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It is important to research the adverse health impacts of war, given ongoing conflicts around the world that harm both civilians and military personnel. Analysis of past wars may also better inform society of the long-term health outcomes of veterans. It has been suggested that there may be different post-combat syndromes with different wars,1 and some aspects of war may be particularly relevant (eg, there is fairly clear evidence for long-term harm to health from being a prisoner of war in the Second World War [WW2]).2–4 Other studies also provide evidence of long-term harm to health among war veterans.5–9 Nevertheless, an increase in all-cause mortality in war veterans has not always been identified,4 and raised mortality rates sometimes only appear later in life.10 Returning veterans may also experience adverse health impacts from unemployment in the immediate post-war period—a likely issue for some after the First World War (WW1). But, on the other hand, it is plausible that some war veterans may experience net benefits from their military experience via training funded by the military and on-the-job skills development, both of which may lead to improved subsequent careers (and associated higher incomes). Studying all these issues is complicated by the ‘healthy soldier effect’, which is a selection effect analogous to the ‘healthy worker effect’.11 A further selection effect is the ‘healthy warrior effect’, whereby healthier personnel within the military are the ones involved in combat (relative to those away from the front lines).11

One war that has had relatively little study with modern epidemiological methods is the South African War, also known as the Second Boer War. This war was fought between 11 October 1899 and 31 May 1902. The forces of the British Empire (which included New Zealand) fought against two Boer states: the South African Republic (Republic of Transvaal) and the Orange Free State. The war resulted in over 100,000 casualties among the imperial forces and cost the British taxpayer over £200 million at the time.12 There were over 7,000 deaths among the Boer combatants and between 18,000 and 28,000 Boers (men, women and children) died in concentration camps.12 The death toll for Africans (at least those participating on the Boer side) was estimated at probably over 12,000.12

For New Zealand military personnel, the official death toll in the Parliamentary record of the South African War was 232 deaths.13 But, given limited follow-up of personnel in the post-war period, we suspected that this mortality burden could be an underestimate. Similarly, given that the historical record has largely focused on the 166 wounded personnel14 (ie, 2.7% of participating personnel, when using the denominator of n=6,080 participants15), we also suspected that the morbidity burden of the war may have been underestimated.

The significance of the South African War for New Zealand is that it was the first overseas war in which this country participated. It also symbolised the nation’s extremely strong relationship to Britain and the British Empire at the time, as per the title of a book on New Zealand and this war: One Flag, One Queen, One Tongue.16 The war also established the trend for future deployments of New Zealand military personnel in conflicts of the twentieth century. That pattern was to send an expeditionary force to operate alongside allies and fight as a junior partner in a coalition. The South African War has also been identified as contributing significantly to cementing New Zealand's national identity.17 Finally, the war also triggered a major societal response in terms of memorialisation, with far more memorials per 1,000 deaths than for other mass-death events in New Zealand’s history (ie, seven times the level for both WW1 and WW2 combined, nine times the level for the New Zealand Wars and 266 times the level of the 1918 influenza pandemic18).

Given this background, we aimed to provide updated and more complete epidemiological information on the health impacts of the South African War on New Zealand military personnel.

Methods

Mortality analyses

We used a dataset on all the war-attributable deaths among New Zealand personnel involved in the South African War (10 contingents). This dataset was built from a list in the Parliamentary record,13 modified slightly by comparisons with a list published in a book from 199919 and information from the Cenotaph website database20 and the New Zealand War Graves Project database21 (see Appendix Table 1). Also, to better identify at least some missed deaths, we searched the ‘Newspapers’ section of the Papers Past database.22 The search period was from the end of the war (31 May 1902) to 31 December 1904. The search term was: “trooper” AND “death” AND “South Africa” AND (“wounds” OR “fever” OR “consumption” OR “measles” OR “invalid”) (n=228 items). More specific searches of individual names were used to follow-up deaths that were potentially attributable to war, where this was suspected. In select cases where the cause of death was not clear, we purchased death certificates.23

Definitions of war-attributable deaths

To define a war-attributable death in this study, we required that the following criteria were all met:

  • The person dying had to have been in the New Zealand military at the time of attestation (ie, we excluded New Zealanders who only participated in other militaries during this war, such as the Australian or UK militaries).
  • The death occurred during military service (including in military training camps) or in the post-war period up to 31 December 1904. For deaths in this post-war period, we made an assessment based on the balance of probabilities and informed by the available information (and sometimes the death certificates) concerning the war being the likely main contributor to the death or not. That is, if the cause of death predominantly related to war wounds or diseases that began while in military service (eg, tuberculosis and enteric fever), it was considered to be a war-attributable death.

Random selection of military personnel potentially exposed to combat (for lifespan analyses)

We randomly selected 253 names from the whole list of 6,339 New Zealand military personnel who were listed on the Cenotaph website database as having served in this war.20 Once their specific contingents were identified (by examining data in the Cenotaph database and personal military files), we removed those who participated in the last contingent (Tenth Contingent) whose troop ship arrived in South Africa just days before the war ended and who were not involved in military action.

Random selection of non-combat military personnel

We randomly selected names of those who were in the Tenth Contingent (n=1,022). We then removed from that group those who had also previously participated in Contingents One to Nine. For both this and the ‘combat exposed’ group above, we also removed duplicates, female participants and those who had participated in non-New Zealand military forces (eg, the UK military). Due to a large number of exclusions (particularly due to participation in other contingents being revealed), we conducted a second batch of random sampling to boost numbers for the analysis, which left a total of 333 selected names.

Lifespan data

We collected data on birth dates from the online military files.24 Date of death was also sometimes in these files, but otherwise we used a range of genealogical sources. These include the Births, Deaths and Marriages database, which contains records of all New Zealand-based deaths in this cohort23 (albeit for those records where there was an exact match between the name, and age and year of death/date of birth, with the data from the military file). In some cases, only the birth year could be identified, in which case we used the mid-year point of that year (eg, 1 July 1880) in the analyses.

In the lifespan analyses, we excluded those who died during the war and those who died in the period from the end of the war (31 May 1902) to 31 December 1904 (if there was any indication of their death being war-related). The latter was on the assumption that such deaths may have been from wounds or diseases related to their war experience. Further analyses took account of the participation and death in WW1.

To compare lifespans with the overall lifespan for New Zealand men, we took the approach of a WW2 study25 and created a synthetic cohort matched to each real veteran in the random samples. That is, in the synthetic cohort we matched each real veteran with a life expectancy value based on that of the average New Zealand man who was born in the same year. Furthermore, this was for life expectancy at the age that these veterans were in 1903 (ie, the year after the one when the war ended). These values have all been estimated for five-year intervals by a large Stats NZ study,26 and we interpolated the values for birth years in between the five-year values provided by Stats NZ. Such a comparison is not unreasonable, in that there is evidence from an analysis of the occupations of the soldiers relative to men aged 25–45 years (as per 1901 Census data) that “although the total force was small, it was a remarkably representative sample, socially and geographically, of the male population.”15

Morbidity data

To assess levels of morbidity, we took a random sample of 100 names from all the 6,339 New Zealand military personnel who were listed as serving in this war (as detailed above). All the medical information in their online military files24 was then examined.

Results

Mortality

Our analysis identified ten additional cases that were probably war-attributable deaths and three that were unlikely to be war-attributable, resulting in a new total estimate of 239 deaths from this war (Table 1). This gave an overall 3.9% risk of death for the total participants (Appendix Table 1). The major cause of death was disease (59%), followed by direct conflict-related causes (30%) (ie, being killed in action or dying from wounds). A statue of one of those killed in action is shown in Appendix Figure 1. ‘Accidental’ deaths were relatively high (11%) and these were caused by a single train crash (15 deaths) and horse-related injuries. The pattern of deaths over time was one of fairly consistent monthly dominance of disease deaths over war-attributable injury deaths (Figure 1).

The major disease groupings were enteric diseases (with dysentery and typhoid) at 36% of all deaths, followed by respiratory disease (10%) and then measles (5%). Disease deaths were more than twice as likely during winter months compared to all the other seasons (risk ratio of 2.08; 95% confidence interval [CI]: 1.65 to 2.63; Appendix Table 1).

The worst year of the war in absolute terms was 1902 (Appendix Table 1; Appendix Figure 1). It had the worst month for war-attributable injury deaths (the military action at Langverwacht Hill), the worst month for disease deaths (a measles outbreak) and the worst month for accidental deaths (the railway crash referred to above).

The risk of death was highest for the first three contingents, peaking at 10.3% for the Third Contingent (Appendix Table 1). It was lowest in the last two contingents— though deaths from disease continued to impact on these groups after the end of the war. Nevertheless, when just considering conflict-attributable injury deaths (killed in action and death from wounds), the Seventh Contingent stood out with a 5.4% risk of death. The Seventh Contingent sustained 50% of all such deaths, due to the action at Langverwacht Hill.

The average age of death at 25.5 years (Table 1) can be compared to the lifespan of the veterans of 68.6 years (for Contingents One to Nine, exposed to combat, Table 3). This suggests that these soldiers lost around 43 years of life of average. For the 239 deaths, this sums to around 10,300 years of lost life.

Table 1: Mortality in New Zealand military personnel associated with the South African War (see Appendix Table 1 for additional details).

Figure 1: Deaths of New Zealand military personnel attributed to the South African War by month of death (from January 1900 to December 1902 [ie, not showing 1 death in 1899 and 10 deaths in 1903/04]).*

* The worst month for mortality (February 1902) reflected military action with 68% (25/37) of the deaths being KIA/DOW (particularly military action at Langverwacht Hill). The second highest peak in August 1902 reflected a measles outbreak. The third, in April 1902, represented a railway crash.

Morbidity impact

Based on the random sample of military files, an estimated 39% of personnel suffered some form of reported injury or illness (95%CI: 30%–49%; Table 2). The commonest grouping was infectious diseases (26% of all personnel), and this included enteric disease, malaria and measles. The next most common grouping was injury (14%). Horse-related injuries were more common than direct war-attributable injuries in this sample.

Table 2: Mortality and morbidity impacts of the South African War based on a random sample of participating New Zealand military personnel.

* Out of the random sample of 100 military personnel there were two duplicates and one missing military file, hence variation in the denominator (ie, it was n=97 if not stated or n=98 as indicated otherwise). The sample includes personnel from all contingents, including those that departed in April 1902 just before the war ended. It included all illnesses documented in the military files, including those after the war until the military file was effectively closed.

Lifespan of veterans

Many exclusions from the initial samples were required, particularly because around half (50.2%) of the members of the Tenth Contingent had already been in at least one earlier contingent (Table 3). There were differences between the combat and not-combat groups in the post-war period (mean lifespans of 68.6 years and 65.5 years respectively; Table 3), but the higher participation by the Tenth Contingent in WW1 contributed to this. When this was accounted for in the analysis, these differences narrowed, with this difference not being statistically significant (mean lifespans of 68.5 [combat] and 69.1 years [non-combat]; Table 3).

When compared to the lifespan of the matched synthetic cohort (using life expectancies for all New Zealand men at their respective ages in 1903), this military population had very similar lifespans (67.3 years in the military and 67.8 years in the matched cohort; Table 4).

