How POW inventions advanced medicine during the Second World War

Voice over: "Technological and medical advancements often emerge from war. When faced with life or death challenges and low resources, those caught up in conflict learn to improvise and think outside the box. Innovations born from war span a wide range of fields, from the roll out of antibiotics to the development of computer science, microwaves and even Gaffa Tape. But one surprising area where medical innovation thrived during conflict was in Far East Prisoner of War camps during the Second World War.

Prisoners of War faced unrelentingly lethal conditions, such as brutal beatings from guards and forced slave labour. Tropical diseases, injury and malnutrition were rife. As many as a quarter of Far East Prisoners of War died during the ordeal. But that figure could have been much higher, if it were not for the ingenuity and determination of these inmates, who came from all walks of life and rallied together for their collective survival. So, how were they able to be so inventive with so few resources? What creative solutions and inventions did they come up with? And are any of their ideas still in use today? 

When war broke out in September 1939, all males aged between 18 and 41, except for those who were medically unfit or needed in key industries, were required to register for service. Men from all walks of life and professions enlisted to join the fight, which meant that the Allied army of the Second World War was largely made up of volunteers and conscripts, in contrast to modern armies, trained purely for military purposes. In captivity, POW doctors and camp commanders soon realised they could harness this diversity of background and skills to tackle the unique challenges they faced. 

Far East POW camps were a melting pot of professions and trades, from plumbers and