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MEDICAL EXPERIENCES IN SIAM (Thailand)

The following is an abstract of the experiences recorded by Capt. S.S. Pavillard, Medical Officer of "D" Battalion of 650 prisoners of war sent from Changi, near Singapore, to Siam by the Japanese as a working party. The period covered is from April 1942 to August 1945.
(It should be presumed that the writer, when referring to D Battalion is referring to the more commonly known "D" Force which was one of many "Forces" sent into Thailand)

The march of 15 miles from Changi to Havelock Road, Singapore, proved very exhausting. The men carried all their kit and had for the previous three months been on a starvation diet. Many fell out of the line of march suffering from "black outs" and heat exhaustion. On our arrival at Havelock Road Camp we found that conditions were deplorable in every respect. The complete absence of latrines was responsible for the ground being fouled and for the outbreak of bacillary dysentery. Washing and cooking facilities were totally inadequate and the whole camp area had been used as a refuse dump by the local Asiatic community. The morning after our arrival one of the men was found to have died during the night from cardiac beri beri, which no doubt had been precipitated by the gruelling ordeal of the previous day.

Arrangements were immediately made to clean up the camp, but the men were still grossly overcrowded in the bug and louse-infected huts. Consequently many slept in the open. The men were worked as coolies and although the rations showed some improvements on Changi standards, this was not sufficient to prevent the widespread outbreak of deficiency diseases, particularly beriberi and pellagra. These conditions prevailed throughout our captivity and the men lived on the threshold of avitaminosis. Any great exertion or fatigue invariably caused an outbreak of beriberi and pellagra. The men were "paid" at the rate of 10 cents a day representing approximately 1/6d per week and out of this sum essentials such as soap had to be bought.

The most prevalent diseases were beriberi pellagra and bacillary and amoebic dysentery. Practically the whole camp suffered from scrotal dermatitis (B deficiency). This caused great irritation and resulted in a weeping dermatitis. Diphtheria was prevalent at the time and many men contracted diphtheric scrotums. We had brought a very limited supply of drugs from Changi, which were soon exhausted. The Japanese gave us no drugs whatsoever, but at our request allowed us to make purchases locally.

On October 12th, we left Havelock Road and marched to Singapore Station carrying all our kit. Here we entrained in covered goods wagons- 32 men to a truck, the floor area of which was about 18 ft by 7 ft (5.5 x 2.15 metres) There was not even the most primitive sanitary arrangements on the train and on arrival at Seremban, our first stop after a journey lasting some 13 hours, we must have provided excellent entertainment for the local populace. This exposure of our men to ridicule was repeated at every halt on our journey through Malaya and Siam. There was a great shortage of drinking water and washing facilities were non-existent.

On our arrival at Ban Pong on October 17th, we were marched to a camp sited in a paddy field which was completely under water. This was the first opportunity I had had to hold proper sick parades. There were many cases of diarrhoea and dysentery and one case of diphtheria. The hut that went by the name of "hospital" was flooded to a depth of 2ft. (61 cm) and was grossly overcrowded, the patients lying on bamboo platforms 2 to 3 in. (5 to 7.5 cm) above the water. The water was full of mosquito larvae and there were many cases of malaria. As a result of my sick parade 20 men were left behind when, next day, we started on our long march up-country.

Throughout our captivity everything had to be carried on our backs. Therefore our drugs were split up into small parcels and carried by volunteers. The experience of later parties proved the wisdom of this method, for in the majority of cases parties left their medical supplies at Ban Pong on the understanding that the Japs would forward them by river transport. Of course the supplies were stolen by the Japs and the parties never saw them again. We took two days to march along the made-up road from Ban Pong to Kamburi (some 39 kilometres). During the march many men suffered from heat exhaustion and stomach cramps due to loss of salt by sweating. Some became so exhausted that I ordered them to fall out; they were collected into groups and were later picked up by Japanese lorries. During the march the Thais gave us fruit, salt, aspirins and quinine. The only water available was from roadside wells and could not be boiled or chlorinated. During later stages of our march through the jungle, men drank from stagnant pools which were often full of mosquito larvae.

