Why everyone in Scotland should know the name Kragujevac
The Louisa Jordan Hospital provides a critical ICU resource in the current pandemic. The name, which has caused unexpected media comment (it appears, for political reasons) celebrates the name of a valiant – the word is carefully chosen – Scottish nurse, who died fighting a terrifying typhus epidemic which swept through the Serbian army during the First World War.
The battlefield on which she died in 1915 was the field hospital in Kragujevac, which was totally overwhelmed by the casualties and the virulence of the epidemic; which, at the time it struck medicine still had limited resources to fight, without the equipment or modern protocols, and the medical staff were required to operate in unspeakably appalling conditions. There was a lack of physicians and other medical professionals because they had been seconded to the army, which led to the rapid collapse of the health status of defenceless populations. Malnutrition, overcrowding and a lack of hygiene paved the way for typhus.
In November 1914, typhus made its first appearance among refugees and prisoners, and it then spread rapidly among the troops. One year after the outbreak of hostilities, typhus killed 150,000 people, of whom 50,000 were prisoners in Serbia. A third of the country’s doctors suffered the same fate. The mortality rate reached an epidemic peak of approximately 60 to 70%. This dramatic situation dissuaded the Germano-Austrian commandment from invading Serbia in an attempt to prevent the spread of typhus within their borders. Drastic measures were taken, such as the quarantine of people with the first clinical signs of the disease, but attempts were also made to apply standards of hygiene among the troops to prevent body lice infestations.This description of epidemic typhus is taken from the Encyclopaedia Britannica online (http://www.britannica.com/science/typhus):
“Epidemic typhus has been one of the great disease scourges in human history. It is classically associated with people crowded together in filth, cold, poverty, and hunger; with wars and famine; with refugees; with prisons and jails; with concentration camps; and with ships. It is caused by the bacterium Rickettsia prowazekii and is conveyed from person to person by the body louse, Pediculus humanus humanus.
Epidemic typhus was clearly differentiated as a disease entity from typhoid fever in the 19th century. Major progress in combating the disease began only after 1909, when the French physician Charles-Jules-Henri Nicolle demonstrated that typhus is transmitted from person to person by the body louse. (Nicolle later won the Nobel Prize for his efforts.)
At the close of World War I the disease caused several million deaths in Russia, Poland, and Romania, and during World War II it again caused epidemics, this time among refugees and displaced persons, particularly in German concentration camps.”
It has been passed over by some that Louisa Jordan was not alone working in the Kragujevac hospital. A little of Scotland died there with her, part of the great Scottish casualty list of the Great War. Among the other casualties in that hell-hole was Dr Elizabeth Ness McBean Ross (1878-1915). She was one of eight children; with two brothers and five sisters. In a striving and successful family one sister and one brother also became physicians. What makes this remarkable is that Elizabeth Ross was among the very earliest small generation of women to graduate in medicine in Britain.
Women were only able to enter the Scottish Universities at all from 1892, following a decision by the University Commissioners, appointed under the slowly liberalising provisions of the Universities (Scotland) Act of 1889; which more generally also introduced formal University entrance qualifications. The progressive Principal of Glasgow University towards the end of the 19th century, the theologian John Caird (1820-98) was determined to promote the cause of women in education; he was the first President of the Glasgow Association for the Higher Education of Women, which was established in 1877, and when the independent Queen Margaret College for women opened in nearby North Park House in 1883, Caird soon managed to provide University teaching support.
The new women-only Queen Margaret College soon followed, to be taken over by Glasgow University and soon after an even more daunting male-only barrier was broken, by the College producing the first woman medical graduate of Glasgow University; indeed – of seminal historical significance – the first woman to graduate in medicine in Scotland. Marion Gilchrist (1864-1952) graduated from Glasgow University in 1894, by that time already aged thirty years, having striven to break through the ‘iron ceiling’ imposed on women’s ambition that had prevailed before her triumph; graduating only
two years before Elizabeth Ross matriculated at Glasgow University in1896 to study medicine, aged just eighteen years. Elizabeth Ross graduated in 1901.
Elizabeth Ross was, by any standards a remarkable woman. Not only an early woman physician, following graduation she traveled to Berlin for further study, worked in East Ham in London; then in Colonsay. She became the world’s first woman ship’s surgeon, but her career took an extraordinary turn, that remains exotically mysterious to this day. She travelled to Persia (Iran) in 1908 to become an assistant to a local physician in Isfahan; for a very brief spell. By her own account she was bored in Isfahan. She had a “desire for something beyond, something outside the commonplace and conventionality of everyday British life”. Perhaps the closest clue to Ross’s spirit is her liking for the undercurrents in the work of that free, anarchic spirit, the poet and adventurer Robert Service; a close contemporary of Ross, Service was also a Glasgow student, and his father had worked for the same bank as Ross’s father. In any case, Elizabeth Ross quoted from Service’s poetry in her own published account of her work in Persia. The boredom ended when she became the physician to Samsam-al-Saltana (Najafqoli Khan, 1846?-1930) the revolutionary chieftain who controlled most of Bakhtiariland; just before the revolution overthrew the Shah. She remained working in this volatile region for the family until around 1913, when in a deteriorating situation she had to be rescued by an Indian Army officer Arnold Wilson (later a Conservative MP) and his soldiers, whose own account is rich in Foreign Office machinations.
