- Some encouragements from medical and surgical work carried out as a P.O.W. in the far east (Hong Kong Argyle St. Camp and Japan Shinagawa POW Camp)
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Journal of the Royal Naval Medical Service, Vol 44 (1958) (Pages 77 - 96) - Hugh Cleave (Medical Officer-in-Charge of, the Royal Naval Hospital, Hong Kong, 1941) :
It is embarrassing to write this little essay in the first person as it will inevitably sound egotistical, but I am well aware that similar difficulties, or far worse, must have been encountered in Malaya and elsewhere. Nevertheless, it is a record of what can happen to men living under primitive conditions and on an unnatural diet, and of the medical and surgical relief that it may be possible to give them. My records on leaving Hong Kong for Japan were confiscated by the Japanese , so that the account of the cases treated in Hong Kong is from memory , but it has been checked up carefully where possible . The records for the timespent in Shinagawa P.O.W. Hospital , Tokyo , are complete . It will be more interesting if the conditions of the two P.O.W. camps are very briefly described so that the background of the work can be appreciated .
Taken prisoner while holding the posts of surgical specialist at , and Medical Officer-in-Charge of the Royal Naval Hospital , Hong Kong , on 25th December , 1941 , I had two preliminary moves before arriving at the officers ' camp at Argyle Street , in Kowloon , Hong Kong , in May , 1942. I remained there until May , 1944 , when with eight other medical officers I left for Japan . This camp had been occupied early in April , 1942 , before our arrival , and much had been done by officers and ratings to improve it in every way possible with the meagre facilities available to them .
Argyle Street Camp , Hong Kong , consisted of eleven wooden sleeping huts , a cookhouse hut and bakery hut . Outside the main camp were two additional huts which , after many requests , we were finally allowed to use as hospital huts for isolation and treatment of the worst cases . All bunks were of plain wood . The P.O.W. had to produce and carry his own bedding . At each stage of his captivity a P.O.W. had to carry all his belongings no matter how weak or sick so that clothing and bedding were very scanty . This led to a reversal of the normal preference in Hong Kong for the winter to the summer . The number of beds varied slightly in each hut ; roughly they held 40 beds each with 21-3 feet between each pair of beds .
The camp site was in some respects unfortunate as the large dusty parade ground lay on the windward side , so the huts and food were constantly covered in windy weather with a fine dust , which was undoubtedly responsible for spreading much of the bacillary dysentery . In 1942 Hong Kong had a severe plague of flies , due to the breakdown in the sanitation system . Flies were seen in unbelievable numbers .
The camp personnel consisted of officers of the R.N .. R.N.V.R. , R.N.Z.N.V.R .. Hong Kong R.N.V.R. , and Dockyard Defence Corps ; Officers of the Middlesex Regiment , Royal Scots and Royal Engineers ; and later on Canadian officers from the Winnipeg Grenadiers and the Royal Rifles of Canada ; I.M.S. doctors and officers from two Indian regiments - the 2/14 Punjabs and 5/7 Rajputs ; members of the Hong Kong Volunteer Defence Corps ; and about 40 other ranks and ratings who were employed in the cookhouse , etc. The total number of P.O.Ws varied from time to time due to drafts in and out , but was between 450 and 580 men .
Diet consisted of boiled white polished , broken rice of the coolie grade - there are many grades of rice according to size of grain and the extent the grain has been broken in the threshing . The more broken smaller grains easily become a soggy , repulsive mass on cooking . Some rice meals were replaced by bread meals . Bread was baked in the oven made in the camp and we had about three bread meals a week . The bread was a very light brown colour .
The vegetables varied from year to year and according to the season . In 1942 we had many sweet potatoes - a valuable addition which became rapidly scarcer . " Greens " consisted of the various types of Chinese cabbage and spinach and ever - increasing amounts of chrysanthemums . In all fairness it must be stated that in the writer's opinion the Chinese " White " cabbage is unsurpassable for flavour . In summer we had also the acceptable egg plant ( Aubergine ) . We also had frequent supplies of a very large white radish ( Daikon ) which on boiling produced a most offensive smell and a most offensive flatus .
Boiled soya bean meals replaced the rice about twice a week . Soya beans require very prolonged boiling and even then are most indigestible . Animal protein consisted of boiled and , latterly , baked fish which was dealt out to the huts in rotation , as there was never enough to go round more than two to three huts at a time . The fish meal occurred about once every ten days and the ration was about six ounces .
Plain tea was supplied two to three times a day according to the fuel situation . Peanut oil and , later on , some ghee were provided each month . Peanut oil is excellent in flavour and practice , but ghee - Indian butter purified by heating - produces diarrhoea until the body gets used to it . We also had a small ration of sugar each month .
It must be emphasized that the diet showed a progressive decrease in quantity and quality all the time that the camp was occupied from 18th April , 1942 , until 20th May , 1944. For example , the sweet potato supply soon ceased for all practical purposes , while the chrysanthemum issues became larger and more frequent . More important , the quantity and quality of the fish deteriorated . The fish supplied became increasingly frequently the Canton Mud Fish . This fish looks splendid , but it has a taste that makes it inedible even to very hungry white men . After many experiments we turned it into a bouillabasse , heavily flavoured with curry powder . The soup was consumed by about half the camp and the other half lacked not only the soup but the vegetables that were put into it . Also when a really first-class fish was supplied - and some of the best fish in the world is found round Hong Kong - it was often in a decomposing state , and had to be buried at once . This disheartening scene was witnessed many times . However , the contractor had fulfilled his contract to supply so much fish a week .
The caloric value of this diet varied from 2,000 calories a day at the start and working down to 1,000 calories at times in 1944. The rations were delivered once a month . We then worked out the daily ration of rice , frequency of bread meals , and the amount of peanut oil we could issue to each P.O.W. A little food came into the camp via the canteen in 1942 and 1943 , but after that the food from this source was negligible . The canteen continued to supply cigarettes and curry powder , soya bean sauce , and condiments .
