James Le Fanu

‘For every problem there is a solution: neat, plausible and wrong’. H.L.Mencken

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Fighting off evil with grass soup

Dr James Le Fanu on how Japan’s prisoners of war proved invaluable to medical science.

THE CAMPAIGN for compensation by British survivors of the Japanese war-time prison camps has led me to re-read one of the most remarkable medical documents I have ever come across.

At first, "Deficiency Diseases in Japanese Prison Camps", published by the Medical Research Council soon after the war, seems to be a straightforward account of the many types of illness caused by the diet on which the prisoners subsisted for three-and-half years or more. But it turns out to be much more than that.

The report was compiled by two doctors – Michael Woodruff, who describes the military camp in the Changi area just south of Singapore, in which 50,000 British and Australian troops were interned, and Dean Smith, who covers the civilian camps in Hong Kong and Singapore.

The basic diet was, of course, appalling. The staple, rice, "was mostly very dirty, containing foreign material ranging from dead rats to cigarette stubs and cockroach excreta", which, when removed, reduced the pitiful quantities supplied by the Japanese by around a third.

"Weevil infestation of cereal and pulses was very great, especially in the later years of internment." There was no attempt to extract these, however, as weevils were a good source of protein. There was hardly any meat or dairy produce and insufficient salt and cooking fat.

Predictably, this grossly deficient diet resulted in rapid weight loss and the appearance of a whole range of symptoms due to vitamin deficiency: swelling of the legs and heart failure, painful fissures of the mouth and scrotum, skin rashes, burning painful feet, nerve inflammation and failing vision.

This enormous threat to the life and health of the internees was averted by extracting every last milligram of vitamins and nutrients from other sources. Rice polishings are a good source of vitamin B1 and so protected against beri-beri, as were soya beans, which were soaked and ground down to provide soya bean milk for invalids and children.

Pine needles chopped finely and boiled in water for 20 minutes produced a tea with a high vitamin C content. Grass and green leaves were crushed and the pulp extracted with cold water by percolation to provide a concentrated non-toxic source of riboflavin. With these and other measures, thousands of deaths were undoubtedly prevented – helped by the adaptive powers of the human body. Doctor Smith notes that, with a dietary deficiency of around 500 calories, "there was a steady fall in weight, which ceased after a while, and it appeared a new equilibrium was established at a lower metabollic level." At this new equilibrium, the prisoners were able to do sufficient work to look after themselves, and as a result, the mortality rate in the civilian camp was no higher than was normal for the general population in the years before the war. In a camp population of 3,500 in Singapore there were 218 deaths over a period of three-and-a-half years, but only 21 of these were directly attributable to malnutrition. There could be no more remarkable instance of the successful application of the principles of nutrition to the prevention of disease.

But the report is unique in another respect. It must be remembered that most of the vitamin deficiency syndromes had been identified only in the preceding couple of decades (and there is still a lot to learn about them). Here, in the dreadful conditions of the internment camp, was the perfect opportunity to do so.

The medical officers would have had more than enough to occupy themselves, but enormous efforts not only went into carefully observing the many different manifestations of vitamin deficiency, but also into conducting experiments as to how they might be treated. Thus, the relative efficacy of rice polishings, yeast or grass soup were compared in a group of patients with florid mouth ulcers caused by riboflavin deficiency. (Grass soup was the best.)

The systematic studies led to the identification for the first time of the nature and probable cause of previously unidentified symptoms of vitamin deficiency, including the central loss of vision called amblyopia, which was found to be due to a lack of riboflavin.

With masterly understatement, Major General J. Bennet, in an introduction to the report, describes it as making "no mean contribution to science". Beyond that, it could be said to symbolise what the war in the Far East was all about – the triumph of reason and humanity over barbarism and ignorance.

FINALLY, medical ingenuity of an entirely different kind: the description by an Australian, Ian Duncan, of "makeshift medicine" as practised by doctors on the notorious Burma-Thailand railway. Surgical instruments were scarce, as most were confiscated by the Japanese, so steel dinner knives were fashioned into scalpels, forks into retractors and spoons were sharpened and used for curretage.

"It was remarkable that major operations were successfully undertaken on these emaciated and exhausted men," writes Dr Duncan, "and astonishing to see the devotion and sacrifice with which they were nursed back to health by their comrades."

Copyright: Telegraph Group Ltd