Blood Brothers: A Medic's Sketch Book Part 9

The Farm: After several months of starvation, some hungry captives suggested to the j.a.panese that a farm could supply extra food for the captives and might reduce the high morbidity and mortality rates.

The farm was started with a few farmers and expanded very rapidly.

Groups of one hundred men each were marched out of camp every morning barefooted to spend the day on the farm.

The farmers worked under many difficulties; the sun became very hot.

Farmers were not allowed to squat down or to bend the knees. They had to work bent over from the waist. They received only a fifteen minute yasume (rest period) in the morning and another in the afternoon.

There was much language confusion; much misunderstanding followed by frequent slapping, kicking or beating.

Nearly every day the j.a.panese insisted upon larger and larger details insisted that more and more patients be returned to duty from the hospital in order to work on the farm. The workers received a small amount of extra food.

Much to my surprise, many sick patients, that we thought were too sick for duty, were becoming rather husky farmers.

More to my surprise, the j.a.p guards soon found they could make extra money by taking farm products to the market in Cabanatuan city, where they were sold to the civilians.

Camp Hospital: The hospital was first opened in June, 1942, by Col.

James Gillespie with the mess halls under Major Jim Rinaman. There were sixty six officers and 183 enlisted men. By July 1st there were 2,300 patients and by August, 2,500.

There were thirty wards (made to hold forty soldiers), often

holding up to one hundred patients. There were upper and lower decks made of bamboo slats. Each patient was allotted a two-by-six foot s.p.a.ce. Seriously ill were kept on the lower decks.

By Dec. 1st, I had been appointed chief of the medical service; I tried to see every patient each day. Since medicines were very scarce, there was actually very little I could do, except give some hope of a better tomorrow.

Dire Economy: In the early days of the hospital, the j.a.panese issued a few cartons of condensed milk that they had captured on Bataan for the benefit of the seriously ill. Unfortunately, most of the recipients of the extra milk proceeded to die in spite of the extra nourishment taking the milk with them. We quickly learned a harsh but valuable lesson: "Do not give extra nourishment to dying patients!"

From then on, the extra food went only to patients who possessed the possibility of recovering plus the will to live.

Malaria: Fully 50% of the 2,400 patients had malaria. For many months all we could do was to give one quinine tablet after each malaria chill, hoping to make them more comfortable. But after the j.a.ps conquered the Dutch East Indies, we received 30,000 three grain tablets of quinine. This allowed us to control most cases of malaria and to cure some.

Occasionally we saw a few cases of cerebral malaria; most of these died in spite of quinine therapy.

Multiple Diseases: Most patients had more than one disease, usually multiple vitamin diseases. Many had lost from one third to one-half of their body weight. Most everyone had either wet or dry beriberi, or a few both.

Beriberi: Wet beriberi cases were bloated with edema usually beginning in the feet and gradually progressing upward to the head. A patient with edema of the feet and legs, after lying in bed all night, frequently found that the edema had spread to his chest and face in the morning.

After being up for several hours, the edema slowly returned to his legs and feet. When the edema became extensive, the patient became nearly helpless unable to get about.

Tropical ulcers often developed in swollen legs, and continued to weep as long as the edema existed. If the edema had been caused by salt intake, it could be, controlled by eliminating salt, but for the most part salt was not a factor, because we rarely had any salt in our diet.

Patients with dry beriberi were usually very thin. Their chief complaint was lightning-like pains (neuralgia) in their legs and feet.

The only relief came from soaking their legs in buckets of cold water.

Many sat up all night trying to obtain some comfort.

On a rare occasion a dry beriberi patient would develop edema in his feet and legs; strange as it may seem, the edema seemed to relieve the pains of the dry beriberi.

Forty years later, some of the survivors still have leg pains in spite of heavy vitamin therapy indicating permanent nerve damage.

Beriberi Heart Disease: Beriberi heart disease was seen frequently, and often resulted in sudden death. Like the legs and abdomen, the heart became enlarged with edema; the beat became irregular. As some patients lay down, their heart would stop beating, especially if lying on the left side.

If you could get to them in time to sit them up, or to ma.s.sage their heart, it was sometimes possible to get the heart started again.