On our first night's stop and again the second night the men were in a very exhausted condition and a great number were suffering from foot blisters. My orderlies and I were dressing feet until 2 am. The Japanese tried to force us to march again the following day, but when I repeatedly pointed out that some 250 men were quite incapable of moving they dropped their bullying tactics and the next day we rested. In view of the physical strain which the men had undergone, I decided thoroughly to examine every one. Many complained of tightness of the chest and difficulty in breathing; and, on auscultation, tachycardia and extrasystoles were found. As a result I reported to the Japs that 150 men would still be unable to continue the march the following day. This report brought forth the usual tirade and bullying attitude; but I pointed out that any deaths would be the direct responsibility of the Jap commander and once again he climbed down. The 150 men remained in Kamburi and rejoined us some time later at Wampo, having made the journey up-river in barges. It is of interest to note that the average age of the men was 35 years and the average time of residence in the East was one year.

The next day we marched through flooded paddy fields before reaching the jungle. The Japs often lost the way and this meant that several times we retraced our steps for many weary miles. At that night's stop at the village of Rajah we found cover for only 100; the remainder slept out and there was heavy rain during the night. There was no provision for feeding except a supply of uncooked rice and an adequate supply of drinking-water was not forthcoming. We had to collect firewood and boiled the rice, which made the first meal since 9 o'clock that morning. After the usual argument we rested the next day and when we resumed the march, seven men were left behind owing to sickness. They too joined us later on. This day's rest did much to restore the men's spirits and they were able to wash themselves and their clothes for the first time since leaving Singapore.

The following day we covered 20 kilometres to the river crossing at Tardau. The route lay through thick jungle and we used footpaths and bullock-cart tracks. We were up to the knees in mud and many men lost the soles of their boots. This day's march was the worst we had experienced but the men's spirits remained high. Many of the stronger men helped their comrades and carried their kit. On arrival at the river crossing we were met by a fanatical Jap officer who, armed with a heavy bamboo stick (with which he satisfied his sadism), herded us into parties of 40 to cross the river in barges.

CONDITIONS AT WAMPO CAMP

A day later we arrived at Tarsau, whence we were sent down-river by barge to Wampo, some 30 kilometres away. Wampo was to be our home for the next 7 months. Our task was to build a section of railway 12 kilometres long, with a viaduct and bridge at each end. Much of the track had to be hewn out of solid rock. The camp consisted of two huts apart from Jap accommodation. Therefore some 67% of the men were forced to sleep in the open until more jungle had been cleared and other huts built. The camp eventually held 1,500 men. The food consisted of plain boiled rice three times a day: there was no tea, sugar or salt. Many men fainted on parade and at work. "Black-outs" were very common and occurred when one stood up quickly after stooping or sitting. Gastro-intestinal disorders were on the increase, as was malaria. We managed to obtain two tents, into which we crowded 50 of the worst sick in order to protect them from the rain. We were unable to obtain prophylactic quinine and had the greatest difficulty in getting it for specific treatment. The Japs eventually supplied 9 gr. (O.5g) per day for five days as a full course; consequently relapses were frequent.

About a week after our arrival at Wampo the first death occurred. The man was a Lance Corporal of the 2nd Gordon Highlanders, who died of acute bacillary and, I suspect, amoebic dysentery followed by a perforated bowel.

On Oct. 28 Capt. Richardson, R.A.M C., reported a case of appendix abscess. The man's temperature and pulse were rising rapidly and it was considered necessary to operate and drain. We had of course no operating room, but constructed a bamboo table in the M.I. room. We had practically no surgical instruments at all (I had been unable to acquire any in Singapore). In fact, we had only three pairs of artery forceps, one pair of scissors (rusty), a few surgical needles and some catgut. Worst of all, we had no knife. I decided to use a cut-throat razor. and I must admit that it was one of the sharpest instruments I have ever employed. As an anaesthetic we used chloroform. Before the start of the operation the Jap M.O. arrived from Tarsau and I asked him if he would assist me or give the anaesthetic. His answer was a silly grin accompanied by the remark that he would just look on. Pte. Riley, R.A.M.C. administered the anaesthetic while Capt. Richardson assisted. The abscess was located and drained.

