Medicine on the Burma railway: lessons from the past

Prisoners of war (POWs) of the Japanese in the Second World War suffered overwork, undernutrition, harsh treatment and exposure to tropical diseases. Not surprisingly there was a medical aftermath for surviving POWs, and the Liverpool School of Tropical Medicine (LSTM) led clinical care and medical research.

Over 4,000 ex-prisoners have been seen in Liverpool since late 1945 – the Far Eastern Prisoners of War (FEPOW) project being led initially by Dr Dion Bell and later Professor Geoff Gill, both tropical physicians and RCP London fellows. For decades after their release, the Liverpool team saw relapses of malaria and dysentery, neurological syndromes due to vitamin deficiency, and chronic worm infestations. Additionally, at least 40% suffered psychological problems now recognised as post-traumatic stress disorder (PTSD). This work became the longest clinical and research collaboration (over 70 years) in the history of LSTM.

Over the last 15 years, LSTM has turned to recording the medical history of the POW experience in the far east. Professor Gill was joined by Meg Parkes as research associate, and she interviewed over 60 surviving veterans to record their POW experiences, stories of survival and post-war experiences.

On the notorious Thai-Burma railway, POWs faced numerous medical challenges and battled to overcome them with little in the way of drugs or medical equipment supplied by the Japanese. The railway was some 400 km long over inhospitable hills and jungle. It was built by a workforce of 60,000 Allied POWs – the majority of which were British – and 20% died before completion, mostly from exotic diseases such as malaria, dysentery, cholera, beriberi and tropical ulcer.

Faced with this medical crisis, ingenuity and innovation became the order of the day. Operating tables and dental chairs were constructed from bamboo. Intravenous drip sets comprised discarded Japanese beer bottles, stethoscope tubing and sharpened hollow bamboo ‘needles’. Vitamin supplements were made from grass and leaves (‘jungle spinach’) or yeast cultures (‘camp marmite’). This – and much more – relied heavily on support from camp workshops, staffed by prisoners who in civilian life were carpenters, metalworkers, plumbers – or even occasionally scientists and engineers. This so-called citizen’s army gave great support to the POW doctors and saved countless lives.

Tropical medicine has learned much from POW medicine, particularly on the remarkable longevity of tropical infections and malnutrition acquired early in life. Military medicine has also drawn from POW experience and research, in particular with regard to screening and treatment of military personnel returning from recent conflict zones in tropical countries, as well as the early detection and appropriate management of combat-related PTSD.

The oral histories recorded by Meg Parkes have formed the basis of the books Captive Memories (M Parkes & G Gill), published by Palatine Books in 2015, and Burma Railway Medicine (G Gill & M Parkes) from the same publishers and released in June 2017. This new book begins with medical experiences of the fall of Singapore and Changi POW camp, explores disease and its management on the Burma railway, and ends with the medical aftermath referred to previously, drawing on the extensive experiences of the LSTM.

Geoff Gill and Meg Parkes, Liverpool School of Tropical Medicine

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