From about the middle of 1943 until the camp was evacuated a more valuable extraneous source of food was by food parcels . These were delivered in small sacks to the Japanese camp headquarters outside our camp once a week . After scrutiny , and frequent removal of some items , the parcels were brought into the camp . The P.O.W. recipients were the lucky few who had certain contacts in Hong Kong . We were allowed to send money out to these contacts , who suffered many indignities and great personal hardship in their errands of mercy . The parcels were widely distributed in the camp as P.O.W.s clubbed together to send out their money to these contacts . Much money also left the camp for the civilian internment camp at Stanley in Hong Kong where many officers had relations and dependants , and where the conditions were very bad .
Our final source of food was the camp garden and bird farm . Volunteers broke up terrible ground and produced tomatoes , sweet potatoes , lettuce , etc. Alongside this we made a small fowl and duck farm . We bought the initial Chinese type and Leghorn fowls , and ducks . The Leghorn fowls soon died of a fowl cholera epidemic , but the Chinese fowls and the ducks did very well . Latterly a good deal of thieving went on by the starving populace under the eyes of the Jap guards , which was very disheartening . The eggs were reserved exclusively for the sick .
The cookhouse merits a few words since it occupied such a large place in our daily thoughts . It contained three large kongs - in other words three small fire boxes for three large open boilers for which we made wooden removable tops . They exactly resembled very large coppers that used to be in all big houses for the family laundry . Two were used for rice and one for the vegetable soup . Outside the cookhouse was a smaller separate kong for boiling water for making tea .
Fuel was a constant , ever growing , anxiety . Large logs were supplied which had to be axed into the correct size by volunteers . The logs were then stacked at the back of the kongs along the exhaust flues so as to dry the wood and make it last longer . The wood became frequently camphor wood . This gave off a most irritating vapour while it was burning , and the cooks always had streaming eyes . We frequently missed meals because , although we had the rice , there was no wood with which to cook it . It is not too much to say that the fuel supply was almost as great a worry as the food supply . Several times the camp went without rice for twenty - four hours because we had no fuel . The hot-water boiler for the tea was run all through the summer months on dry grass gathered from the neighbouring hillside by a band of volunteers . who were allowed out for this purpose . Hot plain tea made a great difference to morale .
As the rice issued monthly to us became smaller and smaller we had to decrease the ration served at each meal and what was much worse we had to make one or two meals each day of rice porridge - a rice ground up and made into a thin type of porridge . The water was rapidly excreted of course .
I write with some knowledge on the diet and cooking , as in 1944 I was elected for three months as the sole naval and medical representative on the messing committee . This consisted of the messing officer in charge of the cooks and the actual cooking , an army officer , one other rank , and myself ; and for my last two months remained as medical representative on the committee .
All personal washing was done from cold showers . The latrines were of the squatting oriental type , but luckily we did have drainage and not cesspits .
Officers were paid in military yen according to their rank but very rapidly a scheme was evolved whereby all senior officers who had above a certain sum were taxed the rest of their yen for a fund which paid yen to the junior officers . This sum was necessary to allow the juniors to participate in the canteen and then , when this failed , in the food parcels scheme . Without the additional help from these sources their deficiency diseases would have become much more severe .
This completes a bare description of our camp , the personnel and the diet , etc.
There were eleven doctors in the camp . Medical meetings were held periodically to discuss our problems and the best means of dealing with them . Lieutenant - Colonel Shackleton , R.A.M.C. , was the senior army doctor , and Surgeon Commander Tincker , R.N.V.R. , was the senior naval one . For the naval side of the camp Surgeon Commander Tincker , R.N.V.R. , did all the clerical work . The Japanese demanded complicated lists before roll call each morning and evening .
Surgeon Lieutenant Dawson-Grove , H.K. R.N.V.R. , and I ran the sick bay . Dawson-Grove is a well-known and much-loved physician in Hong Kong , with whom , from this time until our final release in Tokyo , I worked with utmost confidence and friendship .
The sick bay , merely a cabin at one end of one of the wooden huts , had an electric sterilizer and some shelves . The volunteer dresser . D. C. Longeraine , H.K.V.D.C. , slept there so as to protect our small stock of drugs . Each doctor had carried into camp some items of medical equipment . Doctors were frequently drafted , but most of the time there were three naval , five army , and three I.M.S. doctors .
For drugs we were very badly off . We were indeed fortunate to have some thiamin which had been sent into the camp by a devious route by Dr. ( now Sir ) Selwyn Clarke , D.M.S. , of Hong Kong , who did untold splendid work during all his captivity . He also sent us in some peanut butter for the treatment of our pellagra cases . The Japanese supplied us at infrequent intervals with some drugs which were usually not what we asked for : many bottles of phenol would be sent in . Later on they did supply a little thiamin . As an example of how they would not help us in the simplest matters , one instance will suffice . In 1943 there was a severe , widespread outbreak of scabies , for which we had no sulphur ointment . Repeated requests to the Japanese produced none , so finally we got it via the food parcels by asking for sulphur butter . It was sent in labelled as peanut butter .
The army medical officers worked in the M.I. room , as they called it , from 9 a.m. to 11 a.m. and then Dawson - Grove and I took over for the naval sick . We worked side by side . The medical side of this work will be described briefly .
Patients reported with the usual minor ailments , but in addition we were plagued by the following specific P.O.W. complaints : Vitamin - B deficiency in all its forms - and at that time the symptoms due to each exact component of the B complex had not been worked out - was rampant . Electric or burning feet , which made the nights hideous as any warmth aggravated the pain ; red scrotal dermatitis , which sometimes became exfoliative , causing severe pruritus ; glossitis and dysphagia were common and made swallowing the rice diet very painful ; true beri-beri in most of its forms ; pellagra ; and cheilosis due to riboflavine deficiency , were all seen .
The following efforts were made to obtain extra vitamins of the B complex . A yeast culture was procured and , after a few initial errors , was kept alive and vigorous for the rest of the stay at Argyle Street . The yeast was cultured in two large wooden buckets which were kept warm at the back of the kongs in the cookhouse . One bucket was dispensed each day as a ration to the whole camp we lined up mug in hand . Deficiency cases received a double ration . The empty bucket was then half - filled from the remaining bucket and both were topped up with water , and flour and sugar were added to each bucket . By next day the yeast had become thick and creamy again .
