DISEASE AND ILLNESS PREVALENT DURING THE ANGLO ZULU WAR
1979. Part 1.
An initial overview of physical conditions and general medical problems.
Adrian Greaves and Dr. Alan Spicer.
In the late 1870s, during an age of pox and plagues, humanity remained
largely powerless to prevent disease until conclusive proof of the germ theory
was developed by Louis Pasteur in France and Robert Koch in Germany.
Their bacteriological findings eventually led to the first steps in the conquest of
infectious diseases. At home, environmental sanitation, safe water supplies,
improved sewage disposal systems, pasteurisation of milk, and sanitary
control of food supplies gradually resulted in the virtual disappearance of
cholera and typhoid fever and the marked reduction in diarrhoea and infant
mortality. The subsequent discovery of effective vaccines, based on the
growth of the science of microbiology, initiated not only the eventual world-
wide eradication of smallpox but also caused the marked decline in such
common diseases as diphtheria, tetanus, whooping cough, poliomyelitis, and
measles. In 1879, malnutrition, tuberculosis, influenza, whooping cough,
scarlet fever, measles, syphilis and a host of less significant infectious
diseases were among the major health problems, not only for the British army
but for their families at home. According to the Lancet, UK civilian mortality
rates in 1879 were high with 2.6 % of the population dying each month,
London typically suffered 189 deaths from smallpox in January alone. The
infant mortality rate was 15.3% (under 12 months old) compared with 0.6 %
today. Life expectancy for the working classes in Rutland and Manchester
(where detailed figures were maintained) were a mere 38 years and 26 years
respectively, and for the professional classes it was 42 and 52 years
respectively. With surgery in its infancy, the surgical death rate was nearly
50% of all recorded surgical cases.
Since the beginning of time, malaria has killed more of the earth's population
than starvation, warfare and plague put together. At the time of the Zulu War,
malaria was virtually extinct in the United Kingdom but nevertheless remained
a serious health hazard for the British army in Africa. Referring to the Anglo
Zulu War, the 'History of the Army Medical Department' reveals that bowel
diseases and malaria were the most serious medical problems facing medical
officers. Between 4th January and the 3rd October 1879 there were 9,510
medical admissions from a military strength of 12,615. Of these admissions,
2,789 or 29.3 per cent were due to 'fever' while 1,522 or 16 per cent were due
to enteric fever, dysentery and diarrhoea; and there were 574 admissions
from rheumatism. Any precise diagnosis under active service conditions was
difficult and, according to the HAMD 'there was much confusion over the
separation of fevers due to different causes, this was overcome by an all
embracing diagnosis of "typho-malarial" fever.'
Maj. Ronald Ross of the RAMC spent most of his working life trying to solve
the 'great problem' of how malaria affected soldiers. He knew that soldiers
throughout the British Empire were dying in unacceptable numbers from fever
and, being astute, he also knew that whoever solved the problem would reap
the rewards. He sought to resolve the problem in Europe, through Africa to
India but finally found the solution by looking through a microscope, eventually
receiving the Nobel Prize in 1920.