The camp was now taking shape and we had built a hospital to accommodate 100 men. We had in addition a dysentery wing holding 50. Jungle clearing progressed and the hut accommodation increased daily. The sanitary arrangements rapidly improved and this did much to reduce the incidence of dysentery We were also one of the first camps to have meat, which we bought locally from the Thais. This amount was small, but was privately supplemented with lizards and snakes. These were quite appetising and python steaks tasted rather like fishy chicken. Iguanas were also good, but difficult to catch.

As already stated we were 1,500 strong and after 7 months of hard manual labour we had lost only 15 men. Three of these deaths were due to drowning. Other and less fortunate camps were at this time losing anything from 60 to 120 men per month. In due course I was allowed to set off down-river with the Jap camp commandant and succeeded in buying £800 worth of drugs, including 100 kilograms of peanuts. Prices were very high: 1 tablet of sulpha-pyridine cost $l (in three years it rose to $35) and emetine cost $12 per grain (65 mg.) rising in three years to $100. The arrival of these drugs did much to boost morale. The camp was now finished and parties started clearing jungle for the railway.

DISEASES PREVALENT AT WAMPO

A month after our arrival at Wampo the most common diseases were: malaria (daily on the increase), beriberi (neuritic and oedematous), tropical ulcers, amoebic dysentery (bacillary dysentery had shown marked decrease), diphtheria, pellagra (early signs - i.e. stomatitis, glossitis and skin rash). Among these were some interesting clinical cases, but owing to lack of paper it was impossible to keep notes. We didn't have enough specific drugs to treat all cases; therefore these had to be withheld until the patient's condition was desperate. It was often a very difficult decision to know when, and to whom, to give specific drugs, as so many cases were in need of them. However, by cutting down the recognised dosage it was often possible to tide a patient over the acute phase of his disease, though convalescence was usually prolonged.

In amoebic dysentery it was found that 2 gr. (0.13 g) of emetine would convert an acute E.H. to the more chronic stage of E.H. cysts. This often brought about a cessation of blood and mucus and a rapid improvement in the patient's health. We had no microscope at Wampo and diagnosis depended on clinical findings. The. diphtheria patients often developed pharyngeal paralysis and whenever they swallowed any fluid it regurgitated up the nose. I cannot help feeling that there was mixed infection with Vincent's angina and as I had at the time some N.A.B. a few patients were given 0.45 g. intravenously, with remarkable results, for the membrane disappeared and temperature dropped to normal in a very short period. Yet had a case been only Vincent's angina one would not have expected pharyngeal paralysis to develop, but in most cases, whether they received N.A.B. or not, it did. The Japs would give us no antidiphtheritic serum. In spite of that out of 20 diphtheria cases we lost only two men.

The work on the cliff face was proceeding slowly and the Japs brought in a further 2,000 P.0.W.s. This marked the beginning of what was called "the speedo period". Everything was done at the double; the weekly half-day was abolished and the men had no chance to wash or air their clothes. Scabies, ringworm and other skin conditions were rife. The huts became a living mass of bugs and lice. Tropical typhus, beriberi, pellagra, malaria, dysentery and tropical ulcers were all on the increase. The hospital was full and sick personnel had to work as orderlies. The Japs now started paying officers $20 a month, half of which went towards buying extra food for the hospital - eggs etc.

The men, who were paid 10 to 20 cents a day according to rank, also contributed a proportion of their money. On my original trip to Kamburi I had bought some sacks of rice-polishings and on our advice the Japs eventually included these in the rations. We were able to give each man ¼ pint (14.2c.c.) daily and there was a marked decrease in the incidence of beriberi.

