Makeshift Medicine

Taken from an Australian Medical Journal dated January 1983

Combating Disease in Japanese Prison Camps by Ian Duncan

The Prisoners of War camps in Thailand were dotted along the Kwai Noi River like a string of beans. Some of the camps were in the hot, humid coastal plain, others in the foothills. Others, like those in the Three Pagoda Pass areas, were high in the mountains where winter temperatures dropped below 10°C at night. In the rainy season this must be one of the wettest places on earth. In addition, there was the ever-present language problem which almost certainly aggravated the difficulties.

We were told by the Japanese that though their government had signed the Hague Convention the Army had not and, therefore, the Army was not bound by its terms. Also, as we had dared to oppose the Imperial Japanese Army and had been defeated, we must be punished. The Japanese administration worked in water-tight compartments so that each area controlled by an officer was completely autonomous. This made communication between camps almost impossible. Each Area Commander was responsible for food, clothing and medical supplies within his area. The typical monthly issue of medical supplies for 1,000 men was six to 12 bandages, a small piece of gauze, 10 to 20 ml of tincture of iodine and a few dozen assorted tables of dubious value. Almost all of our own medical supplies and equipment were confiscated after capture.

Jungle camps were, in my experience, built by the men themselves usually after a long march on which they carried all their personal possessions, cooking gear and medical supplies. Accommodation consisted of leaky tents or flies or, if the camps became more permanent, buts of bamboo with attap roofing. During the wet season, causeways had to be built to the cook house, latrines and through the camp lines. At first the men worked from daylight to dark, but later shifts of 30 hours were common. Rest days were rare.

A Medical Officer's Workday

A typical day for the camp medical officer started with a sick parade by the light of an oil lamp. The sick were then separately paraded before the Camp Commander and each man had to be argued about in order to keep the sickest men in camp. As the Japanese regarded the Medical Officer to be responsible for the men being sick, he was punished by beating if the daily quota of men fit for work was not filled. After this, he had to attend to the sick in the camp and in hospital dispensing what he had, mostly sympathy and compassion. The camp hygiene had to be checked daily, especially that of the kitchen and latrines. Wood had to be gathered by all men in the camp who were not in hospital, so that food could be cooked and water could be boiled for drinking and for sterilising eating utensils. When the men returned to the camp after dark, another sick parade was held with the help of an oil lamp. During the wet season, when cholera raged along the river, isolation hospitals had to be established. The Medical Officer was also expected to help to dig graves.

Food and Other Necessities

The Japanese allowed some men to remain in camp as camp staff, but stipulated that their rations should be less than those of the workers. Sick were allowed even less, as the Japanese thought that they would force them back to work by denying food. Everyone suffered from severe deficiency diseases. Most had malaria and dysentery. Few had adequate clothing and boots were a rarity. It was necessary to redistribute any effects of the dead.

Dietetic Deficiencies

In Changi, conditions were much better and the prisoner-of-war authorities were able to do more for the men. It was recognised early that avitaminosis was going to be a major problem and the thiamin/non-fat component of the diet was watched closely. A yeast centre was established in Changi 1 April 1942 and each unit was encouraged to produce its own yeast. For yeast cultures, potatoes, sweet potatoes and rice were used with sugar or gula malacca (syrup). Each man was given 100 ml of yeast daily and it was considered that 600 ml of yeast a day was necessary for the treatment of beriberi. Before the end of the war, a concentrated yeast preparation was being produced. This was known as 'marmite'. Rice polishings were available sporadically and used whenever possible. Riboflavine was obtained from grass extracts. Gardens supplied green vegetable and sweet potatoes though the best were taken by the Japanese.

Improvisations

On the Burma/Thai railway, great ingenuity overcame some of our difficulties. In Burma, by distilling Burmese 'brandy' enough alcohol was made for use in surgery and to sterilise syringes.

Soap was made in Changi using available oils and fats and wood ash. Benedict's solution was also made. Fractional test meals provided acid for the treatment of those suffering from achlorhydria and for making a flux for solder. In Burma, a Dutch chemist Captain van Boxtel, produced emetine from ipecacuanha, which was pure enough for injection and which often produced dramatic results in the treatment of amoebiasis.

Eye lesions were frequent in Burma and Thailand, the most common being granular cornea, corneal ulceration and amblyopia. At Nakom Paton, Major Hazelton AAMC, constructed an ingenious ophthalmoscope using an oil lamp burning coconut oil, parts of a Rolls razor, a metal concave mirror and some lenses.

Treatment of severe dehydration in some patients with dysentery and in most patients with cholera was a serious problem. In most camps, saline solution was made with rain water which was plentiful or with strained river water. In the large permanent camps, water was distilled by means of improvised stills. In the more remote camps, salt was almost impossible to obtain and rock salt was used instead. What was estimated to be the correct amount was dissolved in water and the solution was boiled. Containers were made by removing the bottom from an empty Japanese wine or beer bottle and closing the neck with a wooden cork with a hole in it through which a piece of bamboo was inserted. This was then connected by stethoscope tubing to a cannula carved from a piece of bamboo. By this means an intravenous infusion of saline could be given rapidly with hardly any side effects, apart from occasional rigors. If possible, saline was also administered per rectum.

In the hospital, bedpans made from giant bamboo were used. At Hintok, a complete water system was made from bamboo. Water was drawn from a dam several hundred metres away to a system of showers, dixi-washing points and to cool a still in a water distillery.

In Japan, a Dutch doctor, Bras, constructed a microscope using bamboo and lenses from field glasses. This instrument was good enough to enable blood typing and recognition of malarial and amoebic parasites. In Japan, it was found that frequent small blood transfusions of about 20 ml were often life-saving in the treatment of pneumonia.

It was ironic that immediately after cessation of hostilities, a large carton of penicillin was dropped almost on top of the hospital in Camp 17, Omuta, Japan. Unfortunately we had never heard of it and as no instructions were enclosed, it was never used though we had many men suffering from pneumonia, osteomyelitis, infected wounds and boils.

Medical Personnel

In Changi there was originally a surplus of medical personnel. As the working parties left Changi, this surplus proved to be a boon for, almost without exception, each working party was accompanied by trained medical personnel. The orderlies had to be trained in nursing techniques. As time elapsed the number of trained men decreased due to attrition. Officers and tired, exhausted men were used in the hospital and it was amazing to see the devotion and sacrifice of these untrained men, especially those who volunteered to work in the cholera hospital.

In the larger hospital, combatant officers were recruited as ward masters. They were responsible to the medical officers for discipline and the general routine in the wards. They were also responsible for the supervision of patients, staff and nursing, the organisation of the supply of water in appropriate containers for keeping the patients as clean as possible and for the keeping of records and for running a canteen.

It was usual for all ranks to contribute towards a canteen fund from their pay in order to buy extra food and medicines whenever possible. Officers were paid according to rank. As a large portion of an officer's pay was banked by the Japanese, who also deducted his board and residence from his pay, by the time an officer contributed his share to the welfare fund he had little left.

Most parties were able to keep some records on scraps of paper or on bamboo strips.