by Professor J.C. de Villiers, MD, FRCS
Editors Note: In part II the British medical organisation is covered
The Anglo-Boer War, which marked the transition of the nineteenth into the twentieth century had a wider significance than was realised at the time. For those who see history as more than merely a sequence of events strung together in a causal relationship, there are many possible interpretations of this significance. It may perhaps be ominously significant that the twentieth century commenced with a war in Africa. It may be seen as a dramatic closing scene to an epoch in which a certain type of war was being fought for the last time and yet, even in this so-called 'gentleman's war' there were grim forebodings of newer and more frightening forms of combat. Innovations in military technology issued in new and more powerful explosives and destructive missiles; guerilla warfare, concentration camps and trench warfare. It was, however, also a landmark in the history of military medical organisation.
When one reads the history of surgery in modern warfare, the Anglo-Boer War is always overlooked; this presentation is, therefore, an attempt to indicate the significance of this aspect.
MILITARY MEDICINE AT THE END OF THE NINETEENTH CENTURY
War, which has as its primary aim to destroy and maim, at the same time provides, paradoxically, the opportunity for rapid advance in medical knowledge. From early times the surgeon has been concerned with war wounds. Indeed, it may safely be said that surgery commenced with war surgery until advances in the knowledge of anatomy, physiology and anaesthesia made the surgery of other diseases feasible. At the end of the nineteenth century the knowledge of surgical anatomy was relatively sophisticated in contrast with the knowledge of physiology and the body's reaction to injury which lagged behind. The introduction of antisepsis by Lister in 1867, and Von Bergmann's refine- ment of this to aseptic surgery in 1891, combined with the fairly safe use of inhalant anaesthesia, (chloroform and ether) brought surgery to one of its most exuberant phases of innovation and endeavour. Procedures which had previously been regarded merely as anatomically possible, became practical realities. Diagnostic bacteriology and its natural associate, immunology, were well established, and, last but not least, physical diagnosis had gained a new dimension in the discovery of X-rays by Rontgen in 1895. It was as if these techniques and innovations were awaiting a testing-ground, and the Anglo-Boer War provided it.
THE MODERN RIFLE BULLET
The Anglo-Boer War offered the first opportunity for the large-scale use of modern small arms. The large, soft, leaden bullet of previous wars was replaced by the small calibre, ogival-shaped, nickel-jacketed projectile, which was propelled at a high velocity by a smokeless propellant (Nitro-cellulose). Because the cartridges were smaller and lighter, more of them could be carried and fired per unit time, which increased the number of wounded. This new small calibre, high velocity, hard projectile inflicted damage to tissue of a kind which called for a revision of established ideas about the treatment of war wounds.
The 7mm Model 96 Mauser, generally used by the Republican forces, and the British army service rifle, the .303-inch Lee-Enfield, fired bullets similar in shape, the latter having a slightly greater mass, the former having a higher velocity. As wounding results from the release of kinetic energy (which is calculated by a formula), it is obvious that both these bullets had more or less the same effect. The destructive effect of a bullet on tissue is related to the resistance which it offers to the bullet's flight. Furthermore, any irregularity and yaw of the bullet would cause more energy to be expended in the tissues thereby resulting in greater damage.(1) The new, non-expanding bullets, contrary to expectation, sometimes caused little tissue damage. At an average velocity, i.e., when fired from a fairly long distance, these bullets were found to produce clear-cut entrance and exit wounds of almost equal size. At short range, however, when their velocity was still very high and the energy liberated exponentially related to it, their effect, particularly on a closed cavity such as the skull or a solid organ could be explosive.