OUT BREAK OF CHOLERA

We started up-country at the end of April, 1943, "D" Bn. leaving last. After marching 40 kilometres we arrived at our next camp, Tonchan South and here we first encountered cholera. Information was received that it had broken out at Takanum, some 100 kilometres further up. Full cholera precautions were immediately taken and lectures given, so that when the infection started, as it did on June 8, the men were well acquainted with all its manifestations and there was no panic. I am glad to be able to say that, although "D" Bn. was at different times in three of the worst cholera areas, we lost only 7 men. Considering that some battalions lost up to 50% of their strength, I cannot help feeling that many contracted the disease through sheer ignorance of elementary hygienic principles. Not only was this apparent with cholera, but with dysentery, malaria, etc., the average O.R.'s sense of hygiene was very poor. I was fortunate in having with me in "D" Bn. educated men - lawyers, chartered accountants and business men - who made up 70% of our strength and they could be trusted to carry out advice given.

We found that the camp at Tonchan South was grossly overcrowded and men were sleeping in leaky tents. Sanitary arrangements were totally inadequate and parties were still arriving. In all there were 3,000 P.0.W.s and about 2,000 Asiatic labourers in an area of less than half a square mile (1.3 sq. km.). Soon after our arrival the Jap camp commandant (S/Sgt. Hirumatz) asked me why there was so much sickness. I urged him to let us have a larger sanitary squad, as we were allowed only one sanitary orderly per 500 men. I also warned him of the danger of cholera breaking out, particularly as the coolie labour force washed in the only stream at a point above that at which we were able to draw our water. He would do nothing about it and blamed the men for contracting diseases, saying that they did not wear shirts at night (the majority had none), but wore G-strings. Three days later Hirumatz sent for me and to my joy was in the throes of a malarial rigor. I passed the obvious comment, but he saw no humour in the situation and wanted to be treated I may add that except at Tarsau there was no Japanese medical officer at any camp and consequently we had to treat Japs and Koreans. To have refused would merely have brought serious repercussions on our own sick. Only very seldom did the Japs contribute small amounts of their very inferior drugs.

Before leaving Wampo I had asked for anticholera vaccine and had been refused. However, on April 7, I walked to Tarsau and succeeded in getting some. On the following day, back at Tonchan South, I was asked to see a case and it was the perfect textbook example. This case was reported at once to the Jap commandant, who ordered us to move the man to Tarsau. We argued that such a move would only help to spread the disease. He threatened us, but, fortunately for the men of Tarsau, three more cases were diagnosed within an hour and Hirumatz, by now thoroughly frightened, sent for the Jap M.O. from Tarsau. On his arrival the M.O. agreed with us and we made a small clearing in the jungle, where we pitched the one (leaky) tent available. The men were taken there on improvised stretchers (a rice sack slung on two bamboo poles). By night we had 10 cases, some had died. We applied for more tents, larger parties for clearing and grave-digging but all our requests were refused. The camp commandant said that nothing could be done and the men must be allowed to die. We were therefore forced to take tents from fit men (leaving them in the open) and make up grave-digging parties with officers and the sick. Deaths were occurring at such a rate that we had to dig pits within 30 feet (9.14 m.) of the tents, having too few men to clear jungle.

The coolies were dying like flies and many fled only to die in the jungle. Our working parties were constantly finding and burying the bodies while going to and from work. The Japs moved the coolie cholera tent next to ours; these coolies had no doctors or orderlies and were allowed neither food nor water. Their cries for water were pitiful to hear. However, our orderlies passed both food and water to them without difficulty. The Jap guards were so terror-stricken as to be useless. Three times a day a Jap orderly, with two of our sick men, went to the coolie tent and ordered the removal of the dead and dying. These were dumped into the pit, both dead and alive, along with our dead. The pit was then lightly covered with earth and the stench of putrefaction was terrible.

Some six weeks before the outbreak I had constructed, as a precaution, a small plant for distilling water for intravenous salines. It was a very primitive affair, the condenser being a coiled rubber tube inside a hollow bamboo in which cold water was circulated. The boiler was a 4 gallon kerosene can. Unfortunately it exploded one day, scalding the operator; but it was soon replaced. Within 24 hours of the outbreak we were able to give intravenous salines. The plant was producing 40 pints (22.7l.) daily, and eventually double that figure. The giving bottle was a jam-jar connected to a needle by a rubber tube. It was almost always necessary to cut down to the vein to insert the needle, as the vein was completely collapsed. We had no local analgesic to inject around the skin before cutting, but fortunately most of the men were insensitive to pain. In addition to salines patients were given potassium permanganate 3 gr. (0.2 g.) wrapped in a cigarette paper and swallowed every ¼ hour. Selected cases were given sulphapyridine with what appeared to be satisfactory results.