It is worth noting here that before 1908 the Admiralty had decided it was essential to the Royal Navy (and therefore vital to the Empire) that the Navy make the strategic transition from coal to oil. Huge efforts were made by a British sponsored ‘syndicate’ to find oil; in Persia (Iran). No expense was spared. The announcement that it had been found, in Bakhtiariland incidentally, was made to the Foreign Office on 3rd June, 1908. What followed was state-sponsored capitalism. The British state set up the Anglo-Persian Oil Company (APOC) to exploit the prospect, and the Foreign Office negotiated with the Iranians (most critically the Bakhtiari, who were well armed). APOC and the actual oil extraction operation on the ground were both partly funded and wholly managed by the Glasgow company Burmah Oil Company, under a remarkable 20th century business and engineering visionary from Glasgow, named Charles Ritchie. To place this episode in historic context, this was the beginning of Middle East Oil; APOC became the Anglo-Iranian Oil Company, and eventually British Petroleum (BP): state capitalism to its roots.
Following her adventures in Iran, Elizabeth Ross returned to London to further her studies in Tropical Medicine. She then returned to Iran. It is understood that sometime in 1914, probably late in the year, either the Russians (now Britain’s ally in WWI) approached Dr Ross in Tehran about the urgent need for doctors in Serbia; or she was approached by the Red Cross, but in either case it was a request for her to serve in Serbia, which was seriously short of medical staff and was engulfed by medical crises and contagious epidemics brought on by the War. It should also be remembered that the British would not use the Scottish Women’s Hospitals Service, that separate remarkable band of heroic /scottish women, spurned by the War Office; but not spurned by her allies on both the western and Eastern Fronts did; and glorious service they gave. There were several Scottish Women’s Hospitals in Serbia, although it does not appear to have been part of Elizabeth Ross’s plan to work for them.
In any case, responding quickly to the call, Elizabeth Ross was in Serbia by January, 1915. She first served briefly at a hospital in Nish (it is not clear who ran this hospital), but then she heard that the ‘first reserve military hospital’ in Kragujevac (where another Scot, Dr Katherine MacPhail had served in 1914) had a desperate crisis on it hands, not just floods of Serbian troops, but ravaged by a typhus epidemic; indeed, what began as a military hospital had now become a fever hospital. It seems that Kragujevac was not a Scottish Women’s Hospital, but Elizabeth Ross immediately volunteered to join the hospital nevertheless, along with some gallant British nurses, including Louisa Jordan. Typhus was deadly in 1915. Given her background knowledge as a Fellow of the Society of Tropical Medicine, Dr Ross was as well equipped as anyone for the task, but even in the most propitious circumstances, the capacity to fight Typhus was limited in 1915, and the circumstances in Kragujevac were far short of propitious; in an overwhelmed hospital in Serbia, in the middle of a World War, bent on propagating new methods of mass industrialised killing, the conditions produced by the addition of Typhus to the cocktail of problems, were appalling.
We know that some colleagues from the Scottish Women’s Hospital Service (there was a Scottish hospital relatively close by) visited Dr Ross in the Kragujevac fever hospital. They were appalled at what they saw, and it appears that some spoke to Elizabeth about the impossible nature of the conditions she was working in. Dr Ross’s response was stoic; she is said to have replied with utter, unwavering simplicity “somebody has todo it”. It is the candid understated heroism of uncounted generations ofwomen through the centuries. It is the last words she spoke, of which we appear to have a record. Faced with personal risk or danger, it was also
characteristic of Elizabeth Ross:
“We tramped the road to Anywhere, the magic road to Anywhere,
The tragic road to Anywhere, such dear, dim years ago”.
– Robert Service
It could only be a few days later that Elizabeth Ross contracted the disease; quite probably from the overwhelming infestation of lice, although one highly speculative story is that she was bitten by a female patient. Elizabeth Ross was cared for by one of the nurses. Sometime the following week she was visited byfriends and it was reported that she was feeling better. She died on 14th February, 1915; it was her birthday. The nurse who tended her was dead within the week. I do not know if that nurse was Louisa Jordan.
Each year in Kragujevac on 14th February there is a ceremony performed which I can do no better than allow the Serbian Website dengalnaserben.weebly.com to express the purpose and sentiment:
“Just after 11am on St Valentine’s Day, a long procession of official cars will wind its way through the main street of the Serbian townof Kragujevac towards the city cemetery. At the gate the occupants will disembark and make their way towards one of the snow-covered graves to pay their respects. The grave is distinctive not only becauseit marks the resting place of three young women, but because some of the words on it are in English. On the largest, the headstone reads ‘Here lies Dr Elizabeth Ross’. Underneath in Serbian, it says: ‘They gave theirhearts to the people of Serbia”.
There is a street in Kragujvac named after Elizabeth Ross. Her iconic Glasgow University graduation photograph adorns a Serbian postage stamp. I think it is fitting that the new ICU unit in Glasgow is named after Louisa Jordan. I do not know the identity of the name on the third gravestone; the second nurse who gave her life.