There are several references to diphtheria in the early pages of Notebook B (the third notebook since arriving in Singapore but the second at Changi) though it is not until page 53 that an explanation is provided.

Diphtheria

During August & September 1942 there was a diphtheria epidemic  at Changi.  Many men were affected & although comparatively few deaths occurred the symptoms appeared more severe than the type prevalent in Britain.  Chiefly the nose & throat were affected and membranes were produced in both areas.  Occasionally tracheotomy was necessary to facilitate breathing.  In many cases, however, men reporting sick with… Pellagra were found to be suffering from Diphtheria (K.L.B.) organisms.  Also in other sores, such as sores in the nose, although the usual symptoms of diphtheria were not present.

Book B, page 53

Earlier he had noted that a good gargle for diphtheria was potassium permanganate, 1 in 10,000, and that cardiac trouble seemed to be a complication of diphtheria presumably due to the increased exertion caused by the growth of membranes across the throat (page 3).

Peanut butter as a laxative

February 7, 2010

I doubt whether my father tasted peanut butter before arriving in Singapore, or even knew what it was.  It would have been a rarity in English shops before the War and for that matter some time after it.  Even at Changi he didn’t seem to know what to call it but wrote a note about its laxative properties, at least when on a rice diet.

On the following page he provided a recipe.  As usual, the language is more that of the scientific observer than the gourmand.

Peanuts

An appetizing way of serving these is to grind them up with a pestle & mortar until the oils are caused to form a vehicle for the remaining solids & a thick paste is obtained.  This paste may be spread, like butterscotch, on toast or bread & butter.

Book B, p.4

A Changi Christmas

December 23, 2009

My father was admitted to Roberts Hospital with pellagra on November 9, 1942 and not discharged until February 5, 1943.  He kept daily notes on his condition and treatment but the only time he permitted himself any observations of the world about him was on Christmas Day.  The following notes are reproduced more or less in full though a few unreadable words and passages have been omitted.  He crams a lot into them.  The one comment I’d add now is that they include the only reference I’ve been able to find to the Alexandra Hospital incident  in any of the notebooks other than the three eyewitness accounts that I suspect were written down near to the end of his captivity.

Xmas 1942

Roberts Hospital, a patient with Pellagra, the B1 vitamin deficiency disease – indulging in too much polished rice to the exclusion of cereals & other good things.  Complicated with Tinea Cruris & tertiary infection of Diphtheria & other odds & ends.

Passed a miserable night, having been tortured by the relays of bed bugs which have their homes in the crevices of the bed & mattress & which I am at present quite powerless to eradicate.  However, managed to get off to sleep during the early morning & slept soundly until about 8.30am when I was awakened by the sound of tea mugs being deposited on the tray. A lovely cup of hot milked & sweetened tea followed (the first “official” one for about 6 months)

Later had breakfast of cornflour porridge (sweetened) followed by Tomato (complete with skins & pips) & a thin slice of tongue (unheard of!).  Also 2 slices of rice bread (4” x 2”) the one with army butter (margarine?) the other with pineapple jam (v. good).  Somebody heard to say “You lucky patients”

At this time Ack Ack Williams Pte. popped in to wish a Merry (if possible) Xmas.  I reiterated that I would not add “many of em.”

Contemplating partaking of a noxious Kum Lan cigarette made of cherry leaves  & costing 15c in the Canteen (a rise of some 500%!) –  product of Godfrey Philips India Ltd. Victory V Cigarettes  (which incredibly depicts a V over the rising sun).

At 9.30 a service started over in the next ward accompanied by a rather unsteady accordion. Starts of with “Come Ye, Come Ye to Bethlehem” (rather impossible in the circumstances).  Preaches something about Peace on earth & goodwill towards men (somewhat ironical) & continues with Lord’s Prayer “Give us this day our daily bread”(!)

Toffees (very sticky but very acceptable) distributed to each man.   Another 2 followed out of the blue given by Red X officer who wished me Merry Xmas.   A second pkt of Victory V cigarettes & biscuits followed.  Scoffed many biscuits & sweets.

Bill Sayer came in later in morning & said what an awful breakfast he had.  Couldn’t eat it.  Mabela (?) was full of maggots, biscuits were made of rice & like leather.  Coco  had no sugar & little milk.  Lent me a novel “The Arches of the Years” by Ethel Boileau (Hutchinson & Co London) which incidentally originally belonged to one Carlyle Morier  a sanitary inspector not residing at the POW camp Changi.

Bill’s visit interrupted by Company Officer & RSM Painter who came to wish me a Merry Christmas, a quick recovery & gave a pkt of 3 Castle’s cigarettes & smoked one each.