Malaria is caused by a parasite, known as Plasmodium, because it lives,
swims, and reproduces in the blood. In Victorian times, many soldiers suffered
and died of the disease without knowing they were carrying the malarial
parasite. In the right conditions, the disease evoked various sinister side-
effects which caused fever, ruptured spleen, anaemia, an impaired immune
system which, in turn, encouraged other prevalent deadly diseases, also
endemic, such as typhoid, influenza, dysentery and malnutrition. In 1879,
malaria was a scourge to British soldiers serving abroad as well as indirectly
to their families at home from the consequences of disease.*1
Civilisation and syphilization have gone hand in hand for five centuries, the
disease having been imported into Spain by Columbus's sailors following their
discovery of Haiti and the questionable sexual delights offered them by the
island's generous women. The returning sailors carried the newly acquired
syphilitic bacteria Treponema pallidum and, as heroes, were feted and
bedded by a grateful nation. The bacteria immediately began boring into the
bones and skulls of the population and syphilis rapidly spread across Europe
to Britain. It had no regard for rank or title, royal houses spread it among their
courtesans and the aristocracy while the military rapidly spread it both at
home and abroad. Soldiers were indeed, syphilis's best friend. A soldier far
from home, particularly one facing possible death from a assagai or typhus,
rarely bothered about sexual convention and accepted syphilis as the 'merry
disease'. There was an almost total acceptance of the effects of the disease
with its raging headaches, swollen joints, wartlike lesions and mouthfuls of
sores and ulcers. The disease then entered a latent stage in which no
outward signs or symptoms occurred, but inflammatory changes took place in
the internal organs. The latent stage could last 20 to 30 years. In 75 per cent
of the cases, no further symptoms appeared. When the final stage of tertiary
syphilis did occur, it produced hard nodules in the tissues under the skin, the
mucous membranes, and the internal organs. The brain and skeletal structure
were frequently affected, as well as the liver, kidney, and other visceral
organs. Infection of the heart and major blood vessels accounted for most
During the period of the Zulu War, venereal disease turned out to be as large
a threat as the enemy, directly or indirectly causing more soldiers to seek
medical assistance than any other ailment, although most of the severe cases
were recorded as 'fevers'. For the troops, there was little or no official sex
education and curiously, even the word 'syphilis' was banned from British
newspapers until 1920. In June 1879, of the 300 cases being treated at the
Durban military hospital, most patients suffered from malaria, dysentery or
venereal disease. September 1979's 'The Lancet' records that the latter had
been 'landed from the troopships, the disease having been contracted
previously to the men leaving England'.
At the time of the campaign, the most ruthless killer of mankind, one in six of
all deaths, was tuberculosis, more commonly referred to as 'consumption',
with about 60% of the population suffering its long term effects. Tuberculosis,
or mycobacteriosis, is as old as mankind and even today afflicts third world
countries. The germ thrives when hosts, both humans and cattle, live in
squalid and overcrowded conditions and is spread by coughing and spitting,
drinking contaminated milk and from contact with polluted water, grass,
animal feed and soil. During the Anglo Zulu War, many soldiers joined the
army to escape the squalor and poverty at home, only to contract and then
spread the disease wherever they lived in cramped and filthy conditions, and
these were abundant during the campaign. It is unlikely that army medical
officers knew they were treating T.B. or even understood its cause. All too
frequently during the campaign, soldiers were kept cramped together in
extremely unhygienic conditions. Following the battle at Rorke's Drift, some
six hundred soldiers slept for weeks in overcrowded conditions and squalor,
others lived in equally unsanitary conditions during the siege at Eshowe and
at Fort Pearson similar cramped conditions resulted is mass sickness which
was invariably attributed to the location and not the circumstances. Early
stages of T.B. often produced no symptoms and soldiers could carry the
disease for several years before they deteriorated. Symptoms common in the
advanced stages of the disease included fever, fatigue, night sweats, loss of
appetite, loss of weight, respiratory disturbances such as coughing, chest
pains, and production of blood-stained sputum.
One particular form of TB, Scrofula, was endemic both in the civil and military
populations and was caused by sufferers spitting contaminated phlegm. In the
UK, scrofula was common amongst children who frequently went barefoot and
who contracted the disease through the skin of their feet. This condition
eventually gave rise to the familiar "no spitting" notices which many readers
may still remember. The only treatments at the time included surgical blood
letting, applications of phosphoric acid, ether inhalation and digitalis drinks.
Most physicians viewed the disease with professional nihilism until Robert
Koch discovered the bacillus in 1882.
Influenza was generally known at the time as 'a jolly rant', 'the new delight', a
'gentle correction' or the 'blue plague'. Because it didn't disfigure the features,
rot the genitals or cripple limbs it was not generally considered to be a serious
condition especially as influenza rarely killed its victims except in the case of
children or the elderly, neither of which warranted social concern at the time.