CONDITIONS UP-COUNTRY

On July 1, 1943, 550 men were ordered up to the dreaded Kayu No.3 camp, where they were to work on a cutting 90 ft. (27.4 m.) deep through solid rock. This place was known as Hell Fire Corner. Conditions in the Kayu area were truly appalling; at the river camp there were some 500 living skeletons barely capable of movement. They were awaiting evacuation to Tarsau and were all suffering from the usual beriberi, malaria, dysentery, pellagra and tropical ulcers. During the previous three months there had been 100 deaths each month. Our camp was to be in this Kayu 3 area and sanitary conditions there were a nightmare. We cleared the camp area in torrential rain and erected our leaky tents.

It will be indicative of conditions to outline the course of the stream from which we drew water for all purposes. At its head it ran through a camp of 500 men of "H" Force. They had already lost 220 men from cholera. It then ran through a coolie camp where also there was cholera. From here it ran along the side of a track and was used as a watering-place for elephants. It then entered the original Kayu 3 Camp, containing 500 men - 35 had been lost here owing to cholera. Their cholera compound was on the opposite side of the stream to the camp. Therefore anyone leaving the compound for the camp had to walk through the stream in heavily contaminated boots. The Japanese had strictly and vindictively forbidden the construction of a bridge. Three days later one of our cooks who was washing sweet potatoes in the stream absent-mindedly chewed a piece; he developed cholera in the morning and was dead in the evening.

We were in the Kayu area for three weeks, during which time we had 7 cholera cases, of which 4 recovered. It in not surprising that after this period when men went to work at 8 am and returned at 6 o'clock the following morning, we had 250 heavy sick out of our total of 550. Another party of 500 also had 250 heavy sick and this party moved into Kayu 1 where a hospital and doctors wore available but no drugs. The "fit" men of "D" and "F" Bns were moved up to Kintock for further work and I went with the sick to Tonchan Main Camp, whence I hoped to evacuate the worst cases to Tarsau Base Hospital. I myself was at the time suffering from amoebic dysentery; the last emetine had been used on an acute case some weeks before.

It was now that Hirumatz repeated the behaviour which we had already suffered from at Tonchan South. It was his habit to parade the sick in all kinds of weather and at any time of the day or night. He was under the delusion that he could find fit men among the sick. He frequently accused men of malingering and administered terrible beatings.

On Sept. 3, 1943 I moved north to Kinsayok with 250 of my heavy sick who had been refused evacuation down-river. A few days before leaving, I received a consignment of drugs from the Swiss consul via Mr. Pong. The money to buy these drugs in the black market in Bangkok was subscribed by the European residents, among whom were many Germans and Italians. Conditions were better than anything we had known since Wampo, but they were marred by Sgt. Okado, the Jap medical sergeant. This man, known as Dr. Death, repeatedly beat up the sick and also the doctors, whom he said were responsible for the numbers of sick.

On Jan. 14, 1944, a party of 500 men, mostly "B" and "D" and "F" Bns., were sent to a small camp on the river-bank in order to haul barges through the rapids. I went with them as M.O. The work was easy, but we had practically 100% of malaria. After six weeks these men were sent down to Tarsau and I was ordered back to Kinsayok. On my arrival there I found the camp overrun by rats, many of which were dying from what the Japs said was bubonic plague. The whole camp was turned out to kill rats and in six weeks we destroyed 10,000. Typhus had now started and we had many cases.