“Get ready for the first course”– pea soup, clear (& good) followed by the 2nd & 3rd courses.  Tiffin consisted of a slice of pork (tender & thin & easily cut with the spoon) sweet potato & local pumpkin set in thick brown gravy.  Somebody protested that the latter had been made with burnt rice but the server indignantly replied that he could assure him it was not & added that if this f—–g sauce hasn’t got some rum in it I’ve picked a (unreadable).”  This sauce was poured over a goodly block of excellent Christmas pudding.

After some reading of Bill’s book Williams came in said tiffin was lousy.  Consisted of a cup of bully beef 1 ¼ inch square, 2 thin slices from a small beetroot, & split pea soup & no sweet.  His temper was cooled down however by a piece of Christmas pudding given him legally for his ward, a couple of Cheroots for his Wardmaster.  I fed him on toffees & a cigarette.  Left later to attend a concert in his ward.  Talked of field kitchens, roast duck, boiled rice biscuits et. al.

Continued to read ‘The Arches of the Years” with breaks for toffees, biscuits & cigarettes throughout the afternoon.

Tea consisted of milk sweetened tea but with no bread.  Then there was also no Marmite or indeed treatment of any kind (the MO looked in about dinner time).

Dinner consisted of only one dixie, Cornish pastie (m & v in rice pastie) rice, a few long beans & a slice of Yorkshire pudding.  Also a mug of milk sweetened tea.  Took the rice to keep me in trim.

Read Bill’s book till Bill Batty came in.  Brought 2 tangerines (I asked for a couple of mangos for Christmas the last time he visited with no hope of seeing them.  Even now it is doubtful of their origin).  Also a promised book “Days of Our Years” by Pierre Van Paassen (?) (Angus & Robertson Ltd, London, 1940) also some peanuts to eat while we chatted.  Chatted of old times in Malaya, the war & the Alexandra Hospital tragedy & the loss of Arthur Collins & his pal Sidall who I relieved at Tekong.  Later conversation interrupted by Farrant coming in for his daily evening chat.  Conversation soon changed to watches, one Batty gave to F with hand missing.  Belonged to Bill Brandt who capped the lot by also appearing on the scene.  Soon left on pretext of Batty to go to the boreholes.  Farrant remained to eat part of tangerine, peanuts & a cigarette.  Talked of news – advance in Burma, 100 mile road with 50 bridges cutting off water. Later turned to architecture & chances of getting out of here.

After cup of coco made bed!  Later Ack Ack Williams came along & started to tell some jokes but was soon interrupted by McNeil (orderly) who came along with the red hot news that the Russians were moving south along the Polish frontier.  Lights out went soon after.

Book D, 17-18



That my father devoted nineteen pages to the treatment of dysentery within a couple of weeks of arriving at Changi gives some indication of the incidence of the disease and the challenge facing the improvised hospital.  The pages illustrated below indicates the treatment for “very weak” patients as including colonic lavage, Kaolin, glucose saline, Virol and arrowroot or custard along with Bovril which was obviously still available.
Still, providing treatment in such conditions was only part of the challenge.  Flies were a ubiquious problem, for example, and patients were expected to do their part in eradicating or at least reducing them.

The general practice at Roberts during these early weeks and months included the following:

Precautions against the spread of the disease may be summarized by (1) the elimination of flies (2) personal hygiene.  In more detail these precautions include:

(1) The killing of all flies in the ward and sanitary annex.  This is done chiefly by swatting: many of the patients can help in this respect.  Fly papers, both hanging & placed on the ground, are also used but these are more of a nuisance than anything else.  Swatting should be carried out all day on & around the beds. The fly papers are more or less permanent & when full are replaced by new ones.

(2) The protection of all food from flies. All feeding jars, mugs, cups and utensils are covered after use with squares of gauze.  Bulk foods are stored in fly-proof cupboards, preferably with well ventilated gauze front & for sides.

(3) The protection of all excreta from flies.  All bedpans & urine jars, vomit bowls, spittoons etc. must be emptied immediately after use & rinsed out with cresol solution.

Book A, 56-57

Roberts Hospital

November 7, 2009

But back to Changi.

It was only in 1941 that the British military installation on the promontory was completed.  In fifteen years, as H.A. Probert describes it in his History of Changi, “a piece of virgin jungle had been transformed into one of the most modern and best equipped military bases in the world.”  Given the lack of air defense in Singapore, he continues, it was also essentially obsolete.

