Page 120 - JSOM Winter 2022

This was an unpleasant and disabling disease, with copious Response, Invention, and Ingenuity
passage of stools with blood and abdominal cramps (Figure 1).
In the jungle camps of Thailand, Burma, and Sumatra, amoe- Sanitation
3
bic dysentery was also common. Caused by the protozoan Establishing a clean water supply and effective sanitation were
organism Entamoeba histolytica, amoebic dysentery was typ- imperatives for POW medical and military leaders. In larger
ified by a chronic and very debilitating dysenteric illness. On camps, senior POW officers directed the siting and regular
the Thai-Burma Railway, both types of dysentery together maintenance of deep trench latrines, which were covered with
were the leading cause of mortality. 4 hinged bamboo lids to reduce the breeding of flies. In jungle
camps, strict rules were imposed prohibiting the contamina-
tion of rivers and streams, and bamboo guttering was some-
FIGURE 1 Dysentery Hut, Chungkai Hospital camp, Thailand,
1943. Painted by Gunner Jack Chalker, 118 Field Regiment. times used to deliver fresh water for cooking, ablutions, and
(Copyright courtesy T. Mercer.) medical purposes. 7

Nutritional Support
Local knowledge about edible plants provided by men of the
local Volunteer Forces was vital to European troops newly ar-
rived in the tropics. Whenever possible, FEPOWs traded with
the local population for eggs, chickens, fruit, and rice husks.
7
These husks, or polishings (called dedek in the Netherlands
East Indies), were rich in vitamin B, and in Sumatra, a watery
dedek extract was brewed and added to the daily ration. With
further filtering, this extract was also administered by intra-
muscular injection in severe cases of vitamin deficiency. Rear-
8
ing chickens and rabbits or cultivating vegetable gardens were
often compromised by guards who stole the resulting livestock
or produce. Records also show that starving FEPOWs ate
snakes, lizards, monkeys, dogs, crickets, slugs, and snails. 9

Homemade yeast extract helped halt or reverse the effects of
Many of the locations of imprisonment were in areas of in-
tense malaria transmission, and here recurrent attacks of vitamin-deficiency syndromes. In 1943, FEPOWs and guards
malaria were universal; some survivors of imprisonment inter- sent from Java to the coral islands of Haroekoe and Ambon
viewed at the Liverpool School of Tropical Medicine recalled (the Spice Islands) found little land available for cultivating
50 or more malarial attacks during captivity. The illness was vegetables. Flight Lieutenant Leslie Audus, prewar an aca-
usually nonfatal, but if caused by the so-called “malignant” demic botanist, manufactured yeast using a process secretly
10
variant (falciparum malaria), death could occur as a result of, perfected at the Jaarmarkt camp in Java. Yeast production
for example, cerebral malaria. was also documented in Hong Kong and Singapore and in
Thailand, where Captain Jacob Markowitz RAMC (Royal
Army Medical Corps) used rotting jungle bananas and rice,
11
Epidemics of cholera struck in the more remote jungle camps,
5
leading to profuse diarrhea, dehydration, and often, death. into which
Also in such camps, tropical ulcers were a major problem.
These started with minor trauma, usually to the foot or lower “. . . officers were asked to spit into three times…know-
leg, progressing to deep, eroding ulceration leading to extreme ing that the diastase in the saliva would convert part of
pain and sometimes requiring leg amputation. 6 the starchy rice into sugar. The result after a few days’
fermentation was a vitamin-rich beer worth its weight in
Other diseases encountered included typhus, dengue fever, uranium.” 12
diphtheria, and tuberculosis. Additionally, the whole spectrum
of less exotic illnesses and conditions had to be dealt with—for Ophthalmic symptoms resulting from vitamin A deficiency
13
example, dyspepsia, bronchitis, appendicitis, pneumonia, frac- were alleviated with red palm oil. To aid in the assessment of
tures, and sprains. nutritional amblyopia, Australian medical officer Major Ha-
zleton at Nakom Paton Camp in Thailand constructed a basic
ophthalmoscope. Peripheral nerve damage causing foot drop
7
POW medical officers took what equipment and drugs they 14
could into captivity, but these were frequently limited because was alleviated by homemade walking aids devised by doctors.
most POWs had to march from their place of capture to prison Photophobia resulting from optic nerve damage was alleviated
camps, transporting the supplies as best they could. Medical by sunglasses made from bamboo and colored Perspex. Some
supplies provided by the Japanese were very limited, and oc- grasses were found to contain riboflavin, which was extracted
casional Red Cross parcels were usually withheld. Particular after milling, and in Sumatra, cottela grass leaves provided a
9
challenges were the shortages of drugs and equipment for the rich source of vitamin B.
safe practice of surgery, anesthesia, intravenous fluid adminis-
tration, and dentistry. Blood Transfusion
In cases of gross debility resulting from malnutrition, chronic
infection, and tropical ulcers, blood transfusion was often
This then was the healthcare crisis facing POW doctors and 11
medical orderlies during imprisonment. How these enormous used. Although by modern standards these indications ap-
challenges were met in these most difficult of circumstances pear unusual, POW doctors were convinced of their benefit.
are reviewed in the following section. Doctors trained orderlies in rudimentary blood matching and

118 | JSOM Volume 22, Edition 4 / Winter 2022