Due to the relative benignity of wounds caused by non-expanding bullets fired from long range, there was a phase at the beginning of the war, when many observers, including medical ones,(2) spoke of the 'merciful bullet' or the 'humane weapon' and thought that the wounds inflicted were generally less severe than in previous conflicts. Increasing experience showed that the distance from which the bullet was fired was extremely important and that each wound had to be viewed individually and treated on its own merits. True enough, there were instances of the most remarkable wounds, particularly of the lung and abdomen with hardly any reaction on the part of the patient at all; where there was no bone shattering, the wound tract was virtually free from foreign material. These examples of 'benign injury' were striking when compared with the disastrous effects of the large, expanding, soft bullets of previous wars. As experience accumulated during the war, the problems of delayed wound infection, tissue necrosis, the need for extensive excision of tissue, primary and secondary suturing, exteriorization of the gut, etc., were all extensively described and exposed the error of the earlier optimism about these wounds.
The subject of 'dum-dum' bullets used in this war has evoked much comment, usually emotional and not well informed. It was at Dum-Dum near Calcutta, during the Chitral Campaign in 1895, that the British Army modified the .303-inch bullet in order to improve its stopping power.(3) The nickel-jacket was thinned at the apex and the lead bared to allow it to expand, but the .303 inch Mark IV bullet had the apex hollowed out to produce this effect. Mark IV bullets were on issue to British troops but rapidly withdrawn early on. Soldiers rapidly learnt that by rubbing away the nickel jacket at the apex, the desired effect could be obtained; and this was done on both sides but never on a wide scale. Later, when increased knowledge indicated the effect of wobble tumbling, it became clear that most judgements on the use of expanding bullets were unfounded and the massive wounds observed were due to ricochet bullets or the effect of bone being struck and shattered.(4)
INJURY BY SHELL FRAGMENTS
That injuries caused by shell fragments were relatively uncommon, was commented on by many military surgeons and may be attributed to the nature of the terrain and the wide dispersion of the combatants. It was well recognised that the injuries inflicted were notably different from those caused by bullets and caused large, irregular, cavitating wounds with a greater liability to tissue necrosis and sepsis.(5)
Wound infection was distinctly uncommon in South Africa unless there was contamination by repeated dressings being done. Simply covering the wound and allowing it to heal on its own turned out to be the best management in most cases, much to the surprise of medical and nursing staff in the early phases of the war.
Speaking about the war in South Africa in the Bradshaw Lecture (1918), Sir Anthony Bowlby summarised the situation, 'We had to fight in a very thinly inhabited country, which supported few domestic animals, and which for the most part was quite uncultivated. The soil was dry and sandy, and in many places the rocks projected in the form of the well remembered kopjes. The ground was uncontaminated by manure; it was to a great extent virgin soil.
Rainfall was slight, cloudy days were few, and a hot sun with fresh breezes or strong winds desicated the soil and prevented the growth of any luxuriant vegetation. The consequence of all these conditions was that, in the absence of decaying vegetables and animal matter, the soil was almost entirely free from all pyogenic organisms and bacteriological examination proved that all forms of pyogenic bacteria were absent from the soil of the veld, except in the neighbourhood of the dwellings of man.'(6)
MEDICAL CONDITIONS IN THE TWO REPUBLICS
In the Transvaal, medical care of the civilian population itself was of a low standard. The few doctors that there were, were concentrated mostly in the larger towns and their standards of practice were sometimes of doubtful quality. Although there were about twelve hospitals in the Transvaal by 1899(7), there was a universal distrust, if not fear, on the part of the general population of hospitals, doctors and what went with them. Many foreign ambulances, doctors and nurses referred in their memoirs to this attitude which existed among the general public.
Before 1895, the only permanent military unit in the Transvaal was the Staats Artillerie which had its own part-time medical attendant, Dr Lillpop. Apart from the Staats Artillerie there was no other form of organised military service in the Republics. The Republican Armies, if one could call them that, were virtually entirely voluntary forces which could be called up in time of need but they did not include any organised military medical service.