Roberts Barracks became the hospital for the prison camp.  Formerly housing the Royal Artillery it had to absorb sick and wounded prisoners from across the island, including those from Alexandra Hospital which the Japanese had commandeered.  Given the bombardment it had taken during the invasion it was in no condition to do so.  Water supplies, sewerage systems, buildings and roads had been severely damaged.  This is how my father put it in a note written towards the end of the war.  “To such a camp, with all of its essential services disorganized, the whole of the ‘white’ patients of the Malaya and Singapore garrisons, complete with their medical & associated personnel & multifarious supplies, converged.  It is hardly surprising therefore that for some days chaos reigned, with its accompaniment of hardships, pestilence & death.”

The Australian artist Murray Griffin completed a painting of Roberts Hospital while he was a prisoner at Changi.  Visit the Australian Memorial web site to view the image: http://www.awm.gov.au/exhibitions/sharedexperience/AWMART24491.asp.

My father was posted to Roberts precisely two weeks after the fall of Singapore.  if he had not found the rest of the Royal Army Medical Corps (RAMC) before the invasion, presumably he did now.  I have no idea what his duties were at Roberts; he never talked about them, nor do his notes make any reference to them.  Yet he writes a good deal about the kinds of diseases that always threatened to overwhelm the hospital — well, did overwhelm it — particularly, dysentery, malaria, beri beri, dhobi itch and pallegra.  When he himself became a patient at Roberts on at least two extended occasions, he wrote about that too.

Dhobie Itch

July 12, 2009

Given the tropical climate, camp conditions and meager diet, POWs at Changi were soon succumbing to a variety of digestive and deficiency diseases.  Many also suffered from fungal complaints such as ‘Singapore foot’ (athlete’s foot), ‘tropical ringworm’ and ‘dhobi itch.’

My father contracted dhobi itch — a fungal infection of the groin — within weeks of arriving at Changi.  His early notes contain a number of descriptions of the condition as well as questions about its relationship to other infections.

I am quite convinced that this is the same thing as Tropical Ringworm….  There is a greater inflammation at the perimeter of the infected area;  inside this area the skin is scaly & flakes off, very similar although not so marked as Tropical Ringworm.  Why does Dhobie Itch persist so long compared with Tropical Ringworm?

Book C, 69

There is considerable itching during both day & night, particularly before going to sleep.

Book C, 76

It would be interesting to find out whether these diseases can be eradicated by changing the body surface conditions as for instance:

(1) wearing little & loose clothing, or the opposite

(2) Pyrexia

Book C, 89

I have not yet succeeded in infecting the rest of my body from the dhobie itch…by drying with a towel after showers.  It seems therefore that they are two distant species with specialized habitats.

Book C, 170

When the rash is disintegrating apply TR. BENZ CO: SAL AC. 10g to 1 oz.  This is not too strong.

CHRYSOPHANIC ACID is very strong & should be used with care.

Book C, 171

Rice polishings

July 4, 2009

The technology of rice polishing preceded the discovery of Thiamine with the consequence that B1 deficiency diseases such as beriberi were already widespread in the Far East before World War II.  Among the documents my father somehow managed to bury and retrieve (twice given his move to the POW camp at Krangi) was a series of public health pamphlets put out by the Straits Settlements during the late 1930s.  One of these was based on a radio talk by Ida Simmons who held the remarkable title of Public Health Matron in Singapore.  Published in 1940 it focused on the problem of beriberi and infant mortality on the island.

“In addition to hundreds who die, others drag out a miserable existence suffering from malnutrition, lack of energy, retarded growth; and are totally destitute of the joyousness of a healthy childhood.”

If more nutritional forms of rice were not available, the pamphlet went on to point out, it was essential to supplement polished white rice with foods rich in B vitamins such as milk, eggs, fruit and vegetables.

Maggots, lime, grit and dust aside, this would not be much of an option for the POWs at Changi and elsewhere. One strategy was to gather  the residues of the milling — the rice polishings — and then administer them as a dietary supplement.  None of the principal ways of doing this were particularly pleasant.  Here is how my father described it sometime in 1943.

Rice Polishings

This is the brown bran-like dust which is obtained during the polishing process of rice.  It consists of outer skins of the grain & also includes the embryo.  It contains an abundant supply of the vitamin B & is consequently used to eliminate certain deficiency diseases such as beriberi  & pellagra.

The polishings have not been subject to any subsequent treatment such as cleaning or sterilization. In fact, live beetles occur commonly in the material.  The polishings are kept in cardboard boxes.

The daily dosage is 2 heaped tablespoons & one 1/2 tablespoonful: this is to be divided into two parts and taken once in the morning & once in the afternoon.

The best ways of taking the polishings are:-

(1) Mixed with 3/4 pint of water with 1/2 dessertspoonful of sugar added

(2) Mixed with coconut milk

(3) Mixed with boiled & broken rice in morning breakfast (sugar added)

(4) Neat

The polishings must not be subjected to heat.

Book B, 80