The cooking of the vegetables was done under the supervision of an officer . Vegetables were cut up and then put into boiling water . The lid was replaced and the boiler brought back to the boil as rapidly as possible , and kept on the boil for exactly ten minutes . This was a compromise . We knew that the vegetables had been grown on human manure - the use of nightsoil is traditional in China-and so with that contamination , the handling in its preparation , together with the dust and flies , it must have harboured the various dysentery organisms . Twenty minutes boiling was recommended in the textbooks , but we could not risk so great a destruction of our chief source of vitamins . No case of scurvy was ever seen . Diarrhoea was common , but severe dysentery much less so .
A small supply of eggs came into the camp . For a few months the canteen supplied small Chinese eggs - one egg per person for about one-third of the camp each week . The supply soon stopped , but then the food parcels were organized and produced some ducks ' eggs . Finally our hen and duck runs in the camp garden were a mighty help . All eggs from any source were eaten raw , being stirred up in the rice . After an initial grouse the members of the camp accepted this medical advice most manfully , and soon got used to this dish . Soya bean sauce was excellent as a flavouring agent .
Another source of vitamins was the fruit - bananas , paw-paws and persimmons - which came in the food parcels . Lucky recipients were punctilious in putting a portion of their fruit into a pool , which was distributed by the doctors to the deficiency cases .
Considering the fact that we were living on a pure white rice diet - often as low as 1,000 calories - the health of the camp was amazingly good . The writer feels sure that this was partly due to the very strenuous efforts for increasing the vitamin supply from all possible sources , and to seeing that it was so fairly allocated .
Starvation cedema of the legs was very common and did not respond to thiamin . Eye symptoms became increasingly frequent and severe , and consisted of diplopia , haziness of vision , and inability to read owing to the rapid onset of eyestrain and fatigue and seeing the print in a jumbled manner , with missing letters . The inability to read was a great hardship to the older members , who had much unoccupied time , due to not being fit enough to work in the camp gardens and at other camp duties .
Dysentery occurred , but as we had no microscope it was impossible to be sure of the exact type . We also had several specific outbreaks of acute food poisoning from bad fish or other food , which produced forty to eighty cases of cramps and diarrhea , making people too ill to attend roll call .
There were two cholera scares , but although not familiar with true cholera I remain unconvinced that we had cholera in the camp . The Japanese took stool specimens from two cases of fulminating dystentery at different periods and reported both as cholera . Much unhappiness was then caused by segregating the hut from which each case had come , and by the insertion of a glass rod into the anal canal of every single P.O.W. for stool examination purposes .
For the treatment of dysentery in all its forms we had a little sulphapyridine and sulphanilamide , which had been brought in by the doctors . It was reserved for the very worst cases .
The extreme rarity of pneumonia and broncho-pneumonia in Hong Kong , compared to our later experience in Tokyo , was striking , and was due to the milder climate and the better construction of the Hong Kong camp huts . Malaria , as first attacks or relapses , was fairly frequent , and responded to quinine and atebrine . We had two cases of diphtheria , but luckily they reported early , were diagnosed early , and recovered . We had no anti-serum . The camp was throat - swabbed by the Japanese . Luckily we were spared the extensive epidemic that occurred at the neighbouring camp for ratings and other ranks at Shamshuipo , where there were many deaths from this cause .
Ascaris lumbricoides was widespread , as was to be expected . Luckily we had some santonin .
The surgical work consisted , apart from the operations to be described , of the usual septic conditions , such as boils , carbuncles , otitis externa and whitlows , etc. However , ulceration of the legs and feet deserves special mention . These ulcers were due , we believed , to minor traumata acting on devitalized skin . Everybody had a marked drying and scaling of the skin on this diet , which had such a very low proportion of fat . The ulcers were shallow and tended to spread superficially rather than deeply , unless they were allowed to crust over . Such ulcers would have presented no problem in civilian life , but they were a very real problem to us . They occurred most frequently on the shin and inner side of the leg . Treatment with saline , or weak sodium sulphate or 5 per cent . Gentian violet compresses would render the ulcer clean . The ulceration would then become chronic and if allowed to form a crust the obvious natural treatment - a disappointment lay in store for the patient : after seven to ten days the crust fell off , to reveal not a healed surface but a slightly deeper ulcer than before . Unless these ulcers were kept protected and moist from a compress until completely healed , they would relapse . This treatment was tried and found to be the only one successful analogous to a dog licking a sore .
Superficial septic lesions were common and were opened with a razor blade , without anaesthesia and then promptly healed . This was a contrast to the ulceration mentioned above .
Shoes rapidly wore out , and so wooden camp-made clogs or bare feet were the rule . A case of epidermophytosis was never seen . The dust of the camp kept the interdigital clefts dry , and therefore unfavourable to fungi . The civilization deformities of the feet - so common and so very unattractive in Europeans did not disappear , of course , but they gave no further trouble .
The hospital , which officially took our cases , was the British Military Hospital at Bowen Road . Hong Kong . This meant that the Japanese had to arrange transport from Argyle Street camp on the mainland to the transport . boat and from the boat up to the Bowen Road hospital on Hong Kong island . This gave them some trouble . Moreover , as a race they are terribly suspicious . We thought that they felt that one camp would encourage the other , and exchange any information that had leaked in . In any case they were most loath to transfer our sick to the Military Hospital . We regularly gave them sick lists for transfer , but when at last the transfer was arranged some of the original sick were better and fresh sick were not allowed to be substituted . It was therefore certain that if an acute surgical emergency arose we ourselves should have , in some way , to deal with it . There were a few instruments in the camp brought in by Surgeon Commander Tincker , R.N.V.R. - and several doctors had brought over a few tubes of catgut and some needles and thread .
The writer feared that at some stage in his captivity he would find himself without an anæsthetist and still be expected to do surgery . He had brought some phials of sodium evipan , a syringe and needles , a fine spinal needle and some phials of 1 in 1.500 Nupercaine . These were to prove of great value .
During the summer of 1942 our first case of appendicitis occurred in a naval rating . The Japanese were asked to transfer him to the Bowen Road Military Hospital . They refused , but instructed us to do the operation at the Indian P.O.W. camp . This P.O.W. camp lay one - third of a mile distant from our camp , and the road went downhill all the way to it . The P.O.W.s here were the Indian other - ranks and N.C.O.s from the 2/14 Punjabs and 5/7 Rajputs , who would not turn over to the Japanese ( who ceaselessly tried to induce them to do this ) . These loyal Indians were treated most harshly . There were many deaths in their camp .
