Medic: Saving Lives - From Dunkirk to Afghanistan

by John Nichol

  The Japanese strode into the group and separated off the able-bodied men and the walking wounded. The twenty-one nurses and a dozen stretcher-cases laid out on the sand remained behind, watching as the men were marched away along the beach and out of sight. After a little while, the soldiers came back, and the women saw they were wiping blood off their bayonets. They then lined up the nurses and ordered them to walk into the surf, just as they had done with the men. ‘Chin up, girls, I’m proud of you,’ called out their matron, Irene Drummond,9 in a low voice as machine guns opened up, shooting them in the back. Bullwinkel was hit in the waist, but the bullet went clean through her body and out the other side. She floated face down in the water, pouring blood and apparently dead. The Japanese turned away, bayoneted the stretcher-cases and marched off.

  When she realized they had gone, the nurse struggled ashore and hid in the jungle, where she came across a British serviceman who had managed to survive the massacre of the stretcher-cases, though a bayonet had punctured his lung. They kept each other alive for two weeks, living off scraps from a native village, until they had no choice but to give themselves up. They were brought to Muntok internment camp, where she now whispered her story to Margot Turner. ‘We decided in the camp that we would never mention this incident as, if it got to the ears of the Japs, Vivian’s life might have been in danger. But what tremendous courage she had shown.’10

  *

  Courage of a similar order would be needed by the fifty thousand men who, back in a blazing and devastated Singapore, had surrendered to the Japanese forces of General Yamashita. To begin with they were treated surprisingly well, given the contempt in Japan’s military culture for men who chose to live in captivity rather than die in battle or by their own hand. While hundreds of Chinese were massacred by vengeful Japanese soldiers, the British and Australian captives were marched in a long, dreary line – but with bagpipes playing and singing ‘Tipperary’ – to Changi, an area in the east of the island with a barracks, bungalows, a jail and the sea on three sides. There they were surrounded by barbed wire and pretty well left to get on with their internment.

  Conditions deteriorated when the men refused en masse to sign undertakings not to escape and some who did try to escape were callously executed. Then the food supplies the surrendering soldiers had brought with them ran out and they were left to rely on meagre rations of reject rice from their captors. Illness on a major scale set in, and the task for the doctors and medical orderlies was immense. In the first three months at Changi, the camp’s makeshift hospital admitted sixteen thousand patients, more than half of them with dysentery. Deaths were soon past the two-hundred mark, and accelerating. RAMC trooper George Temple was on duty in one of seven hundred-bed wards filled to overflowing with dysentery sufferers. ‘The conditions were appalling,’ he recalled. ‘Gross over-crowding, no running water, no lighting, no proper sterilization, no existing arrangements for the disposal of hospital and human waste.’ Drugs were scarce and medical equipment nonexistent. The only medicine was Epsom salts, to try to purge the germ from their intestines, followed by chalky kaolin solution to line the stomach. ‘Men were relieving themselves twenty or thirty times a night, which was debilitating enough for them. But then there was no nourishing food to sustain them from further attacks in the future. At night, we would hear the sound of terrible hiccups and retching and know that a man had not long to live and we would be carrying his body out before dawn.’ Semi-starvation brought a host of other problems. Lack of protein and calories sapped strength, while vitamin deficiency caused the skin to peel painfully from men’s most vulnerable parts – their feet and their genitals. Royal Artillery medic Sergeant Joe Blythe reckoned that half of the six hundred men under his care were suffering from malnutrition, and the only supplement he could offer them was a smear of Marmite in hot water.

  But Changi, for all its problems and hardships, would be looked back on as a paradise and its hospital a haven compared with what came next in the prisoners’ lives. Thousands were transported to work camps in conquered Thailand to build a railway line to Burma, through two hundred miles of the toughest mountain and jungle terrain on earth. They were cruelly conned from the outset. RAMC orderly David Jones recalled being told they were going to a sanatorium in the hills that would be especially beneficial for the sick.11 The reality was a five-day trip in a goods train through stifling heat to a jungle hell. Here, in primitive living conditions, worked as slaves, starved and subjected to extreme and arbitrary violence, they would be stretched beyond human endurance.