Table 3: Description and lifespan results of the two cohorts of military personnel used for the lifespan comparison of veterans (exposed to combat vs non-exposed).

* Statistically significant difference in participation in multiple wars (p=0.0012, ANOVA). NS=not statistically significant when comparing the two groups.

Table 4: Mean lifespans for studied populations of military personnel compared to a matched synthetic cohort derived from Stats NZ life expectancy estimates for men by birth year and for their age in 1903.

Discussion

Mortality impact

This study identified an additional seven war-attributable deaths (net number), largely from the delayed impact of diseases experienced while in the military. It was also able to estimate the potentially lost years of life in those dying (ie, 10,300 life years lost). While the New Zealand authorities of the day did produce a final list of the dead (with deaths up to July 1903),13 this should ideally have been updated five or even ten years after the end of the war to account for ongoing deaths. For example, some delayed deaths could have arisen from subsequent operations on war wounds (with operations being more hazardous in this pre-antibiotic era) or from suicide, since post-traumatic stress disorder can be long lasting. Furthermore, an additional aspect to the impact of this war on New Zealand society are the deaths among New Zealanders who joined overseas militaries. This ideally could be estimated in future work—but it may give a total of closer to 300 deaths as per an estimate reported soon after the war.29 Other work shows that for WW1 there were 1,400 extra such deaths of New Zealanders with other military forces (ie, around 7% of the new total for WW130). However, that work required extensive genealogical skills and resources.  

In terms of the major cause of death being from disease (at 59%), this war represents the last time that disease was the dominant cause for wars that New Zealand has been involved in. That is, in WW1, this ‘disease’ cause was down to 7.8%,31 despite the contribution of an influenza pandemic.32 For Australia in the South African War, the proportion of deaths from disease was 47% (286/606).33 For the British forces it was 63% (13,139/20,72119). The statistically higher burden of disease deaths in winter months may reflect the role of infectious diseases associated with close contact (eg, from more time spent inside buildings or in tents) or possibly the immune suppression associated with cold exposure.

Morbidity impact

Morbidity impacts were commonly reported in the random sample of military files, with over a third of personnel experiencing illness or injury (39%). This contrasts to the impression from official statistics, which only focus on the 2.7% prevalence of participating personnel being ‘wounded’ (see the introduction). Recorded illness (26%) was almost twice as common as injury (14%). Even if only focusing on injury, our new estimate of 14% is over five times that from the official records (2.7%).

Furthermore, the military files will have tended to reflect the more severe conditions, and so the true prevalence of morbidity would probably be even higher than our new estimate (eg, if considering lice infestation, non-hospitalised thermal injuries [heat stroke and from severe cold at night], dental injuries from the hard biscuits, non-hospitalised injuries from riding horses and so on). Furthermore, the morbidity would have been ongoing in some cases. One researcher reported cases of veterans experiencing what appear to be post-combat psychological problems and further surgical operations (eg, an operation occurring in 1907).28

Lifespan of veterans

Our analysis suggested no major lifespan differences between veterans who were exposed to combat and veterans who weren’t exposed to combat. International work on this topic used different methods but also identified no increase in mortality of Boer War veterans with post-combat disorders relative to controls with gunshot wounds.34 Nevertheless, this finding in our analysis may partly reflect the modest sample size, which was diluted because of the much higher than anticipated number of exclusions owing to men joining multiple contingents). There might also have been self-selection effects between the two groups and also variation in the rigour of the selection process in the military over time (eg, initially men were sometimes rejected by military recruiters for being ‘indifferent horsemen’19).

Our findings, that there is no significant difference in veteran lifespan, contrasts with research on WW1, where combat exposure appears to have resulted in reduced lifespan for surviving New Zealand veterans.35 This may be accounted for by the more extreme nature of the military experience in these two latter wars (eg, trench warfare in WW1 and the more important role of artillery bombardment in both subsequent wars) and the longer amounts of time spent at front-line conditions for many military personnel in these wars. In WW2 there was also a much higher proportion of veterans who had been prisoners of war, which has been associated with adverse health outcomes (see the introduction).

The finding of similar lifespans for South African War veterans when compared to the average New Zealand male population also contrasts with our findings for WW2 veterans, where a five-year gap was found.25 This could also reflect the more severe war experience of WW2 (as referred to above), but it might also have been that the role of ‘health selection’ was less important for the South African War (ie, less vigorous health screening at the recruitment offices). Indeed, various defects with the rigour of the selection process for New Zealand troops in this war have been described.36

An interesting finding from the lifespan analyses was the much higher subsequent participation by members of the Tenth Contingent in WW1, relative to earlier contingents. Possibly members of the Tenth Contingent were frustrated that, despite travelling to the war zone in 1902, they had not seen combat in the South African War. On the other hand, many of those who had participated (in Contingents One to Nine) may have decided that they had had enough of war and so had relatively lower rates of volunteering for WW1.

Strengths and limitations of this study

This study is the first such detailed analysis of the health of New Zealand military personnel involved in the South African War using modern epidemiological methods. It is also only the second such analysis at a country level, after UK research.1,34 The study also benefited from the availability of online military files, online genealogical databases and the capacity to search online most of the New Zealand newspapers of the period in Papers Past (although this is not a completely comprehensive database).

Nevertheless, this study still has various limitations with the major ones being as follows:

  • For the mortality work, we did not include deaths of New Zealanders participating in foreign militaries (since no list was available and creating such a list would require extremely extensive archival work). Our searches of Papers Past for additional war-attributable deaths would also probably have missed some individuals who died in the post-war period (eg, especially those dying outside of New Zealand and those who died after 1904).
  • For the morbidity work, we only used a random sample of 100 personnel and the military files only focused on conditions causing hospitalisation and not less severe illnesses and injuries. Further research could use a larger sample and study any diaries of the troops.
  • The lifespan analyses were also constrained by the modestly sized random samples (as this was an unfunded study). Future research could attempt to follow-up all the participating personnel—and make more detailed comparisons with WW1.

To what extent were these war-attributable health burdens preventable?

Having considered the morbidity and mortality burdens for military personnel in this war, it is worthwhile to reflect on the extent to which these may have been preventable. Although the New Zealand Government could have chosen not to participate in this war, this counterfactual seems very unlikely, given the country’s strong links to the UK19 and the participation of similar English-speaking countries (eg, Australia and Canada). However, the Government could have decided to send fewer troops, which would have reduced the health burden; the Government did send disproportionately more than Australia and Canada (around 1.8 and 5.7 times more per capita respectively, based on our estimates from published participation data37). There was some opposition to the war in New Zealand,28,38,39 but this does not appear to have prevented further New Zealand contingents leaving for the war during 1902.

More specifically, there were various problems that could all have been better addressed with knowledge of the day and that may have reduced the health burden among participating troops:

  • The inadequate understanding of the military situation by the military leaders on the imperial side. That is, the guerrilla tactics used by the Boers, along with their use of trenches and recent developments with weapons (eg, long-range rapid-firing rifles with smokeless ammunition) that decisively shifted the balance towards favouring defence over offence.12 This meant that imperial forces suffered high casualties when engaging with the Boer forces.12
  • The lack of adequate training has also been noted: “New Zealand units, therefore, embarked on operations after receiving what can only be described as a most inadequate preparation for service in the front line of a major war.”36 Better training may have resulted in fewer combat injuries and accidents from falling off horses (especially among those volunteers who were not already skilled with horse riding).
  • Inadequate military equipment included the outdated single shot rifles issued at the beginning of the war to New Zealand troops.36 This was in contrast to the state-of-the-art weapons used by the Boers,19 though rifles with magazines were supplied at a later stage to the New Zealanders.36 There was also the problem of the relatively small horses for the size of the troops.40 These New Zealand men were described as “fine, tall broad-shouldered men, half as big again as the average Tommy were sent out. Fine to look at, but Oh, the poor horses!”40 The New Zealand horses were also given no time to acclimatise to the new country and were over-worked.19 This situation meant that the horses were less effective in both combat (eg, range and speed of movement) and non-combat situations (eg, transporting supplies and the wounded).
  • The inadequate supplies of clothing and provision of shelter for winter camping were problems: “New Zealand soldiers often endured severe daytime heat, then at night slept in the open with only an overcoat to protect them from the freezing cold.”41 Their clothing “quickly became ragged and was not replaced, which led men of the 6th Contingent to strike.”42
  • The inadequate supplies of food (and the minimal variety of food) and lack of water (for drinking and washing) were problematic.41 “The troopers’ equipment was poor, and on trek they had inadequate food – hard dry biscuits, bully beef (canned meat), sugar and tea. They tried to supplement this with much foraging… They were not issued with soap and their clothing quickly became infected by lice.”42 All these deficits probably contributed to increased risk of diseases.
  • The inadequate medical support for the imperial troops in South Africa was a well described problem.12 This issue was also combined with inadequate attention being paid to how injured troops were to be evacuated after combat (eg, shortages of ambulance wagons12). It has been noted for the New Zealand troops that “when they were wounded on the trek far from hospitals, sepsis (infection) often developed.”42 There were shortages of such basics as water in hospitals.19 Inadequate medical care for New Zealand troops was reported on by a journalist,28 and medical care on troop ships was also a source of complaints, though this problem was dismissed by authorities in an inquiry.43
  • The crowding of New Zealand troop ships has also been described,19 and this was of concern to the New Zealand public after an onboard measles outbreak. Although authorities at the time largely dismissed such criticisms, an inquiry did identify poor ventilation on a troop ship as a problem.43 British troop ships were also described as overcrowded,12 and the subsequent disease outbreaks on New Zealand troop ships in WW1 also suggested persisting problems with crowding and inadequate ventilation.44

Some of these preventable aspects have also been identified as issues with New Zealand’s involvement in other wars. For WW1 these included the poor military planning that resulted in failed campaigns (eg, at Gallipoli and Passchendaele45), the initial lack of protective equipment such as helmets,31 inadequate healthcare services (especially the Gallipoli campaign46), the poor food at Gallipoli47 and outbreaks of diseases linked to crowding in various settings.45 For WW2 there were also apparent examples of defective strategic leadership as per the loss of Crete to German forces (albeit still controversial48).

Other preventable aspects of this South African War were the harm done to the civilian population by the burning and looting of Boer homesteads, the killing of their livestock and the setting up of concentration camps containing thousands of Boer women and children. Many of these people subsequently died of disease (see the introduction).12 New Zealand troops participated in the burning and looting activities,19,28 but unfortunately there has been no full accounting for these activities and why the New Zealand authorities did not intervene or protest to the UK Government. Other actions, such as the looting of Boer bibles by New Zealand troops, may also not have been fully resolved, even to this current day.49

Conclusions

This study found that the mortality was larger and the morbidity impacts of this war were much more substantive than revealed in the prior historical literature for New Zealand, particularly for non-injury illness. The relative importance of death from disease (at 59%) was also a notable feature of this war. But, in contrast to other wars, this study did not identify any lifespan differences between combat and non-combat personnel, or relative to the average New Zealand man at that time. As with other wars involving New Zealand, there is evidence that some of the health burden for participating military personnel could have been prevented with knowledge of the day and better planning to utilise this knowledge.