It required the Jameson Raid in 1895 to awaken an awareness of this defect in planning for eventualities which by then seemed to be inevitable. Four doctors, J.B. Knobel, G.W.S. Lingbeek, J.W. Stroud and H.P. Veale approached President Kruger with the suggestion that an ambulance of about 100 volunteers should be established. This request was acceded to and an initial grant of UK PNDS500 was allocated to the newly-formed Pretoria Ambulance Corps. During 1896 the Z.A.R. became a signatory to the Geneva Convention ana the Pretoria Ambulance Corps became 'Het Transvaalsche Roode Kruis' with its headquarters in Pretorius Street in Pretoria. This organisation was also at times referred to as 'Vereniging van Het Roode Kruis van Geneve'.(8)
Although one would have thought that the mounting war-fever in the Transvaal would spur this organi- zation into action, on the contrary, it remained incomprehensibly indolent, even after war was declared. Neither it, nor the Transvaal Government seemed to sense the gravity of the situation and the urgent need for organisation. Enthusiasm was greater amongst the ordinary citizens, particularly in the country districts, where about 20 Divisions of Het Transvaalsche Roode Kruis were formed in the main towns with Johannesburg and Pretoria following suit. In August 1899, the Transvaalsche Roode Kruis advertised for volunteers for Red Cross work, to which there was an enthusiastic, at times even over-enthusiastic, response particularly on the part of those who wanted to evade the vicissitudes of war. None of this led to smooth organisation. In January 1900, three months after the outbreak of war, the 'Medische Commissie' was appointed with the task 'Om namens de Regeering alle Zaken betrekkende geneeschkundige behandeling ... en van ambulansches ten behoefte van de verskillende Kommandos te regelen.' For this necessary service, a committee constituted entirely of volunteers, had to perform a vital task for a Government which had made no official appointment and gave no guidance at this stage, and never did.(9)
Apart from this semi-official Red Cross organisation, there were a number of field ambulances at Newcastle, Standerton and other places under Drs Ramsey, Welez, Visser, Tren and Shaw. These ambulances were nominally under Dr Lillpop as the recognised head of the military medical service on ac- count of his attachment to the Staats Artillerie. Dr Lillpop was eventually dismissed from his position when an attempt was made at organizing medical matters, by then however it was too late to effect any con- structive changes.
There were also a number of doctors in the Transvaal who were not attached to an official Organisation either military or Red Cross but who served with particular Commandos or independently. They were Drs Watt, Dyer, Tilfer, Dekena, Alport, Moorhead, Van der Horst, Pirow, Green, (Mrs) Weiss, O'Reilly, and Tempelhof.(10) More formal ambulances worked from Pretoria under Drs Rijken, Muller, Kolff and Knobel. The Bourke, Beckett and Glaeser ambulances were staffed by members of the three firms which donated the ambulances. They were formed during September, 1899, and rendered excellent service. Later a private ambulance under Dr A. Juriaanse was added to this group.(11)
The French Ambulance
In September 1899, the French 'Uitlanders' were anxious to be of assistance to the Transvaal Republic, but were advised by the local council to remain non-combatant.(12) In November 1899, an ambulance- hospital was established in the Marist Brothers School, a well organised 48 bed facility which had few patients until after the British occupation, when it became more active.
Apart from this, the French Red Cross donated two fully equipped 100-bed ambulance units to the Trans- vaal Government together with materials, instruments, etc. (One of these was given to Kerckhoff of the Dutch East Indies Ambulance who had lost his equipment in transit at Diego Suarez.)(13)
The driving force behind the establishment of the local ambulance was Madame La Contesse de Rene Ferrieres. The medical attendants were Drs Pierce, Kanin and Mangiamarchi.(14)
The Jewish Ambulance
Under the leadership of Mr Bension Aaron, chairman of the Chevra Kadisha of Johannesburg, an ambulance was constituted in October, 1899. Mr Aaron's cigar factory was converted into a hospital and 100 men who volunteered for service, were trained for their task. The hospital was well-organised and well supplied with all that was necessary and from the beginning of the war it admitted patients and supplied equipment to other temporary hospitals in Johannesburg. The medical officer attached to this unit was Dr D. Horwich. Later a branch of this ambulance functioned at Elandsfontein where other hospitals were also active in caring for the sick and wounded brought from the front by train.
