Pinetown, Natal,
May 1900.

Now we are really at work at last, and though I can't say everything is working very smoothly, I think the patients are being well looked after, and I suppose we must expect to have to worry through difficulties for some time to come.

On April 26th the Princess Christian Hospital train brought us fourteen officers and sixteen men, all stretcher cases, and all very ill.

They had come from Field Hospitals, and if one did not know how impossible it is to nurse them or even feed them up there, one would say it was almost murder to have sent them a journey of many hours (over 200 miles) in a jolting train.

There were no wounded in this first batch, and I think only about four or five who were not suffering from typhoid in one stage or another, from a few days, up to three weeks or more.

It was day and night work for us for the first two or three days, as each man seemed to need individual nursing if he was to have a chance of pulling round; the orderlies (though very willing) had everything to learn of ward duties; they could not even undress these men when they had been lifted on to their beds, much less had they any idea of washing them; a delirious man was a new experience to them, and if he got out of bed and lay on the floor, the orderly would go and ask Sister what he had better do!

The doctors told us that four of these patients could not live through the first night (several of them had severe hÆmorrhage), but they all struggled through that night, and it was a week later when one poor fellow of the Royal Artillery slipped through our fingers from sheer exhaustion, without ever having become conscious. His mates told us that he had been in a hospital previously with a sunstroke, and had been down with typhoid for some time before he arrived here.

I can't describe the condition of these men; they have not had their clothes off for weeks, creeping things are numerous, but we are getting them clean by degrees. Those who have been ill some time have sore backs—I can't say "bed-sores," as they have had no beds.

Many of them have come from Elandslaagte, and I believe they are very short of both milk and water up there—none of the latter for washing purposes.

Several of the men had been with us over a week before they became conscious of their surroundings at all; but in the case of those who were conscious, the comforts of a good bed, and a good wash, brought tears of gratitude to their eyes. With many of them it was months since they had slept in a bed: few have done so since they landed in this country, and some of them seem such boys to have gone through so much.

I spent a good deal of my time at first helping the sister in the officers' ward, getting her patients washed and made comfortable, and it was most piteous to see these young fellows—most of them, probably, brought up in luxury—so wasted and thin, and so grateful for the little that we could spare time to do for their comfort.

Lieutenant —— had been laid up for two months with a bullet in the groin, and is now very ill again with typhoid.

Captain ——, of the R.A.M.C., had been all through the siege of Ladysmith, and had typhoid up there; now he has liver trouble and looks wretchedly ill; I fancy he will have to go home for operation.

Captain ——, of the Royal Artillery, was the worst case of typhoid amongst the officers, for some time his temperature persisting in keeping up to 105 and 106, and he was very delirious; he was always thinking he could see parties of Boers, and he told me I was the worst scout he had ever come across, as I did not see them. He is doing well now.

Lieutenant ——, of the Army Service Corps, had been ill for four weeks with typhoid before he was landed here (still with a very high temperature). He told me that no less than five times had he been moved on a stretcher, from one place to another, as his regiment shifted about, and he said that the order to move always seemed to come in the evening, when his temperature was at its highest, and he was feeling so bad, that at last he begged them to leave him behind to die; they had never been able to give him suitable food, and often not enough of unsuitable, and when at last he got to the line he had 280 miles of jolting over a single-line rail, before he reached us—such treatment for a case that, at home, we should be almost afraid to lift from one bed to another! But he is really mending now, and I hope we shall soon be able to send him home to recruit.

I have never had to give so much stimulant to any patients as we have had to give to these men; all the first night I was going round giving milk and brandy, or bovril, to the worst cases, while the night sister sponged those whose temperatures were the highest; several of the men were on ten ounces of brandy for the first few days. They have been so overworked, and underfed, for some months past that they did not seem to have an ounce of strength left to battle with the fever.

An Army Lady Superintendent is supposed to take charge of a ward herself—generally the officers' ward; but I have not taken a ward yet, as, until we fill up, there are enough sisters, and it seems more profitable for me to go round supplying the sisters' needs from the stores, looking after the cooking, and the house-boys, and the washerwomen (I fear that my hair will turn grey in my efforts to keep the typhoid linen separate), to say nothing of the cows, which are not a success; and we have had to resort to frozen milk from Australia—generally good, but sometimes there is a difficulty about unfreezing it.

We have no Quartermaster here, and the man in charge of the stores is quite unused to his job, so I have to see to a great many things with which an Army Lady Superintendent has, as a rule, nothing to do.

I am very much afraid some of our orderlies will be getting typhoid; of course they find it difficult to realise a danger they can't see, and though we all lecture them about taking precautions, we are so busy ourselves, that it is difficult to enforce them; and just at first there were so many patients quite unconscious and with severe diarrhoea and hÆmorrhage, so that it meant constant changing of sheets, &c., by the orderlies.

I think I told you some of the orderlies were ill when our first patients (from the train accident) arrived; it proved to be a form of dengue fever they had, and now the medical officers also are indulging in it; it is rather like influenza—high fever for two or three days, and then they are very weak and pulled down for a few more days. I only hope the sisters will refrain from having it until the orderlies have had a little more education: at present they are about as useful as an average ward-maid at home, and the sisters have to act as sister, staff nurse, and probationer too; but I don't want to grumble at them as they are working well, anxious to learn, and very patient with the men (some of them half delirious) who call "Orderly, orderly" all day long.

If they had had a few R.A.M.C. men amongst them, or even one or two R.A.M.C. ward-masters, it would have been easier; as it is, there is not a single man amongst them who knows anything of the usual routine in a hospital, though they are well up in "First Aid" (for which we have no use here).

The buildings are getting on, and we are ready for more patients as soon as they can get a train to bring them down. We hear nothing of more medical officers, sisters, or orderlies as yet.

One of the men said to me that he did not think any of us could understand what a luxury it was to have a wash, a comfortable bed, and clean clothes; that for months he had been marching and sleeping (in the open) in one suit of clothes, frequently wet through, and remaining wet until the sun came out to dry them; he said that on the high veldt the nights were very cold, and they frequently had nothing but their greatcoats to sleep in; if they were lucky, and the baggage waggons had kept up with them, they would also have a blanket and perhaps a mackintosh sheet; but that the baggage waggons had a habit of getting stuck at the last drift, and then they had only what they carried.

If we had only come out to South Africa to nurse this one batch of thirty officers and men back to health, I think it would have been worth while, for they were just about as bad as they well could be, and one can't help thinking of the anxiety of their poor friends at home, who will have seen them reported on the "danger lists" from their Field Hospitals; and we go plodding on night and day trying to make them pull round. Only one man has died, and I think the rest will get on, though some of them are still pretty bad.

Captain —— had Cheyne Stokes breathing for two nights, and made us very anxious, but now he is distinctly better.

The Bishop of Pretoria came to lunch with us the other day, and was very nice in visiting the men.

We are expecting more men any day now, and on the 25th of this month we are to be officially "opened" (on Princess Christian's birthday, I believe); a crowd of people are expected from Durban and from Pietermaritzburg.

I could not help thinking the other day, when all these thirty men were dumped in upon us in a couple of hours, of the old days in London when we thought we had had a very heavy day if six or eight patients were admitted to our ward in a day; and there we had everything ready to hand, and several well-drilled nurses to help. Here I can see it will take a little time before the sisters will realise that it is useless to try to have things done just the same as we can at home, and for them to distinguish between the essentials of good nursing, which we must have, and the superfluous finish, which we must do without.