Appendix

Appendix Figure 1: A statue of a New Zealand soldier killed in action in the South African war (Govern-ment Gardens, Rotorua, New Zealand; photograph by the first author).

Appendix Table 1: Mortality in New Zealand military personnel associated with the South African War—additional details to Table 1.

Appendix Table 2: Changes to the mortality burden associated with the South African War for New Zealand military personnel (relative to the available list of deaths from the South African War available at the start of this study in the AJHR dataset13).

Summary

Abstract

AIM: We aimed to update and provide more complete epidemiological information on the health impacts of the South African War on New Zealand military personnel. METHODS: Mortality datasets were identified and analysed. Systematic searches were conducted to identify additional war-attributable deaths in the post-war period. To estimate the morbidity burden, we analysed a random sample of archival military files of 100 military personnel. Lifespan analyses of veterans included those by level of combat exposure (eg, a non-combat sample came from a troopship that arrived at the time the war ended). RESULTS: We identified 10 additional war-attributable deaths (and removed three non-attributable deaths) to give a new New Zealand total of 239 war-attributable deaths. Given the average age of death of 26 years, this equates to the loss of 10,300 years of life. Most deaths (59%) were from disease rather than directly from the conflict (30%). Over a third (39%; 95%CI: 30%–49%) of personnel were estimated to have had some form of reported illness (26%) or injury (14%). The lifespan analysis of veterans suggested no substantive differences by exposure to combat (68.5 [combat] vs 69.1 years [non-combat]) and similarly when compared to a matched New Zealand male population. CONCLUSIONS:  The mortality burden was larger and the morbidity impacts on the New Zealand military personnel in this war were much more substantive than revealed in the prior historical literature. There is a need to more fully describe historical conflicts so that their adverse health impacts are properly understood.

Aim

Method

Results

Conclusion

Author Information

Nick Wilson: Department of Public Health, University of Otago, Wellington, New Zealand. Christine Clement: Te Puke, Bay of Plenty, New Zealand. George Thomson: Department of Public Health, University of Otago, Wellington, New Zealand. Glyn Harper: Professor of War Studies, Massey University, Palmerston North, New Zealand.

Acknowledgements

Correspondence

Prof Nick Wilson, Department of Public Health, University of Otago, Wellington, New Zealand

Correspondence Email

nick.wilson@otago.ac.nz

Competing Interests

Nil.

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28. Robson N. Counting the Cost: The Impact of the South African War 1899-1902 on New Zealand Society. [MA Thesis]. Massey University, 2012. https://mro.massey.ac.nz/bitstream/handle/10179/4418/02_whole.pdf?sequence=3&isAllowed=y

29. Auckland Star. The Veterans' Home. Auckland Star Vol XXXIV, Issue 295, 11 December 1903. https://paperspast.natlib.govt.nz/newspapers/AS19031211.2.26.

30. Harper G, Clement C, Johns R. For King and Other Countries. Auckland: Massey University Press, 2019.

31. Wilson N, Summers JA, Baker MG, Thomson G, Harper G. Fatal injury epidemiology among the New Zealand military forces in the First World War. N Z Med J 2013;126:13-25.

32. Summers JA, Shanks GD, Baker MG, Wilson N. Severe impact of the 1918-19 pandemic influenza in a national military force. N Z Med J 2013;126(1378):36-47.

33. Australian War Memorial. Australia and the Boer War, 1899–1902. https://www.awm.gov.au/articles/atwar/boer.

34. Jones E, Vermaas RH, Beech C, Palmer I, Hyams K, Wessely S. Mortality and postcombat disorders: U.K. veterans of the Boer War and World War I. Mil Med 2003;168:414-8.

35. Wilson N, Clement C, Summers JA, Bannister J, Harper G. Mortality of first world war military personnel: comparison of two military cohorts. BMJ 2014;349:g7168.

36. Crawford J. “The Best Mounted Troops in South Africa?” (Chapter 6). In: Crawford J, McGibbon I (Eds). One Flag One Queen One Tongue: New Zealand, The British Empire and the South African War. Auckland: Auckland University Press, 2003.

37. Pakenham T. “The Contribution of the Colonial Forces” (Chapter 5). In: Crawford J, McGibbon I (Eds). One Flag One Queen One Tongue: New Zealand, The British Empire and the South African War. Auckland: Auckland University Press, 2003.

38. McKinnon M. “Opposition to the War in New Zealand” (Chapter 3). In: Crawford J, McGibbon I (Eds). One Flag One Queen One Tongue: New Zealand, The British Empire and the South African War. Auckland: Auckland University Press, 2003.

39. Hutching M. “New Zealand Women’s Opposition to the South African War” (Chapter 4). In: Crawford J, McGibbon I (Eds). One Flag One Queen One Tongue: New Zealand, The British Empire and the South African War. Auckland: Auckland University Press, 2003.

40. Crawford J. “The Impact of the War on the New Zealand Military and Society” (Chapter 13). In: Crawford J, McGibbon I (Eds). One Flag One Queen One Tongue: New Zealand, The British Empire and the South African War. Auckland: Auckland University Press, 2003.

41. Ministry for Culture and Heritage. 'South African 'Boer' War: Conditions in South Africa', URL: https://nzhistory.govt.nz/war/south-african-boer-war/conditions-south-africa, (Ministry for Culture and Heritage), updated 7-Mar-2018.

42. Phillips J. 'South African War - The troopers in South Africa', Te Ara - the Encyclopedia of New Zealand, http://www.TeAra.govt.nz/en/south-african-war/page-3 (accessed 3 January 2020).

43. New Zealand Times. The Transport Commission. New Zealand Times Vol LXXII, Issue 4767, 24 September 1902. https://paperspast.natlib.govt.nz/newspapers/NZTIM19020924.2.5.

44. Summers JA, Wilson N, Baker MG, Shanks GD. Mortality risk factors for pandemic influenza on New Zealand troop ship, 1918. Emerg Infect Dis 2010;16:1931-7.

45. Wilson N, Harper G. New Zealand's peak year for wartime mortality burden: the important role of the Battles of Messines and Third Ypres (Passchendaele) in 1917. N Z Med J 2017;130:58-62.

46. Rogers A. With Them Through Hell: New Zealand Medical Services in the First World War. Auckland: Massey University Press, 2018.

47. Wilson N, Nghiem N, Summers J, Carter M-A, Harper G. A nutritional analysis of New Zealand military food rations at Gallipoli in 1915: Likely contribution to scurvy and other nutrient deficiency disorders. N Z Med J 2013;126(1373):1-18.

48. Ministry for Culture and Heritage. 'The Battle for Crete: The controversies', URL: https://nzhistory.govt.nz/war/the-battle-for-crete/the-controversies, (Ministry for Culture and Heritage), updated 20-Dec-2012.

49. Robson B. 'What a trophy for one Christian to loot from another!' The Dominion Post 2019;(14 November). https://i.stuff.co.nz/national/117018477/what-a-trophy-for-one-christian-to-loot-from-another.

50. Ministry for Culture and Heritage. 'NZ units in South Africa 1899-1902: The contingents', URL: https://nzhistory.govt.nz/war/nz-units-south-africa/the-contingents, (Ministry for Culture and Heritage), updated 17-May-2016.

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It is important to research the adverse health impacts of war, given ongoing conflicts around the world that harm both civilians and military personnel. Analysis of past wars may also better inform society of the long-term health outcomes of veterans. It has been suggested that there may be different post-combat syndromes with different wars,1 and some aspects of war may be particularly relevant (eg, there is fairly clear evidence for long-term harm to health from being a prisoner of war in the Second World War [WW2]).2–4 Other studies also provide evidence of long-term harm to health among war veterans.5–9 Nevertheless, an increase in all-cause mortality in war veterans has not always been identified,4 and raised mortality rates sometimes only appear later in life.10 Returning veterans may also experience adverse health impacts from unemployment in the immediate post-war period—a likely issue for some after the First World War (WW1). But, on the other hand, it is plausible that some war veterans may experience net benefits from their military experience via training funded by the military and on-the-job skills development, both of which may lead to improved subsequent careers (and associated higher incomes). Studying all these issues is complicated by the ‘healthy soldier effect’, which is a selection effect analogous to the ‘healthy worker effect’.11 A further selection effect is the ‘healthy warrior effect’, whereby healthier personnel within the military are the ones involved in combat (relative to those away from the front lines).11

One war that has had relatively little study with modern epidemiological methods is the South African War, also known as the Second Boer War. This war was fought between 11 October 1899 and 31 May 1902. The forces of the British Empire (which included New Zealand) fought against two Boer states: the South African Republic (Republic of Transvaal) and the Orange Free State. The war resulted in over 100,000 casualties among the imperial forces and cost the British taxpayer over £200 million at the time.12 There were over 7,000 deaths among the Boer combatants and between 18,000 and 28,000 Boers (men, women and children) died in concentration camps.12 The death toll for Africans (at least those participating on the Boer side) was estimated at probably over 12,000.12

For New Zealand military personnel, the official death toll in the Parliamentary record of the South African War was 232 deaths.13 But, given limited follow-up of personnel in the post-war period, we suspected that this mortality burden could be an underestimate. Similarly, given that the historical record has largely focused on the 166 wounded personnel14 (ie, 2.7% of participating personnel, when using the denominator of n=6,080 participants15), we also suspected that the morbidity burden of the war may have been underestimated.

The significance of the South African War for New Zealand is that it was the first overseas war in which this country participated. It also symbolised the nation’s extremely strong relationship to Britain and the British Empire at the time, as per the title of a book on New Zealand and this war: One Flag, One Queen, One Tongue.16 The war also established the trend for future deployments of New Zealand military personnel in conflicts of the twentieth century. That pattern was to send an expeditionary force to operate alongside allies and fight as a junior partner in a coalition. The South African War has also been identified as contributing significantly to cementing New Zealand's national identity.17 Finally, the war also triggered a major societal response in terms of memorialisation, with far more memorials per 1,000 deaths than for other mass-death events in New Zealand’s history (ie, seven times the level for both WW1 and WW2 combined, nine times the level for the New Zealand Wars and 266 times the level of the 1918 influenza pandemic18).

Given this background, we aimed to provide updated and more complete epidemiological information on the health impacts of the South African War on New Zealand military personnel.