It was during the 'Begbie disaster' on 24 April 1900, that this ambulance rendered its greatest service to the Transvaal Republic. It functioned for some time after the British occupation and then handed over its assets to the British medical authorities.
Of the better organised medical services in the Transvaal were the ambulance trains which were constructed in the workshops of the Z.A.S.M. and won high praise from continental and British doctors alike. The best-known of these carried the wounded from Modderspruit to Natal and Pretoria. The other two of these so-called 'Vliegende Ambulansche' commuted between Bloemfontein and Pretoria and later between Kroonstad and Pretoria with the gradual retreat of the Republican Forces from the Orange Free State. Even the function of this fine service was marred by organisational ineptitude, petty intrigues, personal vendettas and indiscipline.(15)
In Pretoria, the Volks Hospitaal was particularly active as was the Staats Meischeschool which had been converted into a military hospital, under the control of the first Dutch Red Cross ambulance. The first Staatstehuis became a hospital, first under Dr Haylett and later, Dr Veale. The second Staatstehuis was also converted into a hospital and the building on the racecourse turned into an auxiliary hospital.
The Orange Free State
Information on the medical organisation in the Orange Free State is very scanty. An official Red Cross Society of the Orange Free State, also a member of the Geneva Convention, was established with Dr A.E.W. Ramsbottom at its head. There was, however, as little formal medical organisation in the Free State as there was in the Transvaal. Of the doctors who were attached to the Ambulance service, Dr H.J. Poutsma remained with the commandos of General de Wet and President Steyn. Drs Ramsbottom, Voortman, Krause and Bidwell were captured by the British Forces just after the Battle of Modder River and sent to Cape Town to be returned ten days later without their ambulances. Although many doctors were attached to the Free State ambulance some were active with the different commandos such as Drs Melville, Mangold, Van der Poel and Van Wyk.
The need for medical aid was keenly appreciated particularly by the Consul-General of the Orange Free State in Holland, Dr H.P.N. Muller, who appealed to the headquarters of the International Red Cross in Geneva. It was in no small measure due to Dr Muller's activities that the International Red Cross assisted the two Republics so extensively.(16)
FOREIGN AMBULANCES WHICH RENDERED AID TO THE TWO REPUBLICS
Into the aforementioned organizational jumble, fourteen foreign ambulances arrived between November 1899 and the first half of 1900 to assist the two Republics. Many of the doctors who accompanied them commented on the lack of organization, some being so bitter about it that they rejected the Boer cause which they had come to South Africa to serve. The result was that friction arose between them and the 'Mediesche Commissie'. Most of the foreign ambulances had, more or less, to go where it was felt they were needed or, sometimes, where they, on their own initiative, established that the need existed or where action could be expected. The only exceptions were the first Dutch and the first German Red Cross ambulances which had arrived early and had more or less forced their way through to satisfactory positions for themselves and for the people they were intended to serve. This infusion of 'foreign aid' was not always very welcome. Denys Reitz writing about Commandant-General Piet Joubert's attitude towards it states, 'Een namiddag wys hy my 'n kabelgram van 'n Russiese Vereniging wat aanbied om 'n ambulans uit te rus in geval van oorlog, en toe ek my genoeČ uitdruk, was ek verbaas om hom te hoor są dat by die aanbod van die hand gewys bet. Hy są toe: "Jy sien, my kind, ons Boere hou ons nie met hierdie nuwerwetse dinge op nie; ons bossie-middels is goed genoeg." The universal distrust in which the Boers held 'uitlanders' and their disinclination to go to hospital would only dissipate with experience and for this there was precious little time. On the lighter side, a number of the units with radiological apparatus reported that all and sundry flocked to see and experience the new wonder of radiography.
