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

Rice

June 20, 2009

During the first few weeks of captivity at Changi the POWs were still heavily reliant on the food supplies they brought with them.  This gave the meager meals a certain eclectic quality.  On Saturday March 21, just over a month after his capture, my father described his rations for the day as follows:

Breakfast

Small portion of tinned bacon, Heinz beans & tomato sauce

Boiled rice

3 biscuits

Mug of tea

Dinner

Boiled rice & a little tinned pineapple boiled up with it.

Tea

Boiled rice, either curried or plain, with a little local vegetable & corned beef added.

Mug of tea

It was more than a week after assembling the POWs at Changi that the Japanese delivered the first rations.  These consisted largely of rice.  As Brian MacArthur describes it in Surviving the Sword, relief was short-lived as the rice was maggot-infested and in any case consisted largely of broken grains, husks and gravel.  It was also dyed yellow and smelled strongly of sulphur.

Even had the rice been of reasonable quality, it would have still presented a challenge.  In Britain at least, the pre-war cuisine — if you could call it that — had little place for rice.  My father was completely unfamiliar with it, except as rice pudding.   Not that he cared for it very much.

The notes from March and April 1942 express a certain curiosity edged with wariness.  They also indicate early concerns about the possible health implications of a rice-based diet.  There would be much more about that to follow.

Rice should never be soaked for longer than 1 hour, but must be washed thoroughly.  When boiling the rice the grains must not be “packed” in the boiler.  Otherwise they will tend to cluster themselves in hard lumps & eventually retain heat so that they “burn.”

Limed rice can only be told when in the sack by tapping the latter with a stick when the lime dust is caused to come out as dust.

Malaya does not grow very much rice & most of it has to be imported for home consumption.  It is to keep out grain-eating insects during transit & storage that the lime is added.

Rice causes constipation.

Book C, 118-119

Rice should always be steamed, not boiled.

Rice obtained from the bottom of the pan, which is usually burnt, is much sweeter than the remainder.

Eating of large amounts of rice causes the passage of large quantities of urine (due to the large amounts of water absorbed by the rice).

Book C, 126

Undercooked polished rice, if eaten in quantity, is liable to cause jaundice.

Book C, 137

Polished rice is entirely white & shiny & slips easily through the fingers. Unpolished rice shows longitudinal streaks of brown on the surface, giving the whole grain a matt finish.

Rice boiled with coconut milk is said to be very delicious.

Book C, 148



Anti malarial drains

June 13, 2009

 

Latrines, incinerators, Otway pits and anti-malarial drains; besides food and disease, these were the main notebook topics (and presumably preoccupations) during the first few weeks and months at Changi. Such was the prevailing necessity. But the notes also reflected my father’s interest and training. He had developed a passion for natural history as a teenager and had already published a few notes in the The Entomologist’s Monthly Magazine and elsewhere. As far as I can tell, his drawing skills were largely self taught though he had done a number of technical illustrations for the Bulletin of Entomological Research while working at Farnham House Laboratory. He had also qualified as a sanitary inspector before the war and had been trained to do anti-malarial work with the RAMC.  In any case, he returned to the topics again and again in his notes.

In later life, the fascination with drains became almost obsessive. We moved house several times when I was a child and in almost every instance it wasn’t long before my father was excavating a patchwork of ditches in the garden. So deep were these that when digging them he would sometimes disappear completely from view save for the occasional shovel-full of earth tossed into the air.

There weren’t many mosquitoes in our part of Devon but then of course that wasn’t the point. The reasons for the obsessiveness lay elsewhere.


Given the climate and conditions, flies were both a general nuisance and major health threat. Every effort was made to stamp them out, including the literal; at Roberts Hospital doctors, orderlies and even patients had their fly-swatting quotas. Here is a diagram of an early fly-trap for an Otway pit constructed with a metal funnel “such as a petrol funnel with the stem sawn off” and a wooden box with a hole in the bottom to take the funnel.