  What puzzled the prisoners was the lack of common sense on the part of the Japanese. ‘Had they fed us reasonably well and refrained from brutality, the railway would have been built much sooner,’ Temple noted. As it was, a third of them were to die, and the survival of the rest was largely because the doctors and medics among them performed miracles untaught in medical schools or hospital wards back home. Against a backdrop of barbarism and indifference, they would carry out feats of outstanding bravery and inventiveness.

  It took immense courage to stand up to slave-driving Japanese camp commanders who demanded that the sick should join the work parties carving a passage through jungle and bare rock, digging out boulders, building viaducts and embankments, laying track. Doctors such as the Australian Lieutenant Colonel Edward ‘Weary’ Dunlop took regular beatings to prevent the flimsy bamboo huts that passed for a hospital being raided for men who had been felled by malicious guards, malaria, dysentery, beri-beri, diphtheria and flesh-eating tropical ulcers and could barely raise their heads, let alone toil in the heat. The Japanese would demand fifty; the doctor would offer ten and then stand his ground. At night he would smuggle reasonably fit men into the hospital so he could produce them on demand the next morning and keep their captors happy. He took huge chances with his life by hiding the illicit camp radio – possession of which was punishable by death – in his medical supplies. He paid for his guile and his guts. On one occasion, Dunlop was made to stand at attention for two whole days outside the guardhouse in an attempt to break his spirit. Then they made him kneel for another twenty-four hours, but still he grinned – literally, according to many witnesses, his smile infuriating the guards even more – and bore every indignity, every beating. His defiance lifted the spirits of skin-and-bone men on the brink of caving in mentally and physically.

  Jack Chalker, a fellow PoW, thought Dunlop the most valiant man he ever met. ‘He was tall, and the Japanese didn’t like that so they made him kneel to beat him up. But, knowing very well he was going to get beaten up, he would still go to them again and again to try and get better conditions for us or to stop their brutality. For somebody to do that continuously, on our behalf, for three years, deserves ten Victoria Crosses, because it was not in the heat of battle but very real, deliberate courage. He had ulcers from being knocked about by the guards and he suffered from typhus and dysentery, just as we did, but he was like a human dynamo.’ The light Dunlop generated was an inspiration. In these dreadful camps, where life sank to a humdrum of cruelty and death, doctors and medics – with little more than Epsom salts and quinine to dispense – were the last link to a better world of hope and humanity.

  With virtually no proper equipment, the operations the surgeons among them carried out were remarkable, from amputations to brain surgery.12 With a complicated appendectomy to perform, Captain Stanley Pavillard laid out his instruments – a cut-throat razor, a pair of rusty scissors, three pairs of artery forceps and some catgut. No scalpel, not even a knife. At another camp, a doctor extracted a deeply embedded wisdom tooth with a chisel. Out in the jungle and under canvas, Dunlop operated on a soldier with a perforated peptic ulcer in the middle of the night because the patient would otherwise not have made it to morning. The only light was from a hurricane lamp and a torch. As he bent over his patients, there were times when the doctor, as susceptible to disease as the men he served – perhaps more so, since he was constantly in contact with infection – was s
o sick himself he could barely stand. He carried on despite the difficulties because he was that sort of man. For Dunlop and the scores of doctors like him, the call of duty was a cry for help that never ended and which they never shirked.

  Some of the worst problems to deal with – for patient and doctor alike – were ulcers from wounds that would not heal in the fly-blown, disease-laden jungle heat. Some were the result of savage beatings by guards, but even simple scratches from working bare-legged in the thick undergrowth or an insect bite could turn black overnight, fester and deteriorate dangerously. Flesh decayed, exposing bone, then flies laid eggs in the bone and their maggots ate away at the marrow. Once the rot had set in, only radical surgery could stop it spreading.