Methods

Mortality analyses

We used a dataset on all the war-attributable deaths among New Zealand personnel involved in the South African War (10 contingents). This dataset was built from a list in the Parliamentary record,13 modified slightly by comparisons with a list published in a book from 199919 and information from the Cenotaph website database20 and the New Zealand War Graves Project database21 (see Appendix Table 1). Also, to better identify at least some missed deaths, we searched the ‘Newspapers’ section of the Papers Past database.22 The search period was from the end of the war (31 May 1902) to 31 December 1904. The search term was: “trooper” AND “death” AND “South Africa” AND (“wounds” OR “fever” OR “consumption” OR “measles” OR “invalid”) (n=228 items). More specific searches of individual names were used to follow-up deaths that were potentially attributable to war, where this was suspected. In select cases where the cause of death was not clear, we purchased death certificates.23

Definitions of war-attributable deaths

To define a war-attributable death in this study, we required that the following criteria were all met:

  • The person dying had to have been in the New Zealand military at the time of attestation (ie, we excluded New Zealanders who only participated in other militaries during this war, such as the Australian or UK militaries).
  • The death occurred during military service (including in military training camps) or in the post-war period up to 31 December 1904. For deaths in this post-war period, we made an assessment based on the balance of probabilities and informed by the available information (and sometimes the death certificates) concerning the war being the likely main contributor to the death or not. That is, if the cause of death predominantly related to war wounds or diseases that began while in military service (eg, tuberculosis and enteric fever), it was considered to be a war-attributable death.

Random selection of military personnel potentially exposed to combat (for lifespan analyses)

We randomly selected 253 names from the whole list of 6,339 New Zealand military personnel who were listed on the Cenotaph website database as having served in this war.20 Once their specific contingents were identified (by examining data in the Cenotaph database and personal military files), we removed those who participated in the last contingent (Tenth Contingent) whose troop ship arrived in South Africa just days before the war ended and who were not involved in military action.

Random selection of non-combat military personnel

We randomly selected names of those who were in the Tenth Contingent (n=1,022). We then removed from that group those who had also previously participated in Contingents One to Nine. For both this and the ‘combat exposed’ group above, we also removed duplicates, female participants and those who had participated in non-New Zealand military forces (eg, the UK military). Due to a large number of exclusions (particularly due to participation in other contingents being revealed), we conducted a second batch of random sampling to boost numbers for the analysis, which left a total of 333 selected names.

Lifespan data

We collected data on birth dates from the online military files.24 Date of death was also sometimes in these files, but otherwise we used a range of genealogical sources. These include the Births, Deaths and Marriages database, which contains records of all New Zealand-based deaths in this cohort23 (albeit for those records where there was an exact match between the name, and age and year of death/date of birth, with the data from the military file). In some cases, only the birth year could be identified, in which case we used the mid-year point of that year (eg, 1 July 1880) in the analyses.

In the lifespan analyses, we excluded those who died during the war and those who died in the period from the end of the war (31 May 1902) to 31 December 1904 (if there was any indication of their death being war-related). The latter was on the assumption that such deaths may have been from wounds or diseases related to their war experience. Further analyses took account of the participation and death in WW1.

To compare lifespans with the overall lifespan for New Zealand men, we took the approach of a WW2 study25 and created a synthetic cohort matched to each real veteran in the random samples. That is, in the synthetic cohort we matched each real veteran with a life expectancy value based on that of the average New Zealand man who was born in the same year. Furthermore, this was for life expectancy at the age that these veterans were in 1903 (ie, the year after the one when the war ended). These values have all been estimated for five-year intervals by a large Stats NZ study,26 and we interpolated the values for birth years in between the five-year values provided by Stats NZ. Such a comparison is not unreasonable, in that there is evidence from an analysis of the occupations of the soldiers relative to men aged 25–45 years (as per 1901 Census data) that “although the total force was small, it was a remarkably representative sample, socially and geographically, of the male population.”15

Morbidity data

To assess levels of morbidity, we took a random sample of 100 names from all the 6,339 New Zealand military personnel who were listed as serving in this war (as detailed above). All the medical information in their online military files24 was then examined.

Results

Mortality

Our analysis identified ten additional cases that were probably war-attributable deaths and three that were unlikely to be war-attributable, resulting in a new total estimate of 239 deaths from this war (Table 1). This gave an overall 3.9% risk of death for the total participants (Appendix Table 1). The major cause of death was disease (59%), followed by direct conflict-related causes (30%) (ie, being killed in action or dying from wounds). A statue of one of those killed in action is shown in Appendix Figure 1. ‘Accidental’ deaths were relatively high (11%) and these were caused by a single train crash (15 deaths) and horse-related injuries. The pattern of deaths over time was one of fairly consistent monthly dominance of disease deaths over war-attributable injury deaths (Figure 1).

The major disease groupings were enteric diseases (with dysentery and typhoid) at 36% of all deaths, followed by respiratory disease (10%) and then measles (5%). Disease deaths were more than twice as likely during winter months compared to all the other seasons (risk ratio of 2.08; 95% confidence interval [CI]: 1.65 to 2.63; Appendix Table 1).

The worst year of the war in absolute terms was 1902 (Appendix Table 1; Appendix Figure 1). It had the worst month for war-attributable injury deaths (the military action at Langverwacht Hill), the worst month for disease deaths (a measles outbreak) and the worst month for accidental deaths (the railway crash referred to above).

The risk of death was highest for the first three contingents, peaking at 10.3% for the Third Contingent (Appendix Table 1). It was lowest in the last two contingents— though deaths from disease continued to impact on these groups after the end of the war. Nevertheless, when just considering conflict-attributable injury deaths (killed in action and death from wounds), the Seventh Contingent stood out with a 5.4% risk of death. The Seventh Contingent sustained 50% of all such deaths, due to the action at Langverwacht Hill.

The average age of death at 25.5 years (Table 1) can be compared to the lifespan of the veterans of 68.6 years (for Contingents One to Nine, exposed to combat, Table 3). This suggests that these soldiers lost around 43 years of life of average. For the 239 deaths, this sums to around 10,300 years of lost life.

Table 1: Mortality in New Zealand military personnel associated with the South African War (see Appendix Table 1 for additional details).

Figure 1: Deaths of New Zealand military personnel attributed to the South African War by month of death (from January 1900 to December 1902 [ie, not showing 1 death in 1899 and 10 deaths in 1903/04]).*

* The worst month for mortality (February 1902) reflected military action with 68% (25/37) of the deaths being KIA/DOW (particularly military action at Langverwacht Hill). The second highest peak in August 1902 reflected a measles outbreak. The third, in April 1902, represented a railway crash.

Morbidity impact

Based on the random sample of military files, an estimated 39% of personnel suffered some form of reported injury or illness (95%CI: 30%–49%; Table 2). The commonest grouping was infectious diseases (26% of all personnel), and this included enteric disease, malaria and measles. The next most common grouping was injury (14%). Horse-related injuries were more common than direct war-attributable injuries in this sample.

Table 2: Mortality and morbidity impacts of the South African War based on a random sample of participating New Zealand military personnel.

* Out of the random sample of 100 military personnel there were two duplicates and one missing military file, hence variation in the denominator (ie, it was n=97 if not stated or n=98 as indicated otherwise). The sample includes personnel from all contingents, including those that departed in April 1902 just before the war ended. It included all illnesses documented in the military files, including those after the war until the military file was effectively closed.

Lifespan of veterans

Many exclusions from the initial samples were required, particularly because around half (50.2%) of the members of the Tenth Contingent had already been in at least one earlier contingent (Table 3). There were differences between the combat and not-combat groups in the post-war period (mean lifespans of 68.6 years and 65.5 years respectively; Table 3), but the higher participation by the Tenth Contingent in WW1 contributed to this. When this was accounted for in the analysis, these differences narrowed, with this difference not being statistically significant (mean lifespans of 68.5 [combat] and 69.1 years [non-combat]; Table 3).

When compared to the lifespan of the matched synthetic cohort (using life expectancies for all New Zealand men at their respective ages in 1903), this military population had very similar lifespans (67.3 years in the military and 67.8 years in the matched cohort; Table 4).

Table 3: Description and lifespan results of the two cohorts of military personnel used for the lifespan comparison of veterans (exposed to combat vs non-exposed).

* Statistically significant difference in participation in multiple wars (p=0.0012, ANOVA). NS=not statistically significant when comparing the two groups.

Table 4: Mean lifespans for studied populations of military personnel compared to a matched synthetic cohort derived from Stats NZ life expectancy estimates for men by birth year and for their age in 1903.

Discussion

Mortality impact

This study identified an additional seven war-attributable deaths (net number), largely from the delayed impact of diseases experienced while in the military. It was also able to estimate the potentially lost years of life in those dying (ie, 10,300 life years lost). While the New Zealand authorities of the day did produce a final list of the dead (with deaths up to July 1903),13 this should ideally have been updated five or even ten years after the end of the war to account for ongoing deaths. For example, some delayed deaths could have arisen from subsequent operations on war wounds (with operations being more hazardous in this pre-antibiotic era) or from suicide, since post-traumatic stress disorder can be long lasting. Furthermore, an additional aspect to the impact of this war on New Zealand society are the deaths among New Zealanders who joined overseas militaries. This ideally could be estimated in future work—but it may give a total of closer to 300 deaths as per an estimate reported soon after the war.29 Other work shows that for WW1 there were 1,400 extra such deaths of New Zealanders with other military forces (ie, around 7% of the new total for WW130). However, that work required extensive genealogical skills and resources.  

In terms of the major cause of death being from disease (at 59%), this war represents the last time that disease was the dominant cause for wars that New Zealand has been involved in. That is, in WW1, this ‘disease’ cause was down to 7.8%,31 despite the contribution of an influenza pandemic.32 For Australia in the South African War, the proportion of deaths from disease was 47% (286/606).33 For the British forces it was 63% (13,139/20,72119). The statistically higher burden of disease deaths in winter months may reflect the role of infectious diseases associated with close contact (eg, from more time spent inside buildings or in tents) or possibly the immune suppression associated with cold exposure.

Morbidity impact

Morbidity impacts were commonly reported in the random sample of military files, with over a third of personnel experiencing illness or injury (39%). This contrasts to the impression from official statistics, which only focus on the 2.7% prevalence of participating personnel being ‘wounded’ (see the introduction). Recorded illness (26%) was almost twice as common as injury (14%). Even if only focusing on injury, our new estimate of 14% is over five times that from the official records (2.7%).

Furthermore, the military files will have tended to reflect the more severe conditions, and so the true prevalence of morbidity would probably be even higher than our new estimate (eg, if considering lice infestation, non-hospitalised thermal injuries [heat stroke and from severe cold at night], dental injuries from the hard biscuits, non-hospitalised injuries from riding horses and so on). Furthermore, the morbidity would have been ongoing in some cases. One researcher reported cases of veterans experiencing what appear to be post-combat psychological problems and further surgical operations (eg, an operation occurring in 1907).28

Lifespan of veterans

Our analysis suggested no major lifespan differences between veterans who were exposed to combat and veterans who weren’t exposed to combat. International work on this topic used different methods but also identified no increase in mortality of Boer War veterans with post-combat disorders relative to controls with gunshot wounds.34 Nevertheless, this finding in our analysis may partly reflect the modest sample size, which was diluted because of the much higher than anticipated number of exclusions owing to men joining multiple contingents). There might also have been self-selection effects between the two groups and also variation in the rigour of the selection process in the military over time (eg, initially men were sometimes rejected by military recruiters for being ‘indifferent horsemen’19).