On April 1, I went down with tropical typhus and have never felt so ill. There were several other cases and we were moved under an improvised awning. The heat at this time was intolerable - in fact so bad that clinical thermometers registered 104°F throughout the day. The only way to ascertain a patient's temperature was to take it first thing in the morning or last thing at night. For 17 days I had fever and this was followed by malaria. I had lost so much weight that I was forced to sell my fountain pen to the Thais, for which I got $25 and used it to buy eggs. Throughout our captivity almost everyone was forced at one time or another to sell personal valuables in order to supplement rations. A great deal of Japanese equipment (chungkols, shovels, axe-heads etc) was also sold. The risk was heavy, as penalties were exacted with animal ferocity.

In May and June large parties of heavy sick arrived from Tarsau and Chungkai, bringing, fortunately, a number of doctors with them. On June 6 we received the first consignment of food and drugs from America. Much of the food and a large proportion of the drugs were appropriated by the Japs; even so, what we received was a godsend. As an indication of the scale of Japanese thieving, we received one parcel for every 6½ men, although we knew that one food parcel per man had arrived.

Month after month of the appalling conditions, during which time men were not allowed to report sick at an early stage of their diseases, rendered their ultimate cure difficult or impossible even if specific drugs were available. When men were eventually allowed to report sick the clinical picture was usually complicated by the fact that the patients were suffering from several diseases at the same time. Furthermore, they had lost interest in things around them and the will to live. I have on many occasions argued and reasoned with the unfortunate men, but they were exhausted beyond the limits of human endurance. Even today we are still fighting to save some of the pitiful human wrecks who have survived the last three years.

At Christmas we were allowed a pantomime. It was a great show, and cheered everyone up. We heard that officers and men were to be separated; the men felt this keenly, for we had worked side by side for the past 3 years and the officers had always stood between the Japs and their men. On one occasion Major Clark, in the course of an argument with the Japs, was struck heavily and his eardrum was ruptured, this injury gave him much trouble.

On May 12, 1945, we started our journey to Pratchia, 110 kilometres the other side of Bangkok. We travelled as far as Non Pladock in open trucks in very heavy rain. At Non Pladock, as usual, no arrangements had been made. We spent the night in two semi-collapsed huts which had previously been used by coolie labour. The huts were indescribably filthy.

On the 14th, after crossing the river by barges, we waited four hours in blistering sun (most men had no shirts) for the Bangkok train to arrive. The river water was too dirty to drink, so we chlorinated water from adjacent paddy fields. At 1 p.m. a meal was brought to us from a nearby P.O.W. camp. This was to be our only meal until we reached Bangkok Docks the next morning.

At 6 p.m. we arrived at Bangkok goods station, which had been heavily blasted by our bombers. In a few sheds left standing were Jap fighting troops on their way to Burma. The whole area was full of bombs, ammunition, mortars, etc. We embarked on barges at 10 o'clock and made a 7-hour trip down the river to Bangkok Docks and prayed there would not be an air raid. This trip was in keeping with all journeys organised by the Japs - extremely uncomfortable - there were 50 men per small barge. We arrived at about dawn and had at once to unload the junk which the Japs seem to find indispensable on any move (wood, petrol, some rice, etc.). We finished this job by 9 o'clock and were allowed 20 minutes for a meal which was provided. Immediately afterwards the men were split into working parties and sent to construct emplacements and defences of all kinds in the dock area and in Bangkok. I had 70 sick by this time but the Japs would allow only 50, so I had to pick out the 50 worst cases.

Early in July we received a small consignment of American Red Cross drugs (our second and last during our captivity). After the armistice had been signed we discovered that the Japs had been withholding 35 cases of drugs and hundreds of blankets.

CONCLUSION

At long last the signs that the end was near became evident. On Aug. 16 we noticed Japanese troops burning papers and in the afternoon there was a parade of their camp staff. When the parade was over some Korean guards signalled across the barbed wire the information that the war was finished.

As an indication of the incidence of sickness among P.O.W.s it is of interest to note that during the period of our captivity I saw an average of 120 cases a day; while at Kayu this figure rose to 500 a day.

Our evacuation to Bangkok was delayed by the arrival of 450 P.O.W.s who had been in contact with smallpox. These men had been marching since June and had covered 600 kilometres.

On Sept. 8 Lady Louis Mountbatten visited the camp and shook most of us by the hand. She was the first white woman we had seen for 3½ years.

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