Doctors were not unduly perturbed as the condition created the status quo of
medical perfection, of everybody ill and no one dying. Doctors did, though,
notice that a lung from a healthy body would float in water while that of a 'flu
victim would promptly sink, otherwise little medical intervention took place or
was considered necessary.* 2 The several symptoms of a simple attack would
have included a dry cough, sore throat, nasal obstruction and discharge, and
burning of the eyes; more complex cases were characterised by chills,
sudden onset of fevers, headaches, aching of muscles and joints, and
occasional gastrointestinal symptoms. On campaign in Africa in 1879, the risk
of death increased as the disease was invariably accompanied by viral or
bacterial pneumonia which was encouraged by cramped conditions or an
absence of weatherproof accommodation.
Health hazards, illness and disease to which the British soldier was especially
exposed in Natal and Zululand.
A concise overview of health hazards in Zululand can be found in the
Appendix to the Army Medical Department's 'Report on the climate and
Diseases of Natal and Zululand. * 3
Dysentery is not very common, but the occurrence of bloody urine is very
frequent in both man and animals, and tapeworm exists to such an extent that
Dr. Jones says "almost every second person you meet with has worms of
some sort." The water in this locality is slightly brackish, but not apparently
productive of any injury to health. On the whole, Dr. Jones regards the Lower
Tugela division as being "remarkably healthy."
With respect to the climate and diseases of the Upper Tugela between
Umsinga and the river, Dr. Dalzell, district surgeon, looks on fever as
comparatively rare, never having seen any serious cases except those
brought out from North Zululand:-
"The high lands here are remarkably healthy. It is likely that white men living
in the deep valleys would take fever, but no white men live there." Dysentery
and rheumatism appear to be more common in this locality, where also
tapeworm exists "in abundance."
Cases of sunstroke have occurred, and Dr. Dalzell speaks of the heat in the
valleys during the summer months as "terrible" between the hours of 11 and
3p.m., also the Tugela (18 or 20 miles only from this) runs in a deep valley.
"Troops could not easily be kept healthy there, owing to the intense heat,
while horses would almost inevitably die in great numbers unless stabled."
The water in the district is generally brackish. Such then is the brief outline of
the peculiarities of climate and prevalence of disease in Pietermaritzburg and
the northern and north-eastern districts of Natal.
The sanitary precautions against these conditions that suggest themselves as
being most important are:-
That troops should never, unless compelled by some strategic necessity, be
encamped in a valley, but should occupy as high a ground as practicable, and
that tents should be pitched for the men to sleep in whenever possible. That
hot coffee or cocoa should never be omitted when men turn out at or before
daybreak, and that men on guard should always be provided with this ration,
to be used as soon after 4 a.m. as it is possible to light a fire.
For the prevention of dysentery it is most desirable that the wearing of cholera
belts by the men should be stringently enforced. With a view to the avoidance
of tapeworm, strict orders should be given that the internal organs of animals,
such as liver, kidneys, brain, etc., are not to be eaten, and that all meat is to
be thoroughly cooked. The preparation of tea and coffee, to be carried in the
men's water-bottles, should be encouraged as much as possible, so as to
ensure the water being thus boiled before use.
In consequence of the water being brackish, and as it also, owing to its
contamination with the droppings of animals, constitutes one of the means by
which the tapeworm ovum finds its way into the stomach, it would be
advisable that every means should be utilised for collecting the pure rain
water as it falls, and using it for drinking purposes only. Very little ingenuity
would be required to extemporise a rude funnel by which large quantities
could be gathered and conducted to a receptacle for the use of each
company. The men should be warned against eating the wild fruits that may
be met with. The minor diseases of Zululand correspond with those of Natal
and need only the same precautions.
A report just received from Rev. R. Robertson, of the Church of England
Mission, confirms the foregoing in every particular. After an experience of 18
years' residence he says, "I look upon Zululand as a most healthy country;
"many white men have died there it is true, but in many cases it was their own
fault, in my opinion. Intestinal worms are very prevalent indeed."