Their camp had a large sick bay with two sterilizers and an operating theatre table . Our patient was carried down to this camp on a stretcher by four volunteers . Captain Strahan , I.M.S. , gave the anæsthetic there was some ether and a mask in the Indian camp - and Captain Woodward , I.M.S. , assisted me . The operation went uneventfully and was necessary . A razor blade was used for a knife , and Lieutenant A. H. Cobb , H.K. R.N.V.R. , very kindly lent me his nail scissors , as I had none . The patient was carried back to our camp and made a quick recovery .
Our second case occurred in the winter months . An army captain had . a perforated duodenal ulcer . The same procedure was followed , but he was not a very robust type and suffered much pain from the jolting trip . The sick bay was unheated . All these factors and the operation combined to produce much shock . It was decided to leave him in the camp that night to increase his chance of recovery . The Japanese corporal agreed to this proposal . Next morning the patient was brought back to our camp . He developed some bronchitis , but after that made an excellent recovery and had no further ulcer symptoms while I remained in Hong Kong .
Captain Saito , Imperial Nipponese Army , was in charge of all the medical arrangements for our camp , but he took only the slightest interest in us , and we saw him infrequently . When Captain Saito learned that the patient had remained overnight in the Indian P.O.W. camp he was very angry indeed , and this probably led to the change in procedure for the next operation .
Shortly afterwards we had another perforated duodenal ulcer from the army section , in a patient who knew that he had a duodenal ulcer . At the last moment Captain Saito told us that only the surgeon and anæsthetist could take the patient to the Indian camp . This meant that Captain Strahan and I had to carry him uphill back again . It was an exhausting business and very hard . on the hands . The patient did very well , but Strahan and I were determined not to get caught again , so we had made in the camp two leather slings with loops for the handles of the stretcher . We were thus able to carry the stretcher from our shoulders for the next case .
This case was a lieutenant in the Hong Kong Volunteer Defence Corps - a man of 60 who perforated in the summer months . He had auricular fibrillation and was a frail subject . Strahan and I carried him down , and I operated as before while Strahan anæsthetized . The patient recovered well for a time , but died a month later from a subphrenic abscess . This was the only case that I lost doing surgery in Hong Kong and Tokyo . We knew this patient probably had a subphrenic , and were able to get him transferred to the Bowen Road Hospital a fortnight or more before he died .
We thus had three cases of proved perforated duodenal ulcer in about one year in a camp of about 400-500 men . As I never saw or heard of a perforated peptic ulcer in over a year as a P.O.W. surgeon in Tokyo , the factor of mental stress can probably be excluded , as life in Tokyo was infinitely harder than it ever was in Hong Kong . The cause was probably the white rice diet . Our ration of cigarettes in Hong Kong and Tokyo was very meagre and similar , but the difference in our diet was very great - as will be explained later .
Our next emergency was a stoker suffering from atypical appendicitis . He had colic and suprapubic tenderness . After forty - eight hours ' observation he was reported to the Japanese , who agreed to our carrying him down to the Indian camp . At operation I found ileal obstruction due to a Meckel's diverticulum . This was the size of a man's thumb , and was folded back on itself , being attached at its apex to the root of the mesentery . This kinked the ileum . After freeing the apical adhesions the intestinal continuity was restored . As we had no intestinal clamps of any sort it was considered wise not to attempt to excise it . The patient made a speedy recovery and was warned later of his pathology . Recently I saw him in London at a reunion dinner , and learned that he had never had any further abdominal symptoms .
Our next patient was a man of about 50 in the Hong Kong R.N.V.R In civilian life he had long been a private patient for hyperpicsia of Surgeon Lieutenant Dawson - Grove , H.K. R.N.V.R. He was sleeping in the next bunk to his doctor . Dawson - Grove awoke me about 10 p.m. one night because he believed the patient had a perforated peptic ulcer . The diagnosis seemed certain to both of us . The Japanese were informed , but after a long delay Captain Saito sent a message that the patient could be transferred to the Indian camp next morning . This decision appeared to us to amount almost to a death sentence . We therefore boiled our few instruments in the cookhouse and operated on the patient in our isolation hut , under a spinal anesthetic.
The patient did not have a perforated peptic ulcer . However , the sequel is most interesting . He had a stormy convalescence , developing an abdominal mass which eventually discharged through the incision . The abscess contained . quantities of peanut oil , which was unmistakable . The patient's post - operative : diet had been rice ground up , and cooked to the consistency of a thin porridge , and then mixed with peanut oil . Once the abscess had discharged the patient recovered .
We believed that I had missed a piece of glass , which was working its way through the bowel at some point . This is not as unreasonable as it sounds . Very shortly before this the camp had been supplied with rice containing many pieces of glass fragments of all shapes and sizes presumably rice from a bombed " Go-down . " The whole camp was alarmed at this vicious rice . Later we completely solved this problem by the simple solution of washing all our rice on an inclined wooden shute which had little steps set all the way down - a commonly used method for separating gold dust from soil . In our case the rice was washed down and grit and glass were left in the angles formed by the steps . At the time of this case we were eating rice with spikes of glass , taking a long time over the meal , and ejecting the longer spikes .
Our final abdominal case was one of acute appendicitis in an R.A.M.C. orderly , which Captain Woodward , I.M.S. , did in our own camp , I believe under a spinal . The patient was soon back at work . I did one other operation in this same hut under spinal anesthesia . This last case was one of very severe long - standing , 3rd degree hæmorrhoids , which were excised in the usual manner . This camp baker was a most grateful patient .
Shortly after this operation the writer left the camp for Tokyo . One's abiding memory of the medical work at Argyle Street Camp is one of struggling against lack of equipment and supplies . The Japanese did not interfere with the medical work , and in fact showed almost a complete indifference to it , except when the question of cholera and diphtheria arose , and for the endless forms and classifications which they demanded .
The conditions in Tokyo were almost the exact reverse of this . Here the Japanese interfered with the running of the camp hospital at every point and would not allow us to exercise our discretion in using the meagre medicines , which they dispensed to us from the large store of Red Cross medicines actually available in the camp's storerooms .
My other abiding memory is of the great friends I made among the other doctors in Argyle Street , and of how completely free from bickering was the medical set - up there .
