (14,894 children and 4,706 adults) died in the Concentration Camps up to March 1902; that is, about one-fifth of the total number of inhabitants died in a period of about fifteen months. As indicated by the above tables, the children suffered more severely than the adults. The principal causes of the high mortality among the children were measles and pneumonia; since the grownup Boers had never experienced an attack of measles in their childhood, they too, even the very old men, contracted the disease and many of them succumbed to it. The prevalence of pneumonia can be explained on the ground that the temperature fluctuated greatly in the course of the winter, and the nights, in particular, were extremely cold. Whooping-cough, varicella, mumps, and diphtheria were prevalent in all the camps, and typhoid fever, which, as remarked above, is endemic in many parts of South Africa, was very common; so also were diarrhoea and dysentery.
The chief cause of the high mortality in the prison-camps was the fact that such large numbers of men, men whose vitality had been reduced by privations and hardships, were congregated in places which had not been properly prepared to receive them. The unfortunate prisoners often reached the place of detention in a pitiable condition—exhausted and half naked. Furthermore, they were men who had no appreciation of the order that must be observed, when large numbers of people are congregated in one place, in attending to the daily requirements of nature, nor were they willing to be taught. The result was that the ground became filthy; the open spaces in front of the tents were often used in place of the latrines; the contents of slop-jars were simply thrown out in front of the doors, instead of being emptied into receptacles that were deposited here and there for that purpose. The mothers had no idea of nursing, and were unwilling to take medical advice; in order to avoid having to send their children to the hospital, they kept secret the fact that they were sick, thus giving measles, diphtheria, &c., the best possible chance to spread. We read in an English report:[[310]]
A large share of the high death-rate in them is ascribable to the condition in which the women and children arrive. Often they have been half-starved and are broken down in health. It cannot be wondered at that under these circumstances measles and other diseases are inordinately fatal. The dirty personal habits of the Boers, their use of improper and often disgusting remedies, and their ignorant errors of dietetics in regard to young children, have rendered it extremely difficult to secure favourable results in the treatment of cases of sickness among the Boer children. There appears to be no doubt, as indicated in our previous special article, that the measles which has been prevalent has been of a specially malignant type. Its malignancy has doubtless been intensified by the dirty condition of the Boer children, and by the overcrowding that has been permitted in the camps, as well as by the previous bad health of these children. The present reports afford abundant evidence confirmatory of the conclusion at which we had previously arrived, that dysentery, diarrhoea, and enteric fever in a large proportion of the camps have been prevalent as well as measles.
And in another report we read:[[311]]
Measles of a particularly malignant type has prevailed. Its fatality has doubtless been increased by the exhausted and semi-starved condition in which many of the Boers and their children have arrived at the camps. It has been impossible to isolate such cases in the camps; and the crude and ignorant and even mischievous methods of domestic treatment adopted by the Boer women have doubtless increased the evil, as have also the personal uncleanliness of the Boers and their fear of fresh air as well as of clean water. But, as previously pointed out, enteric fever and diarrhoea and dysentery have claimed a large toll of victims, and for the excessive amount of these the deficient sanitary control of the camps must be held in a large measure responsible.
With the arrival of the better season, when the Concentration Camps, under the pressure of public opinion, were thoroughly cleansed, the condition of health improved. Hönigsberger,[[312]] who inspected the camp at Merebank (in Natal) in May 1912, derived a very favourable impression; notwithstanding the fact that the camp lay on low ground near the sea-coast, where the soil was necessarily damp, there was no visible surface water because of an effective system of drainage. The drinking-water facilities were good. Of some 8,000 refugees sheltered there only 110 died between the months of February and May 1902.
3. The War in South-west Africa (1904–7)[[313]]
In the very first year of the war, typhoid fever broke out with great severity. The disease first made its appearance in the war against the Herero nation in the first part of April 1904; it attacked the eastern division of the army, which was commanded by Major von Glasenapp and numbered twenty-five officers and 509 men, in Onjatu (midway between Windhuk and Waterberg), after the soldiers had been exposed to rainy weather, cold nights, and extreme hardship. On April 6 there were six cases of the disease reported, and by April 16 the number of cases had increased to sixty-six; the division was then transferred to Otjihaenena, where the patients were housed in permanent lazarets and the healthy men were quarantined. Throughout the remaining part of the war, typhoid fever played an important rôle; the total number of deaths in the years 1904–7 was 1,491; of these 689 succumbed to diseases, 439 of them to typhoid fever. The soldiers who fought in the battles against the Hereros were most severely attacked; of a total of 470 deaths 283 were caused by typhoid fever and only twenty-two by other diseases. In the three years’ struggle against the Hottentots some 1,200 soldiers died; 375 of them died of diseases; of the 375 typhoid fever was responsible for 156.