Apart from those countries which provided equipped and manned ambulances, several countries sent medical aid in the form of materials and ambulance supplies.
The Belgian-German Ambulance
The Belgian component of this ambulance, to a significant extent, owed its existence to the activities of a Mrs A. Bron and socialist newspapers who were sympathetic to the Boer cause. It was established by means of public funds and was, apparently, given permission by the Belgian Red Cross to use the Red Cross flag until its return to Belgium. There was considerable doubt as to legality of the latter procedure, which was strongly criticised at a subsequent meeting of the Red Cross Society in Geneva. The ambulance, under Dr Coolen, assembled in Amsterdam where the German doctors Albrecht, Leitz and Tilemann as well as the Belgian Dr Delandsheere, joined it.
It left Amsterdam on the Herzog and was accompanied on the trip to Lourenco Marques by the second German and the second Dutch ambulances. In Naples it was joined by Drs Fessler and Bertelsman, the other two members of the German contingent. On their arrival in Pretoria in January 1900, the Belgian and German groups immediately divided their equipment and split into two. In his memoirs Tilemann says that it became obvious on the journey from Europe that the two groups could not function as a unit.(17) Fessler, who was more outspoken than the young Tilemann, thought that the Belgian staff had not been selected well and furthermore, because the Belgian nurses wore short dresses and broad felt hats, 'macht nichts weniger als den Eindruck von Krankenschwester.' On the outward journey, Fessler telegraphed his views to Antwerp and Hamburg and made it clear that he was not interested in working with 'morally uncivilized people who knew nothing of medicine'. As proof of the latter claim, Fessler alleged that the chief Belgian doctor was preoccupied with a pretty nurse. He also claimed that a well-known socialist writer was travelling in the Belgian party in the guise of a nursing sister.(18) It is assumed that his reference was to Alice Bron, whose memoirs provide a very good account of her disillusionment with the war.(19) Fessler also listed a lengthy catalogue of the useless materials with which they were encumbered and suggested that the financial arrangements were suspect. The fact that the Belgians wore the Red Cross emblem, however, galled him most of all.
Fessler was one of the doctors who was appalled by the poor medical arrangements in Pretoria. The doctors had, more or less, to find out for themselves where they had to go. Some of the Belgians went to the eastern front and some to Jacobsdal where they avoided associating with the German Red Cross and took care of the typhoid patients. Fessler himself joined the hospital in Varley's Hotel in Krugersdorp under Dr Von Borne, where he enjoyed the use of his own radiological apparatus.
Dutch aid to the Transvaal Red Cross dated from earlier than that of the other foreign contributors and the information available about it is detailed and extensive.(20)
The first Dutch Red Cross ambulance was sent out immediately on the outbreak of hostilities and was paid for by Het Nederlands-Zuid-Afrikaansche Vereeniging. It arrived in Pretoria on 8 December 1900, under Dr G.W.S. Lingbeek. Also attached to the ambulance were Professor Korteweg and Drs C.W. Vinkhuysen, D. Romeyn, J.C.J. Bierens de Haan and A. Oidtman. They established their main hospital in the 'Staats Meisjeschool' which was already being developed by Dr Heijmans. Professor Korteweg and Dr Vinken organised this sixty-bed hospital so that it could be expanded to take 200 to 300 patients. They employed their own nurses and some of the local Red Cross volunteers. They also had their own X-ray apparatus and co-opted the Pretoria photographer, Wierkitzly, to their staff to help with the radiography. A part of their group went to Modderspruit where it established a clearing station.