  Lieutenant Colonel Albert Coates – a man of nearly fifty who had turned down the chance of evacuation from Singapore in order to stay with his Australian troops – had five hundred such cases at a camp in Burma and had to have each man held down physically while he gouged away the flesh, without anaesthetic. Those who watched found it hard to decide who was braver, the doctor or the patients. ‘Tears ran down their cheeks, they would curse and bite their hands and hold on to their mates like grim death,’ one recorded. ‘Their courage was astounding and their confidence in the colonel absolute.’13 But even this torture too often proved not radical enough to save their lives, and Coates had to resort to amputation. That same witness recalled him bending over a hopelessly eaten-away leg and saying, ‘It’s no good, laddie. We’ll have to take it off for you and give you a chance. When would you like it done?’ More often than not, the patient would give him the nod there and then: ‘Let’s get it over with, sir.’ Under a bamboo shelter with a leaf roof, Coates, clad in shorts with a sweatband on his forehead, would go to work with a scalpel and a saw borrowed from the kitchen, and an hour later the soldier would be back in his bed, drawing on the cheroot the colonel had given him, minus the diseased limb but with a prospect of survival.

  Success was far from guaranteed, however. In the second half of 1943, Coates carried out more than a hundred full-limb amputations (as well as snipping off countless fingers and toes). One man in ten died on the operating table and half of the rest within two months. It was not a hit rate that Coates, a professor of anatomy, would have been content with back home in Melbourne, but in the jungle it was close to miraculous. Many men who otherwise would have died would eventually be able to hobble home on crude prosthetic legs made out of wood, leather from a Sam Browne belt and elastic from a pair of braces.

  Another ‘miracle worker’ was the RAMC’s Captain Jacob Markowitz, who borrowed his saw for amputations from the camp carpenter. An officer who watched one of his open-air operations recalled gusts of wind blowing eddies of dust over the patient ‘while flies and bluebottles in their hundreds buzzed incessantly around and were flicked off when they settled’.14 Markowitz was surgeon at the Chungkai hospital, a collecting point in a jungle clearing for casualties from all the work camps in Thailand. When he arrived in May 1943, there were already seven thousand patients there, stacked on wooden platforms in huts without walls, on top of pools of stagnant, mosquito-infested water. Twenty patients a day were dying, but each day more wrecks arrived from the work camps to add to the numbers. To treat them he had a stethoscope, a spattering of antiseptic and enough chloroform for just two operations.

  While he set his overwhelmed orderlies to root out whatever tools they could find or fashion for surgery, he concluded that blood transfusion was essential to save lives. But how could blood be collected in the absence of sodium citrate, the chemical additive necessary to stop it instantly clotting? From experience in a blood laboratory years earlier, he recalled the answer – keep stirring it with a spoon. With a needle, a few old bottles and the tubing from his stethoscope, he soon had his transfusion kit, and his first success. Blood from a willing donor flowed into the veins of a man dying from anaemia brought on by malaria. He came out of his coma. After that, Markowitz recalled, ‘we gave transfusions for everything. Men dying with dysentery often recovered. Men suffering from vitamin deficiency became more cheerful and regained their will to live. Tropical ulcers healed more quickly.’15 In time, Markovitz would also come up with an answer to the problems caused by the lack of vitamins in the constant diet of polished rice.16 A strange brew of rotten bananas, rice and human saliva17 produced health-giving yeast. ‘This new elixir worked miracles,’ he reported, ‘as swollen stomachs, sore eyes and ulcerated mouths responded to the magic of our cure’. In another camp, an equally ingenious doctor managed to transform a four-gallon kerosene can and some rubber hosing into a plant to produce distilled water, which could then be used as an intravenous fluid for cholera victims.

  Over the next year, Markowitz – ‘a knife, fork and spoon surgeon’, as he styled himself – would perform 1,200 operations in his bamboo theatre, in conditions that reminded him of what he had read about surgery in the Crimean War. He was assisted by illicit supplies of the anaesthetic Novocain, smuggled into the camp by Thai villagers, and the ingenuity of an orderly who scrounged the materials to make retractors, a rectal speculum, a rib-cutter, a quadruple needle for skin grafting, a tracheotomy tube and spinal and hypodermic needles. He operated on a man gored by an angry elephant and another who fell from a tree and had skull fragments in his brain. He repaired a lot of jaws broken by Japanese rifle butts. For gaping tropical ulcers, he preferred skin grafts to amputation, first scraping out the wound with a spoon and then grafting skin from the patient’s thigh to cover it. A soft dressing impregnated with pig fat was applied, and the whole leg then encased in sponge rubber from a mattress until it healed.