Our findings, that there is no significant difference in veteran lifespan, contrasts with research on WW1, where combat exposure appears to have resulted in reduced lifespan for surviving New Zealand veterans.35 This may be accounted for by the more extreme nature of the military experience in these two latter wars (eg, trench warfare in WW1 and the more important role of artillery bombardment in both subsequent wars) and the longer amounts of time spent at front-line conditions for many military personnel in these wars. In WW2 there was also a much higher proportion of veterans who had been prisoners of war, which has been associated with adverse health outcomes (see the introduction).

The finding of similar lifespans for South African War veterans when compared to the average New Zealand male population also contrasts with our findings for WW2 veterans, where a five-year gap was found.25 This could also reflect the more severe war experience of WW2 (as referred to above), but it might also have been that the role of ‘health selection’ was less important for the South African War (ie, less vigorous health screening at the recruitment offices). Indeed, various defects with the rigour of the selection process for New Zealand troops in this war have been described.36

An interesting finding from the lifespan analyses was the much higher subsequent participation by members of the Tenth Contingent in WW1, relative to earlier contingents. Possibly members of the Tenth Contingent were frustrated that, despite travelling to the war zone in 1902, they had not seen combat in the South African War. On the other hand, many of those who had participated (in Contingents One to Nine) may have decided that they had had enough of war and so had relatively lower rates of volunteering for WW1.

Strengths and limitations of this study

This study is the first such detailed analysis of the health of New Zealand military personnel involved in the South African War using modern epidemiological methods. It is also only the second such analysis at a country level, after UK research.1,34 The study also benefited from the availability of online military files, online genealogical databases and the capacity to search online most of the New Zealand newspapers of the period in Papers Past (although this is not a completely comprehensive database).

Nevertheless, this study still has various limitations with the major ones being as follows:

  • For the mortality work, we did not include deaths of New Zealanders participating in foreign militaries (since no list was available and creating such a list would require extremely extensive archival work). Our searches of Papers Past for additional war-attributable deaths would also probably have missed some individuals who died in the post-war period (eg, especially those dying outside of New Zealand and those who died after 1904).
  • For the morbidity work, we only used a random sample of 100 personnel and the military files only focused on conditions causing hospitalisation and not less severe illnesses and injuries. Further research could use a larger sample and study any diaries of the troops.
  • The lifespan analyses were also constrained by the modestly sized random samples (as this was an unfunded study). Future research could attempt to follow-up all the participating personnel—and make more detailed comparisons with WW1.

To what extent were these war-attributable health burdens preventable?

Having considered the morbidity and mortality burdens for military personnel in this war, it is worthwhile to reflect on the extent to which these may have been preventable. Although the New Zealand Government could have chosen not to participate in this war, this counterfactual seems very unlikely, given the country’s strong links to the UK19 and the participation of similar English-speaking countries (eg, Australia and Canada). However, the Government could have decided to send fewer troops, which would have reduced the health burden; the Government did send disproportionately more than Australia and Canada (around 1.8 and 5.7 times more per capita respectively, based on our estimates from published participation data37). There was some opposition to the war in New Zealand,28,38,39 but this does not appear to have prevented further New Zealand contingents leaving for the war during 1902.

More specifically, there were various problems that could all have been better addressed with knowledge of the day and that may have reduced the health burden among participating troops:

  • The inadequate understanding of the military situation by the military leaders on the imperial side. That is, the guerrilla tactics used by the Boers, along with their use of trenches and recent developments with weapons (eg, long-range rapid-firing rifles with smokeless ammunition) that decisively shifted the balance towards favouring defence over offence.12 This meant that imperial forces suffered high casualties when engaging with the Boer forces.12
  • The lack of adequate training has also been noted: “New Zealand units, therefore, embarked on operations after receiving what can only be described as a most inadequate preparation for service in the front line of a major war.”36 Better training may have resulted in fewer combat injuries and accidents from falling off horses (especially among those volunteers who were not already skilled with horse riding).
  • Inadequate military equipment included the outdated single shot rifles issued at the beginning of the war to New Zealand troops.36 This was in contrast to the state-of-the-art weapons used by the Boers,19 though rifles with magazines were supplied at a later stage to the New Zealanders.36 There was also the problem of the relatively small horses for the size of the troops.40 These New Zealand men were described as “fine, tall broad-shouldered men, half as big again as the average Tommy were sent out. Fine to look at, but Oh, the poor horses!”40 The New Zealand horses were also given no time to acclimatise to the new country and were over-worked.19 This situation meant that the horses were less effective in both combat (eg, range and speed of movement) and non-combat situations (eg, transporting supplies and the wounded).
  • The inadequate supplies of clothing and provision of shelter for winter camping were problems: “New Zealand soldiers often endured severe daytime heat, then at night slept in the open with only an overcoat to protect them from the freezing cold.”41 Their clothing “quickly became ragged and was not replaced, which led men of the 6th Contingent to strike.”42
  • The inadequate supplies of food (and the minimal variety of food) and lack of water (for drinking and washing) were problematic.41 “The troopers’ equipment was poor, and on trek they had inadequate food – hard dry biscuits, bully beef (canned meat), sugar and tea. They tried to supplement this with much foraging… They were not issued with soap and their clothing quickly became infected by lice.”42 All these deficits probably contributed to increased risk of diseases.
  • The inadequate medical support for the imperial troops in South Africa was a well described problem.12 This issue was also combined with inadequate attention being paid to how injured troops were to be evacuated after combat (eg, shortages of ambulance wagons12). It has been noted for the New Zealand troops that “when they were wounded on the trek far from hospitals, sepsis (infection) often developed.”42 There were shortages of such basics as water in hospitals.19 Inadequate medical care for New Zealand troops was reported on by a journalist,28 and medical care on troop ships was also a source of complaints, though this problem was dismissed by authorities in an inquiry.43
  • The crowding of New Zealand troop ships has also been described,19 and this was of concern to the New Zealand public after an onboard measles outbreak. Although authorities at the time largely dismissed such criticisms, an inquiry did identify poor ventilation on a troop ship as a problem.43 British troop ships were also described as overcrowded,12 and the subsequent disease outbreaks on New Zealand troop ships in WW1 also suggested persisting problems with crowding and inadequate ventilation.44

Some of these preventable aspects have also been identified as issues with New Zealand’s involvement in other wars. For WW1 these included the poor military planning that resulted in failed campaigns (eg, at Gallipoli and Passchendaele45), the initial lack of protective equipment such as helmets,31 inadequate healthcare services (especially the Gallipoli campaign46), the poor food at Gallipoli47 and outbreaks of diseases linked to crowding in various settings.45 For WW2 there were also apparent examples of defective strategic leadership as per the loss of Crete to German forces (albeit still controversial48).

Other preventable aspects of this South African War were the harm done to the civilian population by the burning and looting of Boer homesteads, the killing of their livestock and the setting up of concentration camps containing thousands of Boer women and children. Many of these people subsequently died of disease (see the introduction).12 New Zealand troops participated in the burning and looting activities,19,28 but unfortunately there has been no full accounting for these activities and why the New Zealand authorities did not intervene or protest to the UK Government. Other actions, such as the looting of Boer bibles by New Zealand troops, may also not have been fully resolved, even to this current day.49

Conclusions

This study found that the mortality was larger and the morbidity impacts of this war were much more substantive than revealed in the prior historical literature for New Zealand, particularly for non-injury illness. The relative importance of death from disease (at 59%) was also a notable feature of this war. But, in contrast to other wars, this study did not identify any lifespan differences between combat and non-combat personnel, or relative to the average New Zealand man at that time. As with other wars involving New Zealand, there is evidence that some of the health burden for participating military personnel could have been prevented with knowledge of the day and better planning to utilise this knowledge.

Appendix

Appendix Figure 1: A statue of a New Zealand soldier killed in action in the South African war (Govern-ment Gardens, Rotorua, New Zealand; photograph by the first author).

Appendix Table 1: Mortality in New Zealand military personnel associated with the South African War—additional details to Table 1.

Appendix Table 2: Changes to the mortality burden associated with the South African War for New Zealand military personnel (relative to the available list of deaths from the South African War available at the start of this study in the AJHR dataset13).

Summary

Abstract

AIM: We aimed to update and provide more complete epidemiological information on the health impacts of the South African War on New Zealand military personnel. METHODS: Mortality datasets were identified and analysed. Systematic searches were conducted to identify additional war-attributable deaths in the post-war period. To estimate the morbidity burden, we analysed a random sample of archival military files of 100 military personnel. Lifespan analyses of veterans included those by level of combat exposure (eg, a non-combat sample came from a troopship that arrived at the time the war ended). RESULTS: We identified 10 additional war-attributable deaths (and removed three non-attributable deaths) to give a new New Zealand total of 239 war-attributable deaths. Given the average age of death of 26 years, this equates to the loss of 10,300 years of life. Most deaths (59%) were from disease rather than directly from the conflict (30%). Over a third (39%; 95%CI: 30%–49%) of personnel were estimated to have had some form of reported illness (26%) or injury (14%). The lifespan analysis of veterans suggested no substantive differences by exposure to combat (68.5 [combat] vs 69.1 years [non-combat]) and similarly when compared to a matched New Zealand male population. CONCLUSIONS:  The mortality burden was larger and the morbidity impacts on the New Zealand military personnel in this war were much more substantive than revealed in the prior historical literature. There is a need to more fully describe historical conflicts so that their adverse health impacts are properly understood.

Aim

Method

Results

Conclusion

Author Information

Nick Wilson: Department of Public Health, University of Otago, Wellington, New Zealand. Christine Clement: Te Puke, Bay of Plenty, New Zealand. George Thomson: Department of Public Health, University of Otago, Wellington, New Zealand. Glyn Harper: Professor of War Studies, Massey University, Palmerston North, New Zealand.

Acknowledgements

Correspondence

Prof Nick Wilson, Department of Public Health, University of Otago, Wellington, New Zealand

Correspondence Email

nick.wilson@otago.ac.nz

Competing Interests

Nil.

1. Jones E, Hodgins-Vermaas R, McCartney H, Everitt B, Beech C, Poynter D, Palmer I, Hyams K, Wessely S. Post-combat syndromes from the Boer war to the Gulf war: a cluster analysis of their nature and attribution. BMJ 2002;324:321-4.

2. Page WF, Brass LM. Long-term heart disease and stroke mortality among former American prisoners of war of World War II and the Korean Conflict: results of a 50-year follow-up. Mil Med 2001;166:803-8.

3. Page WF, Miller RN. Cirrhosis mortality among former American prisoners of war of World War II and the Korean conflict: results of a 50-year follow-up. Mil Med 2000;165:781-5.

4. Guest CS, Venn AJ. Mortality of former prisoners of war and other Australian veterans. Med J Aust 1992;157:132-5.

5. Elder GH, Clipp EC, Brown JS, Martin LR, Friedman HW. The Life-Long Mortality Risks Of World War II Experiences. Res Aging 2009;31:391-412.

6. Bramsen I, Deeg DJ, van der Ploeg E, Fransman S. Wartime stressors and mental health symptoms as predictors of late-life mortality in World War II survivors. J Affect Dis 2007;103:121-9.

7. Venn AJ, Guest CS. Chronic morbidity of former prisoners of war and other Australian veterans. Med J Aust 1991;155:705-7, 10-2.