Early in May , 1944 , together with eight other medical officers , I left Argyle Street at half an hour's notice with such remaining gear as we could carry . For ten days we stayed at Shamshuipo , a ratings and other ranks camp in Hong Kong , and then a draft was formed of between 300 and 400 P.O.W.s , the nine doctors from Argyle Street and one other from Shamshuipo . We sailed for Japan and reached Osaka in June after stopping at Formosa en route . The ship was carrying scrap metal to Japan . We were crowded into one of the ship's holds . Platforms had been made about 12 feet wide . We lay side by side in rows facing each other , feet to feet . In the centre of the hold lay a pile of all our gear . We had no escort and were lucky to reach Osaka without incident . It may be recalled that the Lisbon Mara was torpedoed on such a trip in 1942 with the loss of 840 P.O.W.s.
Dysentery was rife . We were very thankful to entrain for Tokyo , where all the doctors and some R.A.M.C. orderlies left the draft for Shinagawa camp hospital . Here I stayed until liberated , and will describe the life and work in this hospital , which in 1945 became steadily more like a work camp .
Shinagawa was placed on a small island not far from a main railway terminus in Tokyo . To call it a hospital is to emphasize function rather than structure . At one time it had , in fact , been an ordinary work camp . It consisted of five long wooden huts for the treatment of the sick , a stores hut and a house where the Japanese N.C.O.s and privates and one of the two interpreters lived . Each hut for the sick contained four large rooms , two little cabins at the front end - one for the doctors and one for the orderlies and latrines at the other end . A corridor ran at one side of the hut from front to back . Sliding doors separated it from the sick rooms . Each room for the patients had a raised platform about 7 feet wide covered with straw Tatame mats . This platform ran right round the room except for the door side . The door led from the corridor into a space in the centre of the room which was about two feet below the platform , which was used for sleeping and living purposes . Patients kicked off their clogs before mounting the platform .
The Tatame straw mats were about 7 feet long by 3 feet wide . There were about eleven in each room . One slept with one's head to the wall and one's feet towards the centre of the room . These straw mats were infested by fleas in the summer and lice in the winter . The cracks in the wooden walls and ceilings harboured myriads of bed bugs . Mosquitoes were numerous in the summer . Our nights were much broken up by all these insects , added to which in 1945 there were frequent air - raid warnings . In contrast to Hong Kong , I can state that every member of Shinagawa felt perpetually exhausted . The latrines were of the squatting type . The dejecta passed through a hole in the floor into a concrete lined trench that ran underneath for the width of the hut , and which was a perfect breeding place for a great mass of flies . Keeping the latrines clean was a wellnigh insoluble problem there was no lighting at night -and many were the misfortunes that occurred there . The trenches were partially emptied periodically from outside the hut by dipping out the contents with a wooden bucket fixed to the end of a wooden pole . The contents were taken to the vegetable garden at once . Occasionally an outside firm came in to empty the latrines , but these visits almost ceased in 1945 .
All the huts were made of thin wood which was old and full of holes . This made the huts terribly cold and draughty in the bitter winter months . There was no form of heat . Neither was there any water in any hut . All washing was done at two wooden washstands . Each ran almost full length between two of the huts at opposite ends and sides of the camp . One side of one of the wash places was reserved for the tuberculous cases . The Japanese staff had their own little hut , with a central , large , Japanese - type wooden bath heated over a fire . In the winter of 1944 we were allowed to reconstruct a similar one , which had become derelict . The central bath tub was about 4 feet deep , and the temperature of the water was raised as high as it could possibly be borne . Washing was first done at one side of the bath hut , with the use of little wooden oval buckets , filled from the central tub . Then about six to eight people at a time entered the central big bath by climbing up some steps at the side . Each batch was allowed about 5 " in the bath . First the doctors entered , then the order lies , and finally the ambulatory patients . We had one bath each most weeks , and it was undoubtedly the highlight of each week . One felt really warm for about two hours after this . In summer one could wash with cold water as often as one wished .
Incidentally , the camp was swarming with rats . In the cold winter nights they were continually scurrying about the rooms and often over one , and on occasions I have been woken in the winter , as I lay in my blanket - roll , by a rat pulling at my hair .
As already stated , the Japanese headquarters was a house just inside the gate . In it worked eight other ranks and two interpreters , and Captain Tokuda and Captain Saito , who lived outside Shinagawa .
The medical staff , when we arrived , consisted of Lieutenant Gottlieb , U.S.N .. Medical Specialist ; Captain Weinstein , U.S.A. , Surgical Specialist ; Captain Keschner , U.S.A. , Pathologist ; Captain Clayman , U.S.A .; Lieutenant Davis , U.S.N. , C.E.C .; and Lieutenant Mohnac , U.S.A. , D.C. , Dental Officer and qualified Anæsthetist . Of the nine doctors from Hong Kong all were gradually drafted to P.O.W. camps in Tokyo , Yokohama , and Northern Japan except for Captain Warrack , Surgeon Lieutenant Dawson - Grove and the writer . We three stayed in Shinagawa until liberated . Warrack was put in charge of the dysentery hut , Dawson - Grove of the tuberculosis hut , and 1 after treatment for amoebic dysentery - shared the surgical work with Captain Weinstein . However , about the end of August , 1944. Captain Weinstein left for Omori - headquarters for P.O.Ws in Tokyo - where his ability and splendid morale were much appreciated . After his departure I was responsible for the surgery .
We had about 22 orderlies from the United States Navy , and United States Army . R.A.M.C. , and two British other ranks who had been proved to have initiative and energy far beyond the average . The number of patients varied greatly from time to time , but the average was between 160 and 200. They came from all nationalities fighting for the Allies , and had been captured from all the fighting zones in the Far East . A few words must be devoted to our two carpenters , because we owed so much to them . Harry Petterson , Scandinavian engineer , electrical engineer and designer , had been captured at sea by a German raider while working in a British ship . He was interned in Shinagawa . His immense ingenuity and ability enabled him to design and make much of our medical and camp equipment from the most meagre material imaginable Corporal Bowers , R.E. , A.I.F. , was a professional Australian carpenter . His skill and hard work were beyond praise .
