Page 121 - JSOM Winter 2022

grouping, using microscopes and glass slides when available. Medical Equipment
Other equipment used included home-made centrifuges, bam- At Chungkai, trained engineer and medical orderly Private
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boo needles, and rubber stethoscope tubing. Lieutenant Col- Gordon Vaughan, RAMC, recycled cutlery into scalpels, re-
onel M. E. Barrett KVF (Kedah Volunteer Force) undertook tractors, and curettes, and added a metal frame to a hacksaw
blood transfusions at Chungkai Hospital camp in Thailand, blade for surgical amputations. Proctoscopes and even a sig-
describing this work in his report written in late 1945. 15 moidoscope were created using recycled tin cans, with water-
tight joints sealed by folding, crimping, or soldering, the solder
At Chungkai, men queued for rudimentary blood compatibil- extracted from cans. Blades were sharpened on stones, giving
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ity testing after a day’s work. FEPOW medical artist Gunner a razor edge. 22,23
Ashley Old of the Sherwood Foresters regiment documented
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both the queues and also a transfusion in progress (Figure As senior operating room assistant, Vaughan documented
2). Blood from the donor was collected in a vessel and, in all 4,577 operations performed at the three largest hospital
the absence of sodium citrate, was stirred for several minutes camps in Thailand. He fashioned grafting needles, enabling
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with a bamboo whisk to remove the fibrin clot. Defibrinated skin grafts for tropical ulcers: a piece of copper tube had a coin
blood was transferred to a suspended, upturned Japanese beer soldered on the end, with the coin slotted to take three or four
bottle with its base removed, sealed with a cork stopper, with steel hypodermic needles set at an angle. 23
a bamboo spigot placed in the stopper connected to rubber
stethoscope tubing. A cannula at the other end (either a steel For hundreds of men with unresolved deep infective tropical
needle or an engineered bamboo shoot) was inserted into ulcers, amputation was sometimes inevitable. Across captivity,
the recipient’s vein, with the flow regulated by a homemade an incredible array of prosthetics, from the basic “peg leg” to
clamp. 17 sophisticated artificial limbs, was designed and crafted from
wood, bamboo, and metal. The cups for stumps were made
FIGURE 2 Blood transfusion hut, Chungkai, Thailand, 1944. Sketch from laced canvas and other materials padded with rubber or
by Gunner Old. (Copyright Bartholomew family, courtesy State seeds from the kapok tree. The more sophisticated models had
Library of Victoria, Australia.)
articulated knee, ankle, and even toe joints. Examples of these
remarkable prosthetic devices are shown in Figure 3.
FIGURE 3 Details of lower limb prosthetics used in camps on the
Thai-Burma railway. Drawn by Gunner Jack Chalker. (Copyright
courtesy T. Mercer.)

During 1943, at the Chungkai and nearby Tamarkan hospital
camps, more than 3,800 transfusions were performed. How-
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ever, most camps lacked the basic tools and expertise for such
interventions. 18,19
Perhaps Vaughan’s most remarkable invention was a self-re-
Cleaning, Sterilization, and Distillation taining ileostomy tube (Figure 4). Ileostomies were some-
Eating utensils were sterilized in boiling water or passed times performed on men with chronic amoebic dysentery to
through flame. Wood ash made a useful scouring agent, and “rest” the colon and allow healing. Although this is clearly
the leaves and bark of the red ash tree when rubbed together not a modern therapeutic indication, the lack of other effective
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formed a good “soapy” lather. Crushed red ash fruits, when treatments forced POW doctors to find unusual and inventive
thrown into a river, stupefied fish, aiding harvesting. A useful systems. Anecdotally, there were many contemporary observa-
mosquito repellent was found when lalang grass leaves were tional reports of remarkable clinical improvements achieved
rubbed on the skin. The mandibles of red soldier ants pro- with this treatment. However, the collection of intestinal se-
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vided effective first aid “surgical clips.” 20 cretions from the stoma was the main challenge. Ileostomy
“bags” were sometimes fashioned using Dutch water bottles,
Homemade distillation units, large and small, provided sterile when available (British bottles were too bulky). Vaughan’s
water for oral and intravenous use. Heated by charcoal from solution comprised wide-bore drainage tubing, condoms (il-
cookhouse fires, one example used copper tubing from a Mor- licitly obtained from the guards), thread, hypodermic needle,
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ris 10 automobile ! Alcohol, also produced by distillation, syringe, stethoscope tubing, and homemade wooden clamps
was used to sterilize medical instruments and to clean micro- and proved to be highly efficient. The condom was wrapped
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scope slides, and as a surgical antiseptic. Homemade steriliz- and secured around the end of the tube, then placed inside
ers and charcoal braziers were fashioned from gula malacca the stoma and inflated with the syringe and needle to ensure
(molasses) tins. retention.

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