Illness and death
One of the symptoms of cholera is a white stool ... This fellow looked down and saw a milk-white motion; and he saw that I saw it. He just gave me a look and it went right through me; it was the look of a condemned man. He knew he had it. He was dead the next morning.
[Ray Parkin quoted in Hank Nelson, Prisoners of War: Australians under Nippon, Sydney, 1985, 53.]
Disease was the foremost cause of death on the Thai–Burma railway. Almost all prisoners fell ill as a result of excessive work, malnutrition, poor food and the refusal of the Japanese to provide sufficient medical supplies.
Workers often suffered from more than one disease at a time. Only the critically ill were allowed to rest. Men who would have been considered seriously ill in civilian life had to continue working.
Dysentery and diarrhoea caused more than a third of prisoner-of-war deaths. Most prisoners experienced one or both of these illnesses at some time. Their continuous passing of stools caused dehydration and drained them of vitamins essential to their survival.
The lack of a varied diet made avitaminosis (diseases caused by vitamin deficiency) widespread. The most common illnesses were beriberi and pellagra caused by a lack of Vitamin B1 and Niacin respectively which were absent from white rice, the main food supplied by the Japanese.
Pellagra, which caused skin lesions and diarrhoea, was known as ‘the four Ds’: dermatitis, diarrhoea, dementia and death. The symptoms of dry beriberi were wasting and partial paralysis. Victims experienced tingling in their hands and feet, loss of muscle function, vomiting and mental confusion. Wet beriberi — more common — caused oedema (severe swelling). As Stan Arneil, a member of F Force, recalled:
The symptoms were swollen feet and legs as the moisture contained in the body flowed down towards the feet. Ankles disappeared altogether and left two large feet almost like loaves of bread from which sprouted legs like small tree trunks, in bad cases the neck swelled also so that the head seemed to be part of the shoulders.
[Stan Arneil, One Man’s War, Sydney, Alternative Publishing Co-operative, 1980, 278.]
Gallery: medical drawings of tropical ulcers
– click images to enlarge
Gallery drawing 1: A photograph of an advanced tropical ulcer on the leg of a POW at Tha Sao. [AWM P00761.010]
Gallery drawing 2: A medical drawing by Jack Chalker of a tropical ulcer which has eaten away to the bone. [AWM 90889]
Gallery drawing 3: A medical drawing of a tropical ulcer which has eaten away to the bone. [Painting by Jack Chalker, AWM 908854]
Malaria caused around 8 per cent of deaths on the railway. Carried by mosquitoes its symptoms were chills, fevers and weakness. Victims could experience recurring bouts, even after the war.
Tropical ulcers caused only 2 per cent of deaths on the railway but were particularly loathed. Caused by the infection of wounds by microorganisms, they would eat away flesh to the bone. Even the smallest scratch might develop into an ulcer. Rowley Richards, an Australian doctor in Burma (now Myanmar) remembered these painful wounds as ‘shocking’:
as if some kind of animal or acid has been eating its way through flesh, exposing the bone. On the surface, the dead tissue is black and dry, while the dying tissue is a yellowy brown, with pus and moisture visible even deeper into the wound.
[Rowley Richards, A Doctor’s War, Sydney, Harper Collins, 2005, 168.]
The treatment for ulcers was agonising. Ulcerous material was scraped from the wound by a spoon without anaesthetic. Men might also dangle their legs in the river where the fish would eat the rotten flesh. Often amputation was the only option. But without proper medicines and equipment, many patients died.
Cholera, extremely contagious and with a high mortality rate, caused about 12 per cent of prisoner deaths. Spread by food and water contaminated by faeces, it was prevalent in the wet season when latrines overflowed. The symptoms were horrific:
Our friend Freddie is rolling on the ground doubled up with severe stomach cramps, his arms and legs twitching and jerking as his muscles seize up. Then his body erupts with vomiting and a violence forced rush of fluid from his bowels, whitish fluid the colour of rice-water.
[Ian Denys Peek, One Fourteenth of an Elephant, Sydney, Pan Macmillan, 2004, 202.]
With severe loss of fluid, cholera victims became unrecognisable in only a few hours. Victims were tagged when diagnosed, so they could be identified later. They were also segregated in separate huts or camps if possible. Those who died were immediately cremated.
The Japanese feared cholera as much as the prisoners did. This was one of the few diseases for which they provided medication, testing the men with the ‘glass rod’ anal inspection and proving anti-serum.
With deaths occurring most days during the ‘Speedo’ period of mid-1943, each camp would have its rough cemetery. Medical personnel kept details of the grave sites of the dead, so that their bodies could be recovered and identified later. Funerals were held with as much solemnity as possible.
Somewhere back in the jungle came the notes of the Last Post. The babbling murmur of the camp stopped and all the men outside stood still… The acrid smell of the pyre drifted across the camp and, in the smoke, another man was gone.
[Ray Parkin, Into the Smother, London, Hogarth Press, 1963.]
The Japanese allowed the burial of dead prisoners, and in some cases attended funerals. Though indifferent to their prisoners’ suffering in life, they respected them when dead.