The drugs at Shinagawa were all of American Red Cross origin , and were of a high quality . We were only allowed to prescribe within certain limits defined and checked by Captain Tokuda . The total allowed each day was drawn by an American naval orderly from the Japanese sergeant in charge of the drug store . We were also allowed to give plasma infusions with Japanese authority . Bandages were issued infrequently . The rule was that all bandages had to be washed , boiled and used again until they finally became mere tattered fragments .
Just outside the hospital gate was a warehouse bursting with Red Cross clothing and food parcels and other stores . The Japanese would not give them out except at rate intervals in trivial amounts . One instance will suffice to illustrate this state . A draft of P.O.W.s arrived in the winter of 1944/45 . Their ship had been torpedoed en route to Japan from the Philippines . They had travelled from Osaka in their underclothes and shirts with one blanket each . They could not stop shivering violently even for a few seconds . Captain Tokuda examined them individually in a most leisurely manner . No clothes were issued to them . We had to collect every available spare scrap of our own clothing for this purpose . After the capitulation the Japanese became frightened and issued clothing when it was too late .
In the winter of 1944 we were twice issued with American Red Cross food parcels . These issues worked out at one per man , and a few over which made a bank for the most desperate cases .
The diet in Tokyo , as in Hong Kong , became progressively worse in quantity and quality . Two Japanese other ranks were in charge of the storehouse and cookhouse . They issued the rations daily . There were six Allied other ranks cooks who did the actual cooking - even for the Japanese - but the doctors were not allowed to advise and regulate the meals in any way . We were forbidden to enter the kitchen . It was a great contrast to Hong Kong where we always felt that we were making the very best of our meagre rations . I would guess that the diet produced between 1,500 and 2,000 calories a day , but patients who could not work were on a smaller ration , and from 1945 the tuberculous patients were on half rations ! In 1945 all up - patients and staff had to do heavy manual labour . The diet consisted basically of rice , millet and barley . These were much less milled than the white rice of Hong Kong . Soya beans were supplied more frequently than in Hong Kong . The quantity and quality of the vegetables were much inferior .
The standard meal was made up of soup and either rice - barley - millet mixture , or soya beans , or bread , or new potatoes . The soup was flavoured with bones when these were available about three times a week and Mesu ( a salty paste derived from soya beans ) with a few beans and the vegetables . The vegetables varied according to the season . The winter vegetable was the large white radish ( Daikon ) , as in Hong Kong ; the summer mainstay was sliced pumpkin , but in summer we also had green vegetables grown in the camp gardens . The new potatoes as the second course were disliked because , although pleasant to eat , the water in them was rapidly excreted , leaving one feeling weak and hungry . The rice - millet - barley mixture was easily the most sustaining . Soya beans are tasty , but are very hard to digest , even without dysentery . They were frequently simmered all night in an effort to make them softer .
The bread in 1944 was inadequate in amount , but palatable . All too soon it became inedible . The contractor learnt the same trick as our fish contractor in Hong Kong . He delivered mildewed , decomposing bread which , if eaten , caused severe colic and diarrhoea . The Japanese were repeatedly shown this bread . In 1945 we built our own bakery - as in Hong Kong - and baked our own bread . This was palatable , but the ration amounted to only two thick slices per day .
Our cooks had always collected the bones from the meat market , and in 1945 they were careful to say that they were English or they got no marrow fat bones at all . When in 1945 the transport in Tokyo broke down , we had , as well , to fetch our vegetables from the vegetable market about twice a week . A small party of us wearing clogs and loin cloth , with or without shirt , would walk with two Japanese as escort - the 1-13 miles to the market . This was a very pretty sight . On a roofed - over space lay mounds of golden pumpkins , red tomatoes , the purple egg - plant ( Aubergine ) and sweet potatoes . We loaded some of them on to our handcart , and returned along roads which , after the great American fire - raids , were flanked by mile after mile of burnt rubble . Only a few concrete buildings remained standing . The inhabitants seemed apathetic rather than hostile .
We started extensive gardens just outside the camp in 1945. A hard , stony waste ground was broken up . It looked hopeless for gardening , but we underrated the power of night soil , in spite of Chinese experiences . The spinach and cabbage were grown in rows with small trenches on either side of each row . The night soil from the camp was put into the trenches - never dug in - and in the hot Tokyo summer quickly rotted down . The vegetables thrived ! Every available piece of ground in the camp was also turned into garden . The smell of night soil permeated the whole camp .
It was most distressing that , after growing the vegetables , we were allowed no say in when they should be gathered or in what quantity . They would be brought into the store - house , left there for days deteriorating , and then we would get several meals with a glut of vegetables , after having had soup with none at all for some time previously .
The officers had large quantities of military yen , which were useless except to buy a few gramophone records . No food could be bought in Tokyo . I still have some thousands of these yen .Except for that from our gardens , the only extraneous food that ever came into the camp was a dog that walked in , and was stewing in the pot within half an hour .
Our cooking was done in kongs , but early in 1945 all fuel supplies stopped . We then had to obtain our own fuel . In the water surrounding the hospital floated many tree trunks . These had been thrown into the sea for safety.
Some trunks broke loose and drifted past our island . As soon as one was spotted some of us were sent swimming for it . We pushed it alongside a pon toon that lay just outside a part of the hospital wall , hauled it with infinite toil from the sea over an eight feet high sea wall into camp . The trunks were then split up and axed by a special wood party . Many hours were spent by the writer swimming for tree trunks in Tokyo Bay , and in sawing lumber .
This concludes the briefest outline of this squalid camp , which was hot and malodorous in summer and bitterly cold in the winter .
All up - patients had to be lined up each morning and evening for roll call , which was in Japanese . Everybody had to know how to number quickly . In 1944 Lieutenant Davis reported to the Japanese N.C.O. , but in 1945 the doctors detailed as camp representatives the writer was one for three months took it in turns to report ; we detailed the total number of P.O.W.s , the number of up - patients , the number of bed - patients , and patients in the guard house . After this the Japanese N.C.O. would go to each hut in turn and hear the up - patients number in front of it , and then go into each hut and hear each room number . Lack of smartness or inaccuracy in numbering produced a scene of face - slapping . Neither mittens nor gloves were allowed . Chilblains of cars and hands were extensive and very painful .