The trap is fitted on top of the Otway Pit which merely consists of a large hole dug into the ground and covered with a fly proof board with two openings: one to take the fly trap, the second to receive an oil drum to act as a filter.”

Book C, 112-113

There were many other contraptions of this sort. One of them is described more for “its novelty than any efficiency derived from the device.”

“The trap merely consists of a series of lemonade or similar white glass bottles inserted by their necks into holes made to receive them in the vertical timber forming the superstructure of these two improvisations.* Every morning two men visit the traps equipped with two containers, one filled with disinfectant, the other being intended to receive the results of the previous day’s captures. Both containers are provided with handles which are slung over a pole which is carried jointly by the two men. each bottle is visited in turn and half-filled with the disinfectant. The flies are attracted to the light & enter the bottles. Here they fly about trying to escape & eventually get drowned in the disinfectant.

* Otway Pit and Deep Trench Latrine

Book, C 182-183


Originally uploaded by Brian Spittle

Sometime during his final year of captivity — possibly very near the end of it — my father recalled the conditions during the early weeks at Changi.

“Particularly nauseating at that time was the all-pervading stench of decomposing organic matter – excreta, flesh & other residues of war.”

Establishing some sort of sanitation system was therefore an immediate necessity and often required a good deal of improvisation. Here are his instructions for a do-it-yourself incinerator which was critical for disposing hospital waste and other refuse.

Incinerator

All that is required are:


(1) 4 sheets of corrugated iron
(2) 4 concrete slabs 18″ square
(3) 4 lengths of wire
(4) Some form of support to hold up the fire.

Each of the four corrugated sheets are cut in exactly the same way; each with flue or vent cut away at the bottom, & a number of perforations 1/3 the distance up the sheets to draw the fire. The sides of the sheets are wired together.

The incinerator is set on the concrete slabs & is supported by lengths of wire extending from the top corners of the incinerator to the ground as shown in sketch.

Just above the flue a piece of perforated corrugated iron or iron fire bars are placed to support the fire.

Cut in the front corrugated sheet 1″ above the fire bars is the fire door.  This door is on hinges.

Book C, 86

First notes as a POW

May 17, 2009

After becoming a POW at Changi there was an interlude of twelve days before my father made the next entry in his notebook.  What he saw and experienced during this time one can only imagine, though he continued more or less where he left off.   The only obvious change is that he is no longer using a pen.

The first topic, rice eating, must have been very much top of mind.

Rice Eating

It is said that people who have been brought up from childhood on rice suffer from pot bellies.  This abnormal distention is not apparently injurious.

It’s a subject he would return to many times over the next three and a half years.  Indeed, the same might be said of the other topics on this page.

Liq Formaldihyde

This, when diluted down to about 10% solution, is a good anti-fly spray.  It is best used in place of ‘Flit’ in a ‘Flit’ gun.

Biniodide of Mercury, 1-100

This is an excellent disinfectant & when diluted down in water forms a good hand wash.

Tincture of Iodine

This can be used equally well for:-

Changi foot

Tropical ringworm

Dhobi itch

Book C, Page 48.

February 6, 1942

May 10, 2009

My father’s last dated note before before the surrender was on February 6, 1942.  This is precisely one day after Japanese forces  began their bombardment of Singapore, one day before they conducted a diversionary move by landing on the adjacent island in the Straits, Pulau Urbin, and two days before the full-scale invasion began.

You would never know any of this from my father’s notes.  Instead, while Tropical diseasesthe din of warfare raged about him, he was busy compiling a summary of first aid  treatments in the tropics.  These included remedies for Bowel Troubles (Mist. Alba, 1 oz. dose), Sores on Lips (Ung. Ac. Boric), Tropical Ulcers (Sulphonamide paste), Cleaning Wounds (Pot. Permang. crystals; Eusol) and Dhobie Itch.  The treatment for that, reasonably enough, was Dhobi Lotion.

His notes over the next few days before the surrender continued in similar vein with detailed diagrams of drinking wells, wash houses and civil latrines, along with notes on anti-malarial measures, the quality of water and the disposal of urine.