Sudden death at night was a rather frequent occurrence. Many American trained cardiologists still consider beriberi heart disease as a reversible condition, but some ex-P.O.W.s still have the same irregularities.

Pellagra: Pellagra was common, manifest by conjunctivitis, glossitis, amblyopia, angular stomat.i.tis, geographic tongues (often with deep grooves and severe sensitivity), and scrotal dermat.i.tis of varying degrees including sloughing. There was increased pigmentation of the skin sometimes patchy.

Xerophthalmia: Xerophthalmia and optic atrophy were seen occasionally and often left permanent damage to vision, and sometimes complete blindness.

Diphtheria: We had an epidemic of diphtheria some two hundred cases of which 125 died before the j.a.ps obtained a limited amount of ant.i.toxin.

Most survivors had permanent residuals.

Infectious Hepat.i.tis: We had several epidemics of infectious hepat.i.tis, which seemed to be self-limited. At times it was difficult to differentiate it from malaria with jaundice following Atabrine therapy.

In 1943, I had infectious hepat.i.tis for about ten days and turned a bright yellow accompanied by severe nausea and vomiting. Every time someone would mention "food," I would run to

the window and retch. It seemed this happened about every five minutes during the day, as prisoners rarely talked about anything else. The individual would apologize for mentioning food, but it would be only a short time before it was the subject again.

Scurvy: There were several widespread epidemics of scurvy; we could stop these quickly if and when we could persuade the j.a.ps to get a lime or two for each captive.

Diabetes Mellitus: When I entered camp, I was worried about diabetes mellitus, because there was no insulin or other medicine available to treat it. Ironically, starvation solved the problem.

The blood sugar never got up high enough to produce any symptoms.

Red Cross Packages: Just before Christmas in 1942, 1943 and

1944, the laps issued one or two Red Cross food packages, each of which contained seven pounds of food. After the package in 1942, the camp mortality fell miraculously from forty deaths daily to one or two a month. December 15, 1942, was the first day in camp in which there was not a single death.

Refeeding Gynecomastia: Three times during our thirty to thirty-six months of incarceration at Cabanatuan and in Bilibid, following the receipt of one, two or three Red Cross packages, making our diet adequate for from one to six weeks, up to six hundred "refeeding" type of breast swellings (gynecomastia) of various sizes appeared.

After the food in the packages was consumed by the captives, and the diet returned to the starvation-type, the captives with the swollen b.r.e.a.s.t.s noticed that the b.r.e.a.s.t.s were slowly and gradually returning to normal size.

Again after liberation, when the diet returned to normal and remained adequate, many hundreds of refeeding gynecomastia were seen, and lasted from one to eight months, before disappearing. At times the enlarged b.r.e.a.s.t.s were rather tender and even painful.

Dysentery Section of Hospital: Fenced off from the hospital was a quarantined area containing about ten wards-called the Dysentery Section-under the supervision of a separate staff of medical officers and corpsmen.

There was a tremendous sanitary problem. Many of the patients were too weak to leave their wards. Some "pa.s.sed out" on their way to and from the latrine. There was essentially no medicine for these debilitated patients-unless they were lucky enough to

have a friend in Manila and knew how to contact him via the Underground.

Zero Ward: In the Dysentery Section, there was a building that was missed when the wards were numbered. Later, it was called "Zero Ward"

and served as a place to put the seriously ill, essentially dying patients. It was an empty building with wooden floors, and usually contained about thirty extremely ill patients naked lying on the floor, frequently in their own vomitus and dysenteric stool.

Their chances of survival were just about zero. Flies walked casually over their leathery skin; rarely did a patient arouse himself sufficiently to threaten a fly. Most of the patients did not want to be disturbed, typically responding "Please leave me alone; I have suffered enough! Just go away!"

Exhausted and sick corpsmen moved slowly among the dying, trying to keep them clean, and giving them food or medicine, when available.

Operating Room: In the early days of the hospital, the j.a.panese permitted several medical officers to return to Bataan to retrieve an operating table, minimal surgical equipment and a field X-ray unit from the abandoned U.s. Army hospital.

Captives who had needed operations prior to the obtaining of the surgical equipment were operated in Cabanatuan city by j.a.panese doctors with 100% mortality.