The camps from which our patients came varied greatly in the degree of their inhumanity . The patients were always emaciated and exhausted whatever their specific complaints were . Many of the camps in Northern Japan were mining camps , which were bitterly cold in the winter . Neither food , clothing , nor footwear were in any sense adequate for the climatic conditions .
The patients came in batches , following one of Captain Tokuda's visits to the camps in his district . The patients were examined by us in front of Tokuda , and this performance was repeated from time to time until Tokuda ordered their discharge . We had to suggest to him which patients were fit for discharge . One felt very heartless in picking them out , but room in Shinagawa had to be made for new arrivals . Moreover , improvement alone could be expected in the deficiency cases . In 1944 patients were most loath to leave Shinagawa , but in 1945 when our conditions deteriorated rapidly , their attitude changed . In the summer of 1944 staff and patients did not have to work very hard , but from the autumn of 1944 everybody had to work hard and for very long hours . We arose at dawn and worked until late evening on the gardens , getting and axing wood , emptying latrines , making a big air - raid shelter for ourselves , and many small ones for our blankets and other stores , and making a small lake for our hand - worked pump . Patients too ill to do this heavy toil worked at lighter duties in a little packing and sorting factory established at the back of the camp . Work continued irrespective of rain . It must be remembered that no patient had any change of clothing .
The disturbed nights in 1945 aggravated our fatigue . On hearing the siren we had to dress at once and go to the shelters . These were originally trenches dug inside the camp . We squatted in them in spite of the fact that they often contained much water . The patients were frequently too weak to maintain this squatting position and much face - slapping ensued . After many representations we were allowed to build one big air - raid shelter which was designed by Petterson . Work parties went into Tokyo to collect the wooden beams , which formed the skeleton for this shelter , from destroyed buildings . The whole framework was made on the mortice and tenon method with the use of hardly any nails . The shelter was , in fact , necessary . In the last of the great fire raids our tuberculosis hut was set alight but the fire was soon extinguished . The " Go - Downs " just outside the hospital gate were on fire until the dawn , in spite of the herculean efforts of the whole camp , staff and patients . We feared the flames would spread into the camp .
It seems incredible in retrospect that the Japanese made us do physical exercises for 15 minutes daily after the morning roll call . All the medical staff took turns as instructors .
As for the purely medical work at Shinagawa , I feel hardly qualified to write because , although I saw patients on arrival and discharge , I was not in such intimate contact with all phases of their treatment as in Hong Kong . The following generalizations are fairly accurate .
The tubercular patients suffered greatly from their segregation and reduced rations . They were pitifully thin . Surgeon Lieutenant Dawson - Grove did everything humanly possible for them , including artificial pneumothorax work . Some cases were referred to me for phrenic crush under local anesthesia . Tragically , in 1945 Captain Tokuda took over this hut . After that two Japanese N.C.O.s occupied the front bunk , and we were not allowed to enter the hut except by their permission . Tokuda experimented on the patients whose morale naturally deteriorated . It is understood that Tokuda was subsequently executed for these and other crimes .
The adjoining hut for the most severe and acute general medical cases was under the care of Lieutenant Gottlieb . U.S.N. , who worked whole - heartedly for his patients . In the next hut Captain Clayman , U.S.A. , looked after the more chronic and convalescent medical cases . In these two huts were cases of beri - beri , chest diseases , cirrhosis of the liver , nephritis , infective jaundice , etc. The beri - beri was of a different sort to that seen in Hong Kong . We did not have the frequent glossitis , cheilosis , scrotal dermatitis , " electric feet " and pellagra which plagued us there . In Japan the disease appeared to affect particularly the posterior and lateral spinal columns . By contrast , pneumonia was common and our greatest worry . It was the classical lobar or multi - lobar form which we see relatively seldom in England today , and which never occurred in Argyle Street . Most cases responded to massive and prolonged doses of sulphonamides .
Cedema due to protein deficiency , with or without vitamin - B deficiency , was very prevalent . I believe that it was almost entirely a starvation cedema . My own spread all through 1945 from the toes , which it first affected , until it reached the lower part of the thighs . It would almost disappear with a suitable posture . I lay at night on boarding , supported on a trestle at one end and on a higher level window ledge at the other . As the fluid left one's legs painful cramps occurred in the calves . Massive doses of thiamin and nicotinic acid made no difference to this cedema .
Liver damage from starvation was undoubtedly common . We had five cases of cirrhosis proved at post mortem , and in some of them the liver had shrunk to an extraordinary extent . In autopsies for other conditions the liver was large and yellow , while the great omentum was a slender vascular membrane without a trace of fat in it . The next hut was always full of dysentery cases . The stools were examined in the pathology room under the direction of Captain Keschner . U.S.A. Three negative reports were needed before our cases of amoebiasis could be submitted for discharge . In 1945 all dysentery cases were sigmoidoscoped by me or Captain Tokuda prior to discharge . Fresh stool specimens were then obtained and examined forthwith . I must record that I have very seldom seen amoebic : ulceration and never an amceboma . Dysentery cases could seldom be said to be cured relapse was so frequent . Under the conditions of the dystentery . hut reinfection must have occurred frequently . The treatment was under the direction of Captain Warrack , R.A.M.C. He found that sulphadiazine was more effective than sulphaguanidine for the bacillary dysenteries . There was very little emetine and no E.B.I. The chief drug for amoebiasis was carbasone , which was alone available in adequate quantities . We were not impressed by it . Many of these patients were suffering as much from their malnutrition as from their chronic relapsing dysentery .
Our pathology department consisted of a small room adjacent to the operating theatre . Captain Keschner , U.S.A. , was in charge . He had two microscopes and simple laboratory equipment . Post mortems were done by him , while on a few of the most unusual cases Captain Tokuda arranged for a friend , the pathologist to Tokyo University , to do the autopsy . This Japanese appeared most deft and expert . A list of the causes of death at Shinagawa is appended at the end of this report .
