Conduct Under Fire

by John A. Glusman

  The medical picture at Kōbe differed considerably from what the American navy doctors had encountered in the Philippines. Recurrence of malaria was rare among those who had come to Japan, John noted, just as it had been for newly arrived British POWs from Thailand.

  The incidence of tuberculosis, however, was high. The disease haunted Japan, its symptoms first described in a tenth-century medical text. By the late nineteenth century the death rate for haibyō, as it was known, was three times that of dysentery, the second most dangerous acute infectious disease. In 1940, Japan had the third-highest incidence of tuberculosis out of forty-seven countries, attributed in part to dietary deficiencies in protein and calcium, poor sanitation, and overcrowding. During the war tuberculosis became the leading cause of death among Japanese civilians, surpassing even the number of lives lost as a result of military action.

  The technique Fred Berley used on tubercular patients was one he had learned during his internship in San Diego, though it originated in Europe in the late nineteenth century: artificial pneumothorax. Armed with only a syringe, a bit of tubing, and some sterilized bottles, he carefully drained the pleural cavity of liquid and replaced it with air to collapse the diseased lung in an attempt to contain the toxins produced by the tubercle bacillus. It was a painful procedure and a risky one without benefit of a fluoroscope or X-ray. But by listening carefully to the chest with a stethoscope, he was able to pinpoint the best place to insert the syringe. The treatment reduced coughing and fever and ultimately saved the lives, he believed, of several of his tubercular patients, including the ailing Akeroyd.

  The most challenging surgery for Page and Berley involved a POW from the officers’ camp in Zentsji. A wing commander in the Royal Air Force, he sported a large malignant tumor on the parotid gland—the largest of the three salivary glands, which lies on the side of the face and extends from the earlobe to the jaw. Cancer had spread to the bone. To perform the procedure, the doctors first had to brush up on Gray’s Anatomy, a copy of which they borrowed from Nosu. They operated beneath the brain, working gingerly when they encountered severe bleeding. John was dexterous in administering a mixture of chloroform and ether throughout the course of the five-to-six-hour surgery. The tumor was removed along with half of the maxilla, but a certain royal arrogance remained.

  Initially the patient had to be fed a liquid diet through a nasal-gastric tube. Much of the staff donated their Red Cross powdered milk ration for his nourishment. In a few days he recovered sufficiently to sit up and eat.

  “You know I should be eating in the Officers’ Mess,” he said to Dixie Dean, who had been charged with his care.

  “What Officers’ Mess?” Dean asked, incredulous. “There is no Officers’ Mess here.”

  “Well, where do the doctors eat?” he inquired.

  “Downstairs someplace. I don’t really know,” Dean replied. “Anyway,” he continued, “you are a patient and you eat with the other patients. In this prisoner of war hospital all patients are equal, no ranks, and it doesn’t matter if they are black, white, or bloody brindle, they all get the same treatment. They all get the same care, and they all get the same tucker. We have had American officers as patients, and they were happy with our treatment, no complaints. Major John Akeroyd, the RMO of the 2/22nd Battalion, is downstairs. He has TB, is happy to be treated as a patient, and was until recently one of our doctors. Perhaps you think that the doctors get an extra spoonful of rice. I don’t think so, but if they do, bloody good luck to them, because with their help we may get home.”

  It was a brazen statement on Dean’s part, but he couldn’t help himself. What he really wanted to say was, You bloody, arrogant, upstart bastard.

  The next day Page asked Dean if he had had a run-in with his patient, and Dean admittted he had.

  “He can rest assured he will not be eating with the doctors,” Page replied, and a few days later the lieutenant colonel returned to Zentsji.

  Beriberi was a significant nutritional disease in prewar Japan as a result of a thiamin-deficient diet that caused thousands of deaths annually. But unlike tuberculosis, beriberi actually declined during the war years due to government regulations that required rice to be undermilled, which preserved valuable thiamin in the pericarp—so long as rice was available. For POWs already suffering from it, wet beriberi remained a serious problem.