Pietermaritzburg, 28th September, 1878
Common day to day illnesses and adverse conditions which constantly
threatened the soldier included; severe sunburn, effectively treated by
applying juice from the readily available Aloe plant. Diarrhoea, no treatment
available; rheumatism, no treatment until the sufferer was crippled; regular
bouts of dehydration and heat exhaustion; and blisters, the official treatment
was,- "threads of worsted to be drawn through the blister and the sock or
garment, if available, to be well soaped over the injured part".* 4
The more serious medical cases which involved hospitalisation included
scarlet fever, measles, diphtheria, typhus, pneumonia, dysentery, polio and
syphilis. The hospital at Gingindlovu recorded that in April they treated, out of
76 officers; fever1; sunstroke 1; diarrhoea 4; dysentery 4, other diseases 4.
Out of 2,000 other ranks, fevers 180; rheumatism 29; diarrhoea 40; dysentery
29; bronchitis 2; boils 11; other diseases and accidental wounds 44. 'Other
diseases' included venereal cases. The records reveal the medical treatment
for snakebite was copious alcohol (to be drunk).* 5 History records that the
senior medical officer during the campaign, Surgeon General Woolfryes,
blamed the atmosphere for the fevers and dysentery while the soldiers knew
little or nothing about protecting their food and water from the bacteria-
carrying flies. Personal hygiene was still in its infancy, Col. Clarke wrote,
"Latrines and urine pits were dug near the tents, and filled in every morning.
The natives would not use them".* 6 Maj. MacGregor also lamented the
natives' unfamiliarity with latrines and added "A principal difficulty was the
constant death of oxen, often near water, which had to be dragged away and
A correspondent from the Cape Argus visiting Fort Tenedos on the Tugela
River observed that it took three officers at a formally convened meeting to
agree to replace a soldier's worn out boots while "everyone ignored a dead ox
lying in the stream immediately above the bathing place and water collection
point".*8 The sole attempt to purify the visibly contaminated drinking water
was by the issue of charcoal filters to the troops but, although they were used,
they had no effect against bacteria.
As Maj. General R.E.Barnsley of the RAMC noted when referring to the
period, "Our great commanders had never learned that disease has always
been far more destructive than the most devastating engines of war which the
mind of man has conceived. None realised that the preservation of the health
of the troops was the final responsibility not of medical officers but of
commanding officers".*9 Lord Wolseley, undoubtedly the greatest soldier of
his day wrote about the field medical officer as follows, "So long as this fad
continues, my recommended action is to leave him at the base where he may
find some useful occupation as a member of the Sanitary Board". *10
To be continued.......................
*1 Even in World War Two, malaria accounted for over half a million US
military casualties. Malaria has
always been an accompaniment of war and poverty and it continues to control
population growth in Third
World countries. It remains to be eradicated.
*2 David Patterson Pandemic Influenza 1700-1900. 1983.
*3 Army Medical Report Surgeon Major N. Alcock 1878
*4 Precis of Information concerning Zululand War Office Publication 1879
*5 Army Medical Dept. Appendix to report for 1879 item 16.
*6 Precis of Information concerning Zululand War Office Publication 1879.
*7 Precis of Information concerning Zululand War Office Publication 1879.
*8 As quoted in the British Medical Journal July 1879
*9 Maj. Gen. R.E.Barnsley RAMC 'Mars and Aesculapius' Sapphire Press
*10 Lord Wolseley 'The Soldier's Pocket Book' 1886
Part 2. The June 1998 Journal will include;
An examination of Service wounds and treatments, including
i. Battle injuries, their effects and treatment.
ii. Notable surgical cases.
iii. Medicine and surgical techniques of the campaign.
iv. A review of field medical statistics.
We have not found any formal references with regard to the medical treatment
or implications of disciplinary floggings which frequently took place during the
A contempary cartoon revealing
the soldier's nightmare
Consultants in South Africa: David Rattray FRGS, Maureen Richards, Ron
United Kingdom: Lt.Col. Mike Martin, Lt.Col Alan Spicer RAMC, Brian Best,
Ian Knight FRGS
Journal Editor: Dr. Adrian Greaves FRGS
The Secretary, Woodbury House, Woodchurch Road, Tenterden, Kent, TN30
7AE, Great Britain. Tel; 0158O 764189 Fax; 01580 766648
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