8. Keehn RJ. Follow-up studies of World War II and Korean conflict prisoners. III. Mortality to January 1, 1976. Am J Epidemiol 1980;111:194-211.

9. Robson D, Welch E, Beeching NJ, Gill GV. Consequences of captivity: health effects of far East imprisonment in World War II. QJM 2009;102:87-96.

10. Wilmoth JM, London AS, Parker WM. Military service and men's health trajectories in later life. J Gerontoly 2010;65:744-55.

11. McLaughlin R, Nielsen L, Waller M. An evaluation of the effect of military service on mortality: quantifying the healthy soldier effect. Ann Epidemiol 2008;18:928-36.

12. Pakenham T. The Boer War. London: Abacus, 1992.

13. New Zealand Parliament. South African Contingents: (deaths of members of) in South Africa and since leaving South Africa, and particulars as to locality, etc., of graves. Appendix to the Journals of the House of Representatives (AJHR), 1903, H-6A pp.1-15. https://atojs.natlib.govt.nz/cgi-bin/atojs?a=d&cl=search&d=AJHR1903-I.2.3.2.7&srpos=1&e=-------10--1------01903+hZz-6a--.

14. Anonymous. 'Wars – Boer (South African) War, 1899–1902', from An Encyclopaedia of New Zealand, edited by A. H. McLintock, originally published in 1966. Te Ara - the Encyclopedia of New Zealand. http://www.TeAra.govt.nz/en/1966/wars-boer (accessed 12 Jan 2020).

15. McGeorge C. “The Social and Geographical Composition of the New Zealand Contingents” (Chapter 7). In: Crawford J, McGibbon I (Eds). One Flag One Queen One Tongue: New Zealand, The British Empire and the South African War. Auckland: Auckland University Press, 2003.

16. Crawford J, McGibbon I. (Eds). One Flag One Queen One Tongue: New Zealand, The British Empire and the South African War. Auckland: Auckland University Press, 2003.

17. Palenski R. The Making of New Zealanders. Auckland: Auckland University Press, 2012.

18. Wilson N, Ferguson C, Rice G, Baker MG, Schrader B, Clement C, Thomson G. Remembering the 1918 influenza pandemic: national survey of memorials and scope for enhancing educational value around pandemic preparedness. N Z Med J 2017;130:53-70.

19. Crawford J, Ellis E. To fight for the empire. Auckland: Reed, 1999.

20. Auckland War Memorial Museum. Cenotaph database. http://muse.aucklandmuseum.com/databases/Cenotaph/locations.aspx.

21. New Zealand War Graves Trust. New Zealand War Graves Project. https://www.nzwargraves.org.nz/.

22. National Library of New Zealand. Papers Past: Newspapers. https://paperspast.natlib.govt.nz/newspapers (accessed 30 September 2018).

23. Department of Internal Affairs. Births, Deaths & Marriages Online. https://www.bdmhistoricalrecords.dia.govt.nz/search/.

24. New Zealand Government. Archway. Archives New Zealand. www.archway.archives.govt.nz

25. Wilson N, Harper G. Lifespan of New Zealand Second World War veterans from one large cemetery: the case for a national-level study. N Z Med J 2019;132:96-98.

26. Statistics New Zealand. A History of Survival in New Zealand: Cohort Life Tables 1876–2004. Wellington: Statistics New Zealand, (with online tables at: http://www.stats.govt.nz/browse_for_stats/health/life_expectancy/cohort-life-tables.aspx), 2006.

27. Gould A. ‘Difference Race, Same Queen’ (Chapter 8). In: Crawford J, McGibbon I (Eds). One Flag One Queen One Tongue: New Zealand, The British Empire and the South African War. Auckland: Auckland University Press, 2003.

28. Robson N. Counting the Cost: The Impact of the South African War 1899-1902 on New Zealand Society. [MA Thesis]. Massey University, 2012. https://mro.massey.ac.nz/bitstream/handle/10179/4418/02_whole.pdf?sequence=3&isAllowed=y

29. Auckland Star. The Veterans' Home. Auckland Star Vol XXXIV, Issue 295, 11 December 1903. https://paperspast.natlib.govt.nz/newspapers/AS19031211.2.26.

30. Harper G, Clement C, Johns R. For King and Other Countries. Auckland: Massey University Press, 2019.

31. Wilson N, Summers JA, Baker MG, Thomson G, Harper G. Fatal injury epidemiology among the New Zealand military forces in the First World War. N Z Med J 2013;126:13-25.

32. Summers JA, Shanks GD, Baker MG, Wilson N. Severe impact of the 1918-19 pandemic influenza in a national military force. N Z Med J 2013;126(1378):36-47.

33. Australian War Memorial. Australia and the Boer War, 1899–1902. https://www.awm.gov.au/articles/atwar/boer.

34. Jones E, Vermaas RH, Beech C, Palmer I, Hyams K, Wessely S. Mortality and postcombat disorders: U.K. veterans of the Boer War and World War I. Mil Med 2003;168:414-8.

35. Wilson N, Clement C, Summers JA, Bannister J, Harper G. Mortality of first world war military personnel: comparison of two military cohorts. BMJ 2014;349:g7168.

36. Crawford J. “The Best Mounted Troops in South Africa?” (Chapter 6). In: Crawford J, McGibbon I (Eds). One Flag One Queen One Tongue: New Zealand, The British Empire and the South African War. Auckland: Auckland University Press, 2003.

37. Pakenham T. “The Contribution of the Colonial Forces” (Chapter 5). In: Crawford J, McGibbon I (Eds). One Flag One Queen One Tongue: New Zealand, The British Empire and the South African War. Auckland: Auckland University Press, 2003.

38. McKinnon M. “Opposition to the War in New Zealand” (Chapter 3). In: Crawford J, McGibbon I (Eds). One Flag One Queen One Tongue: New Zealand, The British Empire and the South African War. Auckland: Auckland University Press, 2003.

39. Hutching M. “New Zealand Women’s Opposition to the South African War” (Chapter 4). In: Crawford J, McGibbon I (Eds). One Flag One Queen One Tongue: New Zealand, The British Empire and the South African War. Auckland: Auckland University Press, 2003.

40. Crawford J. “The Impact of the War on the New Zealand Military and Society” (Chapter 13). In: Crawford J, McGibbon I (Eds). One Flag One Queen One Tongue: New Zealand, The British Empire and the South African War. Auckland: Auckland University Press, 2003.

41. Ministry for Culture and Heritage. 'South African 'Boer' War: Conditions in South Africa', URL: https://nzhistory.govt.nz/war/south-african-boer-war/conditions-south-africa, (Ministry for Culture and Heritage), updated 7-Mar-2018.

42. Phillips J. 'South African War - The troopers in South Africa', Te Ara - the Encyclopedia of New Zealand, http://www.TeAra.govt.nz/en/south-african-war/page-3 (accessed 3 January 2020).

43. New Zealand Times. The Transport Commission. New Zealand Times Vol LXXII, Issue 4767, 24 September 1902. https://paperspast.natlib.govt.nz/newspapers/NZTIM19020924.2.5.

44. Summers JA, Wilson N, Baker MG, Shanks GD. Mortality risk factors for pandemic influenza on New Zealand troop ship, 1918. Emerg Infect Dis 2010;16:1931-7.

45. Wilson N, Harper G. New Zealand's peak year for wartime mortality burden: the important role of the Battles of Messines and Third Ypres (Passchendaele) in 1917. N Z Med J 2017;130:58-62.

46. Rogers A. With Them Through Hell: New Zealand Medical Services in the First World War. Auckland: Massey University Press, 2018.

47. Wilson N, Nghiem N, Summers J, Carter M-A, Harper G. A nutritional analysis of New Zealand military food rations at Gallipoli in 1915: Likely contribution to scurvy and other nutrient deficiency disorders. N Z Med J 2013;126(1373):1-18.

48. Ministry for Culture and Heritage. 'The Battle for Crete: The controversies', URL: https://nzhistory.govt.nz/war/the-battle-for-crete/the-controversies, (Ministry for Culture and Heritage), updated 20-Dec-2012.

49. Robson B. 'What a trophy for one Christian to loot from another!' The Dominion Post 2019;(14 November). https://i.stuff.co.nz/national/117018477/what-a-trophy-for-one-christian-to-loot-from-another.

50. Ministry for Culture and Heritage. 'NZ units in South Africa 1899-1902: The contingents', URL: https://nzhistory.govt.nz/war/nz-units-south-africa/the-contingents, (Ministry for Culture and Heritage), updated 17-May-2016.

Contact diana@nzma.org.nz
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It is important to research the adverse health impacts of war, given ongoing conflicts around the world that harm both civilians and military personnel. Analysis of past wars may also better inform society of the long-term health outcomes of veterans. It has been suggested that there may be different post-combat syndromes with different wars,1 and some aspects of war may be particularly relevant (eg, there is fairly clear evidence for long-term harm to health from being a prisoner of war in the Second World War [WW2]).2–4 Other studies also provide evidence of long-term harm to health among war veterans.5–9 Nevertheless, an increase in all-cause mortality in war veterans has not always been identified,4 and raised mortality rates sometimes only appear later in life.10 Returning veterans may also experience adverse health impacts from unemployment in the immediate post-war period—a likely issue for some after the First World War (WW1). But, on the other hand, it is plausible that some war veterans may experience net benefits from their military experience via training funded by the military and on-the-job skills development, both of which may lead to improved subsequent careers (and associated higher incomes). Studying all these issues is complicated by the ‘healthy soldier effect’, which is a selection effect analogous to the ‘healthy worker effect’.11 A further selection effect is the ‘healthy warrior effect’, whereby healthier personnel within the military are the ones involved in combat (relative to those away from the front lines).11

One war that has had relatively little study with modern epidemiological methods is the South African War, also known as the Second Boer War. This war was fought between 11 October 1899 and 31 May 1902. The forces of the British Empire (which included New Zealand) fought against two Boer states: the South African Republic (Republic of Transvaal) and the Orange Free State. The war resulted in over 100,000 casualties among the imperial forces and cost the British taxpayer over £200 million at the time.12 There were over 7,000 deaths among the Boer combatants and between 18,000 and 28,000 Boers (men, women and children) died in concentration camps.12 The death toll for Africans (at least those participating on the Boer side) was estimated at probably over 12,000.12

For New Zealand military personnel, the official death toll in the Parliamentary record of the South African War was 232 deaths.13 But, given limited follow-up of personnel in the post-war period, we suspected that this mortality burden could be an underestimate. Similarly, given that the historical record has largely focused on the 166 wounded personnel14 (ie, 2.7% of participating personnel, when using the denominator of n=6,080 participants15), we also suspected that the morbidity burden of the war may have been underestimated.