  Diarrhea, another symptom of beriberi, was a common affliction in the camps. John drafted a paper on it at Kōbe and found that its causes varied, from amoebic and bacillary dysentery to pellagra, food substitutions such as soybean roughage, and any drop in the average daily caloric intake below 1,900. In extreme cases of starvation, diarrhea resisted treatment entirely.

  But far and away the most perplexing complaint was “painful feet,” also known as “burning feet,” “electric feet,” “hot feet,” or even “happy feet” because of the hopping movements POWs made to avoid prolonged contact with the ground. The doctors at Kōbe set up a study group and prepared a handwritten paper on the subject.

  The symptoms were well documented: a severe burning sensation in the soles of the feet, redness and slight swelling, followed by shooting pains. Depression, weight loss, forgetfulness, and circulatory impairment appeared in later stages. The discomfort was worst at night and during wet weather. The disease interfered with sleep, curtailed one’s appetite, and could be so intolerable that during the winters in Japan patients plunged their feet into barrels of cold water or directly into the snow. Fourth Marine James Fraser developed gangrene as a result and watched his feet turn the color of eggplant from the big toe to the smallest, until the flesh peeled away and he self-amputated all ten digits with a nail clipper.

  “Painful feet” wasn’t a “new condition,” as Murray believed. Symptoms of the disease had been described in European military campaigns in the late eighteenth and early nineteenth centuries, and in 1854 a near epidemic broke out during the Crimean War.

  At Bilibid, the American doctors recorded 300 cases of “painful feet” out of a patient census of 800. In Soerabaya, Java, according to Louis Indorf, there were 500 cases out of 3,500 POWs from October 1942 to January 1943. In Hong Kong, Page estimated 2,000 cases out of approximately 7,000 POWs from May to December 1942. “Painful feet” appeared among POWs in the Far East during the first three to five months of captivity and afflicted Americans, British, Canadians, Australians, Dutch, Javanese, and Filipinos alike. There was a marked decline in incidence at the end of 1942 and the beginning of 1943, and the Kōbe doctors could not point to any new cases in Japan. But “there were quite a lot of old cases which relapsed or became aggravated” during the prisoners’ first winter in Japan.

  What could the cause be? the navy doctors wondered.

  It was well known that the POW diet was deficient in protein, fat, and elements of the vitamin B complex, which contributed to the prevalence of beriberi, while a lack of riboflavin and nicotinic acid caused skin lesions. Some victims of “painful feet” displayed lesions; many did not. Moreover, there were some who suffered similar vitamin deficiencies but did not present the symptoms of “painful feet.”

  Could toxicity in old and musty rice be a factor? Not necessarily, because in one officers’ camp in Hong Kong a similarly poor-quality rice was provided without producing the same effect.

  The vascular changes in the lower extremities suggested Raynaud’s disease or erythromelalgia, which Kinosita Ryōjun, a pathologist at Ōsaka University, had seen in Japanese soldiers returning to Japan from the South Pacific.

  The clinical picture for sufferers of “painful feet” was complicated by the fact that many POWs also had other diseases, such as pellagra or beriberi neuritis. Without controlled observation, laboratory analysis, or diagnostic aids, the doctors could only speculate—and experiment.

  They tried administering vitamins A, C, and D—to little effect. They tried nitroglycerin and histamine—with indifferent results. Quinine seemed to provide some relief, but why, they couldn’t say
. So, concluding that “painful feet” was in all likelihood caused by a vitamin B deficiency, they fell back on an age-old home remedy: plenty of bedrest and a balanced diet.

  As mysterious as ancient Chinese medical techniques were to the Allied POW doctors and their patients, one American therapy left the Japanese medical staff at Kōbe awestruck. The case involved a young American POW from Tennessee who was blind, and a British POW whose toes had been amputated as a result of “painful feet.” The blind man managed to get around the hospital at Kōbe by towing on a little cart his buddy who served as the eyes behind him.

  “Turn left,” his friend would call out like a carriage driver. “Turn right.” And the American would obey like a well-trained pony.

  It was a pathetic sight, and a touching one, Murray thought. The men teamed up out of necessity to compensate for their respective infirmities. One had to get food for the other; the other had to show him where the food was before he could even get it. They were best friends out of need, two halves of one man.