The second Dutch Red Cross ambulance was led by Dr I.D. Koster accompanied by Drs W.F.H. Schelkly, Pino and Metz who were later joined by Dr Van der Goot.(21) These doctors were also on board the Herzog with the German-Belgian and second German ambulances. Just outside Lourenco Marques harbour the Herzog was apprehended by the British cruiser H.M.S.Thetis and escorted to Durban under the pretext that it was carrying contraband. After intervention by the Dutch and German governments, the Herzog was released. The incident however heralded the beginning of many problems which were to befall the second Dutch ambulance. It reached Harrismith in January 1900, and from there extended its activities into Natal. It was temporarily engulfed by the advancing British forces under Sir Charles Warren. Although it was promised free conduct, this was withdrawn and it was taken to Ladysmith where it was released three weeks later. It went via Pretoria to Christiana and then back with the final retreat to Pretoria, which by that time was under British Military Rule. In June it was given permission by the British forces to re-join the Boer Commandos. It was instructed to take a prescribed route but was summarily arrested. Those members of the ambulance who were unfortunate enough not to have gone back to Holland earlier including Drs Koster, Pino and Van Houten, spent the duration of the war in Ceylon for alleged contravention of the Geneva Convention.
Dr Van Rijckevorsel left Holland with the third Dutch ambulance in December 1899, with materials and men needed by the first and second ambulances and accomplished this mission in February 1900. He was accompanied by Dr L.J. Jansen, Dr Van der Groot and Dr Van Houten. Dr Van Rijckevorsel himself joined the Russian-Dutch ambulance. In March 1900, Het Transvaalsche Roode Kruis asked for additional Dutch doctors and Drs MacLeod, Pameyer and Von Engelen were sent out. The guerilla phase of the war was in full progress by the time they arrived and organised ambulances had ceased to exist. Dr MacLeod worked at Nooitgedacht, Nelspruit, Komatipoort and later in Lourenco Marques, while Dr Pameyer joined Generals Ben Viljoen and Beyers.
After the fall of Pretoria organised ambulance work ceased. Dr Lingbeek tried to re-organise ambulances for the Boer forces, but failed to obviate the obstructionism of the British authorities and eventually had to accept defeat.
By February 1901, only Drs Bierens de Haan and Pameyer and male nurses Jeltes and Leonhard of the first Dutch ambulance were still with the Boer Commandos but by April 1901, all had returned.
Ambulance of the Netherlands Indies(22)
Dr J.H.P. Kerekhoff and Dr H.C. Buning arrived in Pretoria in January 1900, with an ambulance much depleted of its apparatus and supplies due to the questionable dealings of the authorities at Diego-Suarez. They were provided with replacement equipment donated by France and thereafter proceeded to Modder River. They later had a hospital at Kroonstad during the general retreat towards Pretoria, but for the entire duration of their stay in South Africa they worked for the Pretoria section of Het Transvaalsche Roode Kruis.
The German Red Cross The first German Red Cross ambulance(23) arrived in Pretoria early in December 1900, under Dr Mathiollus, a career military doctor, and two civilian surgeons, Drs H. KĀttner and Hildebrand. Dr KĀttner was a fairly experienced military surgeon, having recently returned from the Greco-Turkish War during which he had written a book on the use of radiology in war surgery. To anticipate matters a little, he was to proceed from South Africa to Manchuria where the 'Boxer Rising' had developed, and, by 1914, he was considered to be one of the most experienced war surgeons of all time. He wrote extensively on many surgical topics and became Professor of Surgery in Breslau where he pioneered much of modern specialist surgery including tissue transplantation and neurosurgery.