The surgical work suffered likewise from Japanese interference . From the end of August , 1944 , I was nominally responsible for the surgery . but no case could be operated on without Tokuda's permission , unless he was out of the camp , when his senior N.C.O. gave the permission . Tokuda may have been . a " Jack - of - all trades , " but it is certain that he was master of none . Repeatedly he would operate on appendicitis cases , pull much small intestine out , and fiddle about for a long time , getting more and more angry and muttering in Japanese : " Strange , strange . " He would then ask me to take over the case and would leave the theatre . I never once saw him find the appendix . As an example of his interference , an Australian patient arrived and was diagnosed as appendicitis . Clinically he appeared to have malaria and this was proved microscopically . Tokuda insisted on doing an appendicectomy in spite of our advice to the contrary . A normal appendix was removed . Luckily the patient came to no harm .
The theatre was small and contained a little electric sterilizer which was adequate for the set of instruments in use . The instruments were American Red Cross supplies and of a high standard . The table and light were good enough . Gowns , towels and gloves were steam - sterilized in an autoclave made by our carpenters . Water was boiled electrically in one container , and the steam led into the base of an adjacent large tin containing the above items . The steam escaped by pressing up the lid of this autoclave , around which was a wooden box packed tightly with sawdust . This produced articles which were sterile but most unpleasant to wear as they were hot and damp .
The temperature of the theatre was that of the climate , as no form of heat was ever obtained . In the winter of 1944/45 we had much snow . Patients were carried from hut to theatre on a stretcher and returned likewise , getting chilled on both journeys . The anesthetics with one exception for a case of severe burns were all spinals ; at the start procaine crystals dissolved in patient's C.S.F. , and latterly pontocaine . Lieutenant Mohnac , U.S.A .. D.C. , gave these anesthetics to perfection . I never once saw a severe post anesthetic chest , which is a great tribute to spinal anaesthesia under these icy conditions . Lieutenant Mohnac was an ideal colleague , to whom I shall ever feel grateful .
The surgical cases were housed in the hut next to the dysenteries . Most were straightforward . Emaciation , coupled with dysentery and heavy labour made hernia and hæmorrhoids exceptionally common . The chronic leg ulceration that was such a feature in Hong Kong was never seen in Tokyo . The complication that worried the patients was intestinal cramps . These patients were very hungry on admission and , in spite of all advice , they could not resist eating their meals . So they ate their rice immediately after their appendicectomy or hæmorrhoidectomy or herniorrhaphy , etc. The cramps were severe , but seldom caused vomiting .
A list of operations is appended at the end , so that only three special cases will be described here .
A sergeant in the Royal Scots had been in Shinagawa some time before my arrival . He had pyloric stenosis , and was considered inoperable . He certainly was very emaciated , weighing only 46 kilograms ( 101 lb. ) . One of the camp cooks , who was exceptionally strong , volunteered to give blood for a transfusion . The patient was given a pint . Luckily it was decided to wait two days before the proposed operation . He had a severe reaction and developed ascites and generalized cedema . However , he gradually returned to his former state . He was then given a course of gastric lavage at night . Very little food was passing the pylorus . At last the great day came and he was explored . He had a healed duodenal ulcer that had almost closed the pylorus . A gastro - enterostomy was performed . It was made difficult by Captain Tokuda - who was assisting constantly getting in the way . However , the patient did very well , put on some weight , and was able to return to his mining camp two months later . He had been particularly unlucky , as he had had two severe attacks of amabic dysentery while at Shinagawa .
The next case of note was a patient who had been producing large quantities of fetid sputum for some time . He also was very ill . Surgeon Lieutenant Dawson - Grove localized the lung abscess in the right upper lobe , and I resected parts of two ribs at the side of the chest and most luckily found the necrotic gangrenous area at once . A considerable amount of this was excised without producing any bleeding and a large tube was inserted . To my delight the patient did very well and was later discharged back to his camp . As I had had very little experience of lung surgery , apart from empyemata , this case was particularly gratifying .
The last patient of note was Dutch . He was admitted with anasarca . Captain Tokuda lanced his legs at the ankies to let out some of the cedematous fluid . When the patient was first shown to me some time later he had obvious crepitant gas gangrene in both legs below the knees . Extensive longitudinal incisions were made and the pus that poured out had an odour only to be described as similar to that of a neglected pigsty . Large areas of skin sloughed , but he survived , and when last seen in an American Hospital ship was making rapid progress .
The only death on the surgical side following operation at Shinagawa occurred in a Dutch patient , who was admitted with very extensive 2nd degree burns of the front of the chest , arms , thighs , head and neck . The burnt areas were very dirty . He was given a general anesthetic , and the areas cleansed and treated with a gentian violet jelly ( Red Cross supplies ) . The patient was given several plasma transfusions and appeared to be doing well . Unfortunately , it was in the depths of the winter , and after about five days he developed extensive pulmonary consolidation and died .
Looking over this description of our work at Shinagawa I wonder if the picture has been painted too blackly , but I do not believe so . The following incident will show the atmosphere in the camp .
In 1945 the Japanese refused to take the dead away for cremation . This had been the practice . The ashes were returned to the camp in a small wooden box which was labelled and put with the others in one of the rooms of the stores hut . Suddenly we were ordered to cremate a body in the camp and were not allowed to do it outside . Much argument ensued , but finally it had to be done . We did our best and it was not easy without apparatus . It was known as " the Shinagawa Barbecue . " As this depressed the patients so much . Tokuda finally agreed to our building an apparatus close to the camp garden , and here all future cremations were performed by us .
To look at the reverse side of the picture - what was the brightest memory of Shinagawa ? Until early in 1945 all the P.O.W.s administrative work , detailing working parties , ventilating camp grievances , fighting the patient's battles , keeping of records , taking the roll call , etc. , was done by Lieutenant J. R. Davis , U.S.N. , C.E.C. His worth was universally recognized , but it was not until he left us for Omori camp that the magnitude of his achievement and his complete selflessness were revealed to us . After his departure his work had to be done by the medical and dental staff of the camp . He will remain an abiding memory to all of us who worked with him at Shinagawa .
As for regrets , one naturally has personal regrets that one did not manage to do more for the patients . We all regretted that we could not do more scientific work under these conditions . We longed to be able to do blood chemistry , and find out the levels of plasma proteins , potassium , and other ions ; and so be able to differentiate between specific vitamin deficiencies and the results of simple starvation on such an unbalanced diet .
Even without the aid of modern science and proper surgical instruments and medicines , a great amount can be done by improvisation , and it is a tribute to human endurance and the amazing resilience of the body that so many men , women and children survived even worse conditions elsewhere .