  Intrigued, Murray decided to examine the blind man’s eyes. His patient had no corneal opacities, so he asked for an ophthalmoscope to examine the retina. The Japanese provided him with a reflecting ophthalmoscope of the kind that came into use in Europe and America a generation after Dr. Richard Libreich’s invention in 1855. An antique, but serviceable—if you stood about three feet away from your subject. And what Murray saw took him by surprise. The retina was intact. The optic nerve appeared to be perfectly healthy, and the optic reflexes were normal. There were no signs of xerophthalmia. In fact, he could find no neurological or ophthalmological basis for the man’s blindness. Then why couldn’t he see?

  In World War I German soldiers suffering from war neuroses in the field were typically treated with electric shock. Neurotics were considered malingerers whose symptoms were a result of the conflict between the instinct for self-preservation and a sense of duty. The doses were so high that men actually died during treatment; others committed suicide afterward. Given the choice, some soldiers decided the front didn’t look so bad after all. In his “Memorandum on the Electrical Treatment of War Neurotics,” written in 1920 for a special commission of the Austrian military, Freud suggested that psychoanalysis might be a more effective remedy for war neuroses than electric shock therapy.

  A neurologist and also a bit of a dreamer, Murray was naturally drawn to psychoanalysis. He had read Charcot, the nineteenth-century French neurologist whose pioneering work on hysteria Freud had translated into German. And he had read the cornerstone of psychoanalytic theory, Studies on Hysteria, in which Freud and his co-author Josef Breuer argued that “hysterics suffer mainly from reminiscences.” By hypnotizing their patients, Freud and Breuer were able to bring the memory of a traumatic event to light, at which point “each individual symptom immediately and permanently disappeared.” Murray decided to try their technique on the blind American POW.

  Slowly, calmly, he coaxed his subject into a trance. He asked him to describe in his own words the traumatic event, then firmly suggested that he would be able to see when he woke up. The result was not instantaneous, as Freud and Breuer had reported in their case histories. But after several sessions, Murray achieved his goal. On awakening to consciousness, his patient reclaimed his sight.

  The Japanese were dumbfounded. The corpsmen were amazed. He’d been as blind as a bat, had had that faraway gaze that blind men have, couldn’t even light a cigarette by himself—and now he could see? It seemed nothing short of a miracle, but it was not without its consequences. The Tennesseean quickly abandoned his British buddy, who would now have to fend for himself on the chow line, having been discarded like an old appliance that has outgrown its usefulnesss.

  Hysterical paralysis was a more common condition at Kōbe. One evening in the fall of 1944 a truckload of twelve to sixteen men arrived at the gate. Some of the POWs had been working on the Siam-Burma Railway. They had been removed to Saigon, and then transported from Singapore to Japan by freighter. For days on end they were kept down in the hold until their convoy, which included the Kachidoki Maru and the Rakuyō Maru, came under Allied submarine attack. Six hundred and fifty-six of the POWs who survived were taken to Japan aboard the 20,000-ton “whale factory” vessel Kibibi Maru.

  Dixie Dean watched as Murray separated the healthy arrivals from the infirm. But it was obvious to Dean who was ill—they all were. They stank to high heaven, were filthy dirty, and couldn’t lift one foot in front of the other. And there was the doc, saying, “He can walk.” To which John Quinn replied: “And he can kiss my arse.” Quinn proceeded to carry the prisoners to the hospital. The corpsmen bathed the men, fed them, and put them to bed. They were exhausted and malnourished, but Murray saw by their gait, by the paralysis they affected, that in some of the cases their physical symptoms merely mimicked illness; they were not caused by it. One by one he hypnotized them, and soon enough, like the blind marine from Tennessee, they were able to see and walk normally out of the hospital.

  The question remained: what was the trauma that triggered their visual and motor hysteria? A beating, a torpedo attack, watching men die on land and at sea. Sometimes there was no sole causative factor except the general predicament of being a prisoner of war. Blindness or paralysis was an unconscious defense against the rigors of reality—and the prospect of more work details.