The significance of the South African War for New Zealand is that it was the first overseas war in which this country participated. It also symbolised the nation’s extremely strong relationship to Britain and the British Empire at the time, as per the title of a book on New Zealand and this war: One Flag, One Queen, One Tongue.16 The war also established the trend for future deployments of New Zealand military personnel in conflicts of the twentieth century. That pattern was to send an expeditionary force to operate alongside allies and fight as a junior partner in a coalition. The South African War has also been identified as contributing significantly to cementing New Zealand's national identity.17 Finally, the war also triggered a major societal response in terms of memorialisation, with far more memorials per 1,000 deaths than for other mass-death events in New Zealand’s history (ie, seven times the level for both WW1 and WW2 combined, nine times the level for the New Zealand Wars and 266 times the level of the 1918 influenza pandemic18).

Given this background, we aimed to provide updated and more complete epidemiological information on the health impacts of the South African War on New Zealand military personnel.

Methods

Mortality analyses

We used a dataset on all the war-attributable deaths among New Zealand personnel involved in the South African War (10 contingents). This dataset was built from a list in the Parliamentary record,13 modified slightly by comparisons with a list published in a book from 199919 and information from the Cenotaph website database20 and the New Zealand War Graves Project database21 (see Appendix Table 1). Also, to better identify at least some missed deaths, we searched the ‘Newspapers’ section of the Papers Past database.22 The search period was from the end of the war (31 May 1902) to 31 December 1904. The search term was: “trooper” AND “death” AND “South Africa” AND (“wounds” OR “fever” OR “consumption” OR “measles” OR “invalid”) (n=228 items). More specific searches of individual names were used to follow-up deaths that were potentially attributable to war, where this was suspected. In select cases where the cause of death was not clear, we purchased death certificates.23

Definitions of war-attributable deaths

To define a war-attributable death in this study, we required that the following criteria were all met:

  • The person dying had to have been in the New Zealand military at the time of attestation (ie, we excluded New Zealanders who only participated in other militaries during this war, such as the Australian or UK militaries).
  • The death occurred during military service (including in military training camps) or in the post-war period up to 31 December 1904. For deaths in this post-war period, we made an assessment based on the balance of probabilities and informed by the available information (and sometimes the death certificates) concerning the war being the likely main contributor to the death or not. That is, if the cause of death predominantly related to war wounds or diseases that began while in military service (eg, tuberculosis and enteric fever), it was considered to be a war-attributable death.

Random selection of military personnel potentially exposed to combat (for lifespan analyses)

We randomly selected 253 names from the whole list of 6,339 New Zealand military personnel who were listed on the Cenotaph website database as having served in this war.20 Once their specific contingents were identified (by examining data in the Cenotaph database and personal military files), we removed those who participated in the last contingent (Tenth Contingent) whose troop ship arrived in South Africa just days before the war ended and who were not involved in military action.

Random selection of non-combat military personnel

We randomly selected names of those who were in the Tenth Contingent (n=1,022). We then removed from that group those who had also previously participated in Contingents One to Nine. For both this and the ‘combat exposed’ group above, we also removed duplicates, female participants and those who had participated in non-New Zealand military forces (eg, the UK military). Due to a large number of exclusions (particularly due to participation in other contingents being revealed), we conducted a second batch of random sampling to boost numbers for the analysis, which left a total of 333 selected names.

Lifespan data

We collected data on birth dates from the online military files.24 Date of death was also sometimes in these files, but otherwise we used a range of genealogical sources. These include the Births, Deaths and Marriages database, which contains records of all New Zealand-based deaths in this cohort23 (albeit for those records where there was an exact match between the name, and age and year of death/date of birth, with the data from the military file). In some cases, only the birth year could be identified, in which case we used the mid-year point of that year (eg, 1 July 1880) in the analyses.

In the lifespan analyses, we excluded those who died during the war and those who died in the period from the end of the war (31 May 1902) to 31 December 1904 (if there was any indication of their death being war-related). The latter was on the assumption that such deaths may have been from wounds or diseases related to their war experience. Further analyses took account of the participation and death in WW1.

To compare lifespans with the overall lifespan for New Zealand men, we took the approach of a WW2 study25 and created a synthetic cohort matched to each real veteran in the random samples. That is, in the synthetic cohort we matched each real veteran with a life expectancy value based on that of the average New Zealand man who was born in the same year. Furthermore, this was for life expectancy at the age that these veterans were in 1903 (ie, the year after the one when the war ended). These values have all been estimated for five-year intervals by a large Stats NZ study,26 and we interpolated the values for birth years in between the five-year values provided by Stats NZ. Such a comparison is not unreasonable, in that there is evidence from an analysis of the occupations of the soldiers relative to men aged 25–45 years (as per 1901 Census data) that “although the total force was small, it was a remarkably representative sample, socially and geographically, of the male population.”15

Morbidity data

To assess levels of morbidity, we took a random sample of 100 names from all the 6,339 New Zealand military personnel who were listed as serving in this war (as detailed above). All the medical information in their online military files24 was then examined.

Results

Mortality

Our analysis identified ten additional cases that were probably war-attributable deaths and three that were unlikely to be war-attributable, resulting in a new total estimate of 239 deaths from this war (Table 1). This gave an overall 3.9% risk of death for the total participants (Appendix Table 1). The major cause of death was disease (59%), followed by direct conflict-related causes (30%) (ie, being killed in action or dying from wounds). A statue of one of those killed in action is shown in Appendix Figure 1. ‘Accidental’ deaths were relatively high (11%) and these were caused by a single train crash (15 deaths) and horse-related injuries. The pattern of deaths over time was one of fairly consistent monthly dominance of disease deaths over war-attributable injury deaths (Figure 1).

The major disease groupings were enteric diseases (with dysentery and typhoid) at 36% of all deaths, followed by respiratory disease (10%) and then measles (5%). Disease deaths were more than twice as likely during winter months compared to all the other seasons (risk ratio of 2.08; 95% confidence interval [CI]: 1.65 to 2.63; Appendix Table 1).

The worst year of the war in absolute terms was 1902 (Appendix Table 1; Appendix Figure 1). It had the worst month for war-attributable injury deaths (the military action at Langverwacht Hill), the worst month for disease deaths (a measles outbreak) and the worst month for accidental deaths (the railway crash referred to above).

The risk of death was highest for the first three contingents, peaking at 10.3% for the Third Contingent (Appendix Table 1). It was lowest in the last two contingents— though deaths from disease continued to impact on these groups after the end of the war. Nevertheless, when just considering conflict-attributable injury deaths (killed in action and death from wounds), the Seventh Contingent stood out with a 5.4% risk of death. The Seventh Contingent sustained 50% of all such deaths, due to the action at Langverwacht Hill.

The average age of death at 25.5 years (Table 1) can be compared to the lifespan of the veterans of 68.6 years (for Contingents One to Nine, exposed to combat, Table 3). This suggests that these soldiers lost around 43 years of life of average. For the 239 deaths, this sums to around 10,300 years of lost life.

Table 1: Mortality in New Zealand military personnel associated with the South African War (see Appendix Table 1 for additional details).

Figure 1: Deaths of New Zealand military personnel attributed to the South African War by month of death (from January 1900 to December 1902 [ie, not showing 1 death in 1899 and 10 deaths in 1903/04]).*

* The worst month for mortality (February 1902) reflected military action with 68% (25/37) of the deaths being KIA/DOW (particularly military action at Langverwacht Hill). The second highest peak in August 1902 reflected a measles outbreak. The third, in April 1902, represented a railway crash.

Morbidity impact

Based on the random sample of military files, an estimated 39% of personnel suffered some form of reported injury or illness (95%CI: 30%–49%; Table 2). The commonest grouping was infectious diseases (26% of all personnel), and this included enteric disease, malaria and measles. The next most common grouping was injury (14%). Horse-related injuries were more common than direct war-attributable injuries in this sample.

Table 2: Mortality and morbidity impacts of the South African War based on a random sample of participating New Zealand military personnel.

* Out of the random sample of 100 military personnel there were two duplicates and one missing military file, hence variation in the denominator (ie, it was n=97 if not stated or n=98 as indicated otherwise). The sample includes personnel from all contingents, including those that departed in April 1902 just before the war ended. It included all illnesses documented in the military files, including those after the war until the military file was effectively closed.

Lifespan of veterans

Many exclusions from the initial samples were required, particularly because around half (50.2%) of the members of the Tenth Contingent had already been in at least one earlier contingent (Table 3). There were differences between the combat and not-combat groups in the post-war period (mean lifespans of 68.6 years and 65.5 years respectively; Table 3), but the higher participation by the Tenth Contingent in WW1 contributed to this. When this was accounted for in the analysis, these differences narrowed, with this difference not being statistically significant (mean lifespans of 68.5 [combat] and 69.1 years [non-combat]; Table 3).

When compared to the lifespan of the matched synthetic cohort (using life expectancies for all New Zealand men at their respective ages in 1903), this military population had very similar lifespans (67.3 years in the military and 67.8 years in the matched cohort; Table 4).

Table 3: Description and lifespan results of the two cohorts of military personnel used for the lifespan comparison of veterans (exposed to combat vs non-exposed).

* Statistically significant difference in participation in multiple wars (p=0.0012, ANOVA). NS=not statistically significant when comparing the two groups.

Table 4: Mean lifespans for studied populations of military personnel compared to a matched synthetic cohort derived from Stats NZ life expectancy estimates for men by birth year and for their age in 1903.

Discussion

Mortality impact

This study identified an additional seven war-attributable deaths (net number), largely from the delayed impact of diseases experienced while in the military. It was also able to estimate the potentially lost years of life in those dying (ie, 10,300 life years lost). While the New Zealand authorities of the day did produce a final list of the dead (with deaths up to July 1903),13 this should ideally have been updated five or even ten years after the end of the war to account for ongoing deaths. For example, some delayed deaths could have arisen from subsequent operations on war wounds (with operations being more hazardous in this pre-antibiotic era) or from suicide, since post-traumatic stress disorder can be long lasting. Furthermore, an additional aspect to the impact of this war on New Zealand society are the deaths among New Zealanders who joined overseas militaries. This ideally could be estimated in future work—but it may give a total of closer to 300 deaths as per an estimate reported soon after the war.29 Other work shows that for WW1 there were 1,400 extra such deaths of New Zealanders with other military forces (ie, around 7% of the new total for WW130). However, that work required extensive genealogical skills and resources.  

In terms of the major cause of death being from disease (at 59%), this war represents the last time that disease was the dominant cause for wars that New Zealand has been involved in. That is, in WW1, this ‘disease’ cause was down to 7.8%,31 despite the contribution of an influenza pandemic.32 For Australia in the South African War, the proportion of deaths from disease was 47% (286/606).33 For the British forces it was 63% (13,139/20,72119). The statistically higher burden of disease deaths in winter months may reflect the role of infectious diseases associated with close contact (eg, from more time spent inside buildings or in tents) or possibly the immune suppression associated with cold exposure.

Morbidity impact

Morbidity impacts were commonly reported in the random sample of military files, with over a third of personnel experiencing illness or injury (39%). This contrasts to the impression from official statistics, which only focus on the 2.7% prevalence of participating personnel being ‘wounded’ (see the introduction). Recorded illness (26%) was almost twice as common as injury (14%). Even if only focusing on injury, our new estimate of 14% is over five times that from the official records (2.7%).