  Another doctor, Stanley Pavillard, used the Trueta method of debriding the wounds made by ulcers and encasing them as best he could to heal themselves. He would apply a little of his precious stock of iodine or sulphonamide and then bind the limb in bandages made from old sheets and bark from banana trees. But there were times when amputation could not be avoided, as Markowitz learned the hard way after a sergeant major pleaded for more time to allow his ulcerated leg to heal on its own. ‘Give it another week, Doc,’ the man pleaded, and the doctor reluctantly held off. It was a kindness that killed. ‘On the evening of the third day, he died in his sleep.’

  *

  In every Japanese PoW camp, there were outbreaks of almost all known diseases, which were liable to spread like forest fires in the unsanitary conditions and among men weakened by overwork and chronic underfeeding. Hospital huts were more like charnel houses – ‘pitiful places, the stench of putrefying flesh and sweating, emaciated bodies huddled together on bamboo slats and tormented by bugs which came out in their thousands to feed on them’, as medical orderly George Temple recalled. At night they were even more fearful places of pain, panic and death. One doctor used up a precious half-grain of morphine to quieten down a man whose loud and violent delirium was distressing the other patients. ‘It is difficult coping with cases in a dark and crammed hut by the light of an oil flare,’ he noted.18

  Once an infection took hold among the men, it was impossible to contain, especially since the guards tended to hang on to any medicines to dose themselves. At his camp, Temple was caught up in an outbreak of diphtheria and had neither the drugs to combat it nor the means to perform the tracheotomies – incisions in the throat – that would enable choking patients to breathe. ‘All we could give them were gargles of permanganate of potash and then, with a pair of long forceps, try to remove the fungus-like growth from their throats.’ As he prodded inside their mouths, the patients would invariably cough and splutter over him. He protected himself as best he could with a face-mask made from an old rag soaked in carbolic, but inevitably he caught the disease himself. He survived it only because the medical officer somehow procured an anti-diphtheria drug. ‘He injected it into my buttocks, and the next morning, as I gargled, the membrane peeled from inside my throat like a large lump of jelly. I was as weak as a kitten but that saved my life.’

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bsp; He survived only to be sent to another camp, where water-borne cholera, perhaps the most feared of all tropical diseases, had broken out. ‘It could turn a perfect physical specimen into a living skeleton in a few hours, his kidneys ceasing to function, his voice a mere croak, oozing continuous fluid from his back passage and doubled with terrible cramps in the stomach until dehydration of the body was complete.’ The victims were isolated in tents away from the main camp. ‘The stench of faeces, mud and slime pervaded the air. Deaths were a daily occurrence – 130 in 10 days – and all bodies had to be burned on a pyre to stop the epidemic spreading. The guards wouldn’t come anywhere near us. Our ration of rice and jungle stew [a concoction of leaves] was left outside the compound, and I used to take mine into the jungle to eat, away from the flies, which were deadly carriers of the disease.’ Temple and his fellow medics sprayed each other with disinfectant as they bravely moved from tent to tent, and he was lucky. The epidemic petered out when the rainy season ended.

  Not all prisoners showed the same selflessness as their doctors and medics. With 350 cases of malaria, diphtheria and dysentery in his camp, Dr Robert Hardie pleaded for a blanket for a man suffering from all of these conditions. ‘One of the officers in his battalion, who had three, refused to lend him one,’ the appalled and disappointed medical officer, trying to do his job with just some quinine, some magnesium sulphate and flavine solution at his disposal, recorded in his diary.19 Against this, ‘Weary’ Dunlop paid tribute to the staff sergeant on his medical team, ‘himself reduced to a near-naked skeleton and shivering with chronic malaria, yet who, when confronted with a man naked and tormented with cholera, dropped his last shred of comfort in the world, his blanket, over the dying man. Only those ill, emaciated and thin, who slept on exposed and rough surfaces in all weathers, could comprehend the depth of his sacrifice.’20