The first German ambulance was, as might be expected, a comparatively model ambulance since its members had had recent experience of the kind of work it was supposed to do. It had its own X-ray ap paratus which was operated by a young South African, Van Alphen, son of the Postmaster-General of the Transvaal, who had been trained as an electrical engineer in Germany.(24) It went to Jacobsdal where it established an efficient hospital in the local school. In addition to its radiological services the hopsital boasted electric lighting as well. It did not have an immense amount of work due to the low rate of activity in that area of operations, except, of course, for the Battle of Magersfontein. The ambulance received high praise for its exemplary service to British wounded from Lord Roberts when he entered Jacobsdal. It was allowed to return to the Boer lines, which it did via Bloemfontein, Brandfort and Kroonstad and in the latter two towns it established temporary hospitals in local hotels. The ambulance was urgently recalled to Germany in June 1900, whence Kuttner proceeded directly to the Far East. The second German ambulance(25) also arrived at Pretoria in December 1900, having come out on the Herzog in the company of the second Dutch and the Belgian-German ambulances. Drs J. Wieting, A. Flockemann and T. Ringel were the medical members of this ambulance. In the early phases of the war they had their ambulance at Springfontein station, but with the general retreat they went to Kroonstad and from there to Heilbron.
The third German ambulance arrived in March 1900, under the leadership of Dr Strehl, who with Dr Sthamer, joined the second German ambulance and partially replaced some of the doctors of the first and second. Dr Strehl worked with Dr Flockemann of the second German ambulance at Heilbron and then went to Bethlehem during the retreat of the Boer Forces from the Free State. Here the two of them were asked by President Steyn and Dr Ramsbottom to stay on as they were the last of the foreign ambulances still serving in the Free State. This they did, until they were ordered to return to Germany which they did from Fouriesburg, which was the last place where they were active.
The last of the German Red Cross Ambulance doctors left the country by the middle of 1900 and by the middle of August, the only German doctor left was Dr Tilemann of the German-Belgian Ambulance. He remained with the Boer commandos in the Eastern Transvaal till the end of the war.
The Irish-American Ambulance(25)
This, probably the most infamous group that arrived in the Republic, consisted of sixty men under Captain P. O'Connor and included the Drs McAulley, Conroy, MacNamarra, Aderpold, Slattery and Long. They were financially supported by the United Irish Societies of America and their initial outlay was something in the order of $3 000. They wore the Red Cross emblem, to which they were not entitled and were therefore not very well received in Cape Town by the British authorities. They then tried Lourenco Marques but their equipment was retained by Portuguese officials. When they arrived in Pretoria, forty-seven of the sixty men took up arms with the Boer forces and the remnant proceeded as an ambulance to work at Christiana.(27) There were loud and prolonged repercussions about this action at later meetings of the International Red Cross Society.
Russian aid to the Boer Republics
There were two Russian ambulances serving in the Republics, the Russian Red Cross ambulance and the Russian-Dutch ambulance. The former was an official ambulance equipped and staffed by the Russian Red Cross.(28) It apparently got its equipment through the authorities at Lourenco Marques without any difficulty, due to the intervention of the Russian Military Attache in the Transvaal, Colonel Gurkho. This ambulance was under a Dr Kuskoff who was asked by President Kruger to establish an ambulance near Colesberg as action was anticipated in that quarter at a fairly early stage. This message from President Kruger was, unfortunately, not delivered to Kuskoff personally but through one of his juniors to which Kuskoff took offence. The President came to hear of the doctor's dissatisfaction as did the public at large. The general reaction was 'Kuskoff knows better than the President where to go and what to do'.(29) The result of this affair was that the President would have nothing to do with the Russian ambulance which eventually settled in Newcastle in an Irish Convent. It had very few patients and, according to Suter of the Swiss Ambulance, dealt mostly with dysentry, typhoid and malaria cases. One of the doctors, Zadofsky, with two nursing sisters organised a hospital in Volksrust where they had ample work to do. Later Drs Davidov, Gollek and Eberhardt of this ambulance opened a forward clearing station at Glencoe and from there sent patients to Newcastle. Finally, when the Government of the Z.A.R. moved to Machadodorp they followed it and then left the Transvaal in August, 1900.