Furthermore, the military files will have tended to reflect the more severe conditions, and so the true prevalence of morbidity would probably be even higher than our new estimate (eg, if considering lice infestation, non-hospitalised thermal injuries [heat stroke and from severe cold at night], dental injuries from the hard biscuits, non-hospitalised injuries from riding horses and so on). Furthermore, the morbidity would have been ongoing in some cases. One researcher reported cases of veterans experiencing what appear to be post-combat psychological problems and further surgical operations (eg, an operation occurring in 1907).28

Lifespan of veterans

Our analysis suggested no major lifespan differences between veterans who were exposed to combat and veterans who weren’t exposed to combat. International work on this topic used different methods but also identified no increase in mortality of Boer War veterans with post-combat disorders relative to controls with gunshot wounds.34 Nevertheless, this finding in our analysis may partly reflect the modest sample size, which was diluted because of the much higher than anticipated number of exclusions owing to men joining multiple contingents). There might also have been self-selection effects between the two groups and also variation in the rigour of the selection process in the military over time (eg, initially men were sometimes rejected by military recruiters for being ‘indifferent horsemen’19).

Our findings, that there is no significant difference in veteran lifespan, contrasts with research on WW1, where combat exposure appears to have resulted in reduced lifespan for surviving New Zealand veterans.35 This may be accounted for by the more extreme nature of the military experience in these two latter wars (eg, trench warfare in WW1 and the more important role of artillery bombardment in both subsequent wars) and the longer amounts of time spent at front-line conditions for many military personnel in these wars. In WW2 there was also a much higher proportion of veterans who had been prisoners of war, which has been associated with adverse health outcomes (see the introduction).

The finding of similar lifespans for South African War veterans when compared to the average New Zealand male population also contrasts with our findings for WW2 veterans, where a five-year gap was found.25 This could also reflect the more severe war experience of WW2 (as referred to above), but it might also have been that the role of ‘health selection’ was less important for the South African War (ie, less vigorous health screening at the recruitment offices). Indeed, various defects with the rigour of the selection process for New Zealand troops in this war have been described.36

An interesting finding from the lifespan analyses was the much higher subsequent participation by members of the Tenth Contingent in WW1, relative to earlier contingents. Possibly members of the Tenth Contingent were frustrated that, despite travelling to the war zone in 1902, they had not seen combat in the South African War. On the other hand, many of those who had participated (in Contingents One to Nine) may have decided that they had had enough of war and so had relatively lower rates of volunteering for WW1.

Strengths and limitations of this study

This study is the first such detailed analysis of the health of New Zealand military personnel involved in the South African War using modern epidemiological methods. It is also only the second such analysis at a country level, after UK research.1,34 The study also benefited from the availability of online military files, online genealogical databases and the capacity to search online most of the New Zealand newspapers of the period in Papers Past (although this is not a completely comprehensive database).

Nevertheless, this study still has various limitations with the major ones being as follows:

  • For the mortality work, we did not include deaths of New Zealanders participating in foreign militaries (since no list was available and creating such a list would require extremely extensive archival work). Our searches of Papers Past for additional war-attributable deaths would also probably have missed some individuals who died in the post-war period (eg, especially those dying outside of New Zealand and those who died after 1904).
  • For the morbidity work, we only used a random sample of 100 personnel and the military files only focused on conditions causing hospitalisation and not less severe illnesses and injuries. Further research could use a larger sample and study any diaries of the troops.
  • The lifespan analyses were also constrained by the modestly sized random samples (as this was an unfunded study). Future research could attempt to follow-up all the participating personnel—and make more detailed comparisons with WW1.

To what extent were these war-attributable health burdens preventable?

Having considered the morbidity and mortality burdens for military personnel in this war, it is worthwhile to reflect on the extent to which these may have been preventable. Although the New Zealand Government could have chosen not to participate in this war, this counterfactual seems very unlikely, given the country’s strong links to the UK19 and the participation of similar English-speaking countries (eg, Australia and Canada). However, the Government could have decided to send fewer troops, which would have reduced the health burden; the Government did send disproportionately more than Australia and Canada (around 1.8 and 5.7 times more per capita respectively, based on our estimates from published participation data37). There was some opposition to the war in New Zealand,28,38,39 but this does not appear to have prevented further New Zealand contingents leaving for the war during 1902.

More specifically, there were various problems that could all have been better addressed with knowledge of the day and that may have reduced the health burden among participating troops:

  • The inadequate understanding of the military situation by the military leaders on the imperial side. That is, the guerrilla tactics used by the Boers, along with their use of trenches and recent developments with weapons (eg, long-range rapid-firing rifles with smokeless ammunition) that decisively shifted the balance towards favouring defence over offence.12 This meant that imperial forces suffered high casualties when engaging with the Boer forces.12
  • The lack of adequate training has also been noted: “New Zealand units, therefore, embarked on operations after receiving what can only be described as a most inadequate preparation for service in the front line of a major war.”36 Better training may have resulted in fewer combat injuries and accidents from falling off horses (especially among those volunteers who were not already skilled with horse riding).
  • Inadequate military equipment included the outdated single shot rifles issued at the beginning of the war to New Zealand troops.36 This was in contrast to the state-of-the-art weapons used by the Boers,19 though rifles with magazines were supplied at a later stage to the New Zealanders.36 There was also the problem of the relatively small horses for the size of the troops.40 These New Zealand men were described as “fine, tall broad-shouldered men, half as big again as the average Tommy were sent out. Fine to look at, but Oh, the poor horses!”40 The New Zealand horses were also given no time to acclimatise to the new country and were over-worked.19 This situation meant that the horses were less effective in both combat (eg, range and speed of movement) and non-combat situations (eg, transporting supplies and the wounded).
  • The inadequate supplies of clothing and provision of shelter for winter camping were problems: “New Zealand soldiers often endured severe daytime heat, then at night slept in the open with only an overcoat to protect them from the freezing cold.”41 Their clothing “quickly became ragged and was not replaced, which led men of the 6th Contingent to strike.”42
  • The inadequate supplies of food (and the minimal variety of food) and lack of water (for drinking and washing) were problematic.41 “The troopers’ equipment was poor, and on trek they had inadequate food – hard dry biscuits, bully beef (canned meat), sugar and tea. They tried to supplement this with much foraging… They were not issued with soap and their clothing quickly became infected by lice.”42 All these deficits probably contributed to increased risk of diseases.
  • The inadequate medical support for the imperial troops in South Africa was a well described problem.12 This issue was also combined with inadequate attention being paid to how injured troops were to be evacuated after combat (eg, shortages of ambulance wagons12). It has been noted for the New Zealand troops that “when they were wounded on the trek far from hospitals, sepsis (infection) often developed.”42 There were shortages of such basics as water in hospitals.19 Inadequate medical care for New Zealand troops was reported on by a journalist,28 and medical care on troop ships was also a source of complaints, though this problem was dismissed by authorities in an inquiry.43
  • The crowding of New Zealand troop ships has also been described,19 and this was of concern to the New Zealand public after an onboard measles outbreak. Although authorities at the time largely dismissed such criticisms, an inquiry did identify poor ventilation on a troop ship as a problem.43 British troop ships were also described as overcrowded,12 and the subsequent disease outbreaks on New Zealand troop ships in WW1 also suggested persisting problems with crowding and inadequate ventilation.44

Some of these preventable aspects have also been identified as issues with New Zealand’s involvement in other wars. For WW1 these included the poor military planning that resulted in failed campaigns (eg, at Gallipoli and Passchendaele45), the initial lack of protective equipment such as helmets,31 inadequate healthcare services (especially the Gallipoli campaign46), the poor food at Gallipoli47 and outbreaks of diseases linked to crowding in various settings.45 For WW2 there were also apparent examples of defective strategic leadership as per the loss of Crete to German forces (albeit still controversial48).

Other preventable aspects of this South African War were the harm done to the civilian population by the burning and looting of Boer homesteads, the killing of their livestock and the setting up of concentration camps containing thousands of Boer women and children. Many of these people subsequently died of disease (see the introduction).12 New Zealand troops participated in the burning and looting activities,19,28 but unfortunately there has been no full accounting for these activities and why the New Zealand authorities did not intervene or protest to the UK Government. Other actions, such as the looting of Boer bibles by New Zealand troops, may also not have been fully resolved, even to this current day.49

Conclusions

This study found that the mortality was larger and the morbidity impacts of this war were much more substantive than revealed in the prior historical literature for New Zealand, particularly for non-injury illness. The relative importance of death from disease (at 59%) was also a notable feature of this war. But, in contrast to other wars, this study did not identify any lifespan differences between combat and non-combat personnel, or relative to the average New Zealand man at that time. As with other wars involving New Zealand, there is evidence that some of the health burden for participating military personnel could have been prevented with knowledge of the day and better planning to utilise this knowledge.

Appendix

Appendix Figure 1: A statue of a New Zealand soldier killed in action in the South African war (Govern-ment Gardens, Rotorua, New Zealand; photograph by the first author).

Appendix Table 1: Mortality in New Zealand military personnel associated with the South African War—additional details to Table 1.

Appendix Table 2: Changes to the mortality burden associated with the South African War for New Zealand military personnel (relative to the available list of deaths from the South African War available at the start of this study in the AJHR dataset13).

Summary

Abstract

AIM: We aimed to update and provide more complete epidemiological information on the health impacts of the South African War on New Zealand military personnel. METHODS: Mortality datasets were identified and analysed. Systematic searches were conducted to identify additional war-attributable deaths in the post-war period. To estimate the morbidity burden, we analysed a random sample of archival military files of 100 military personnel. Lifespan analyses of veterans included those by level of combat exposure (eg, a non-combat sample came from a troopship that arrived at the time the war ended). RESULTS: We identified 10 additional war-attributable deaths (and removed three non-attributable deaths) to give a new New Zealand total of 239 war-attributable deaths. Given the average age of death of 26 years, this equates to the loss of 10,300 years of life. Most deaths (59%) were from disease rather than directly from the conflict (30%). Over a third (39%; 95%CI: 30%–49%) of personnel were estimated to have had some form of reported illness (26%) or injury (14%). The lifespan analysis of veterans suggested no substantive differences by exposure to combat (68.5 [combat] vs 69.1 years [non-combat]) and similarly when compared to a matched New Zealand male population. CONCLUSIONS:  The mortality burden was larger and the morbidity impacts on the New Zealand military personnel in this war were much more substantive than revealed in the prior historical literature. There is a need to more fully describe historical conflicts so that their adverse health impacts are properly understood.

Aim

Method

Results

Conclusion

Author Information

Nick Wilson: Department of Public Health, University of Otago, Wellington, New Zealand. Christine Clement: Te Puke, Bay of Plenty, New Zealand. George Thomson: Department of Public Health, University of Otago, Wellington, New Zealand. Glyn Harper: Professor of War Studies, Massey University, Palmerston North, New Zealand.

Acknowledgements

Correspondence

Prof Nick Wilson, Department of Public Health, University of Otago, Wellington, New Zealand

Correspondence Email

nick.wilson@otago.ac.nz

Competing Interests

Nil.

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