  Some ethical dilemmas at Kōbe had life-or-death consequences but were quietly resolved. The doctors administered local and general anesthesia, depending on the operation, and morphine for post-op pain, though the opium derivative was restricted.

  One patient suffered from secondary syphilis, with a wound in his left buttock “large enough to put a fist into,” said Dixie Dean. He lay in a semicomatose state, his misery relieved only by morphine. One day the doctor stopped by on his afternoon rounds and asked Bud Flood the time of the last dose. The corpsman from Akron, Ohio, told him, and the doctor replied: “Give him another dose, now.” Flood nodded, then looked at Dean, who looked back at him. The next dose would be lethal.

  Flood went to the medical cabinet, prepared the injection, and approached the patient’s bed. “I cannot do it, it will kill him,” he said.

  “Yes, I know, so hand me the syringe,” Dean replied.

  There was hardly enough flesh on the patient’s arm to give him a proper injection, but Dean found a spot and injected the morphine. Twenty minutes later the patient was dead.

  “Murder or euthanasia?” Dean wondered.

  “Whatever name we give it, it was justified, it was necessary,” he said afterward. It was only a matter of time, he rationalized, before syphilis would kill him, and the morphine could be used to relieve the suffering of other patients. He suspected that word would spread quickly around the hospital, but no one ever said a thing to him about it.

  The American doctors were bound by common interest and mutual respect that warmed into lasting friendship. If POWs functioned as members of families, clans, and tribes, which were themselves defined by service organization, ultimately their identity was determined by nationality. Occasionally international tensions broke the surface calm. The Americans found the British patronizing, and Page in particular.

  “It’s dyk,” Page corrected Murray’s pronunciation during a conversation about the Duke of Windsor, “not dk.”

  “Well, I say duke,” Murray answered testily, “because I come from New York, not NyYork.”

  Akeroyd told Dean he thought Tom McCready was a very solid bloke. When McCready heard the comment, he thought it meant he was “as thick as two planks.” Dean assured him, “If he had meant otherwise, he would have said ‘The man is a dill,’ or ‘He’s a useless bastard.’ ”

  The Aussies couldn’t understand how the Yanks could curse each other to high hell and never come to blows. They themselves were regarded as the worst thieves, though the Royal Army Medical Corps had so many sticky fingers, the British doctors joked, that RAMC stood for Rob All My Comrades. At least everyo
ne could agree about the Dutch. Contrary to their reputation for cleanliness in seventeenth-century Europe, they were judged the most foul-smelling because they bathed the least. Indian POWs kept themselves apart from American, British, and Australian POWs, though at Ichioka there had been flashes of racial animosity.

  Such incidents were few and far between at the Kōbe POW Hospital. There was little time to nurse historical grudges when patients were dying of tuberculosis, pneumonia, and beriberi.

  In September 1944 Guy and Victoria Berley received a handwritten letter from Mrs. Neva H. Newman of San Gabriel, California, who had picked up a shortwave broadcast from Radio Tōkyō at 2115 Pacific War Time on the fourth. She copied the message verbatim: “I am in good health. Busy working in beautiful new hospital for Prisoners of War located on scenic site. Happily received your package and letters from home. Love Ferd.” Mrs. Newman added: “I pray that soon your loved son may be reunited with you.”

  Lewis and Sophie Glusman received a similar surprise at their home on Ridge Street. A West Coast ham radio operator intercepted a broadcast, relayed the text of it to the Army Service Forces, provost marshal general, POW Division, who then contacted the family: “Am in good health,” it began. “Working as a neuro-psy . . . Hospital established for Osaka P.O.W. camp. Pleasant surroundings. Received your package and several letters. Love to all, Murray.”

  The broadcasts were the idea of a Japanese-born American named Kazumaro “Buddy” Uno, who had been on Bataan at the time of the invasion of Corregidor. With the blessing of the Imperial Japanese Army, Uno drew up a staff of American, English, and Australian POWs from radio, journalism, and nightclub entertainment. Their task was to read messages solicited from POWs in the Far East that were then transmitted overseas from Radio Tōkyō’s downtown studios. Mixed in with these ostensible public service announcements was a fair dose of Japanese propaganda.