The Russian-Dutch ambulance(30) was a unit which came to South Africa after the Dutch Red Cross had decided to send a fourth ambulance unit in conjunction with a Russian contingent. A committee in St. Petersburg, under direction of a Dutch pastor, Mr Gillot, had collected funds to provide the requirements of the Russian contingent. Considerable official difficulties were encountered as the ambulance represented two states. The Russians, however, thought that the combination with the Dutch Red Cross would facilitate contact with the people of the Transvaal. The leader of this ambulance was Dr Van Leersum, whose colleagues were Dr Romein and Dr Cartier van Dissel. The Russian medical personnel consisted of Drs Weber, Von Rennekammpf, Bornhaupt and Kukharenko. They arrived in Pretoria in February 1900 and, as did the other foreign contingents, experienced the difficulty in finding a place to work. Some went to Colesberg, some to Modderspruit and Petrusburg, while some worked in the ambulance train which plied between Modderspruit and Pretoria. Most of them were active in the south-western Free State then went to Kroonstad and Fourteen Streams. Some of the sisters worked in the hospital at Krugersdorp under Dr Fessler.(31)
The Swiss Red Cross Ambulance(32)
Early in 1900, Drs Montmoullin, KĒnig and Suter arrived in Pretoria and also experienced difficulty in finding a place to establish a unit. At first they helped on the ambulance train from the Natal front (the lot of all those medically qualified personnel who were unoccupied) and later took care of British prisoners-of-war at Waterval, north of Pretoria. Suter eventually went to the eastern front and the others worked in the Johannesburg General Hospital until after the British occupation. The Swiss contingent left Durban in October, 1900.
The Scandinavian Ambulance(33)
This ambulance Corps was raised by the Scandinavian community in Johannesburg under the leadership of Johannes Flygare. Three Swedish nursing sisters who were working in Johannesburg joined the ambulance and Dr Vilhelm Boeck Bidenkap was in charge of medical matters from October to November, 1899. This ambulance served at Mafeking from the end of October to late in November 1899 and was then transferred to Magersfontein. After the relief of Kimberley, the ambulance went to Jacobsdal. Dr Bidenkap left the ambulance in November and was thus not present at the Battle of Magersfontein where problems arose as a result of the lack of his medical direction. The ambulance was disbanded in May, 1900.
Dr Joseph Hamar was a Swede who worked on the Eastern Front but had no association with the Scandinavian Ambulance Corps. He did however work closely with the Dutch Red Cross.
The Sivewright Ambulance(34)
In November 1899, Sir James Sivewright sponsored an ambulance which consisted predominantly of South African medical students who were studying at Edinburgh University. Dr and Mrs Gray from Aberdeen were in charge of a section of this ambulance which consisted of A. Johnson, a British Medical Student, and the South Africans L. Fourie, D. Luther and G.H. van Zijl. The rest of the ambulance was led by Dr A.C. Neethling who had recently qualified and who had with him A.J. du Toit, W.W. Hamman, C.T. Moller, J.L. Schreiner and a nurse, Mrs Bamford. The formation of this ambulance evoked a bitter reaction in Britain. Many letters were written to the press and questions asked in Parliament about this 'treasonable' act. When the Sivewright ambulance arrived in Cape Town it was coolly received by the British authorities there and, to add insult to injury, President Kruger declined its services when he was telegraphed the news of its presence! It travelled to Lourenco Marques whence, eventually, all the South Africans and Mrs Bamford reached the Transvaal. The Grays and Johnson, however, had to make their way back to Durban. Those who were in the Transvaal split up, some of whom joined Het Transvaalsche Roode Kruis under Dr Neethling on the Eastern Front. Fourie and Schoeman served under Dr Veale in the Bourke Ambulance just before the fall of Pretoria, after which they returned to Edinburgh. Moller at first served with General de la Rey and then later, with General Smuts until the end of the war when he too returned to Edinburgh to complete his studies.
By the end of 1900 all foreign ambulances in South Africa had returned to their countries of origin and only a few individual doctors and male nurses remained with the Boer commandos, rendering what aid they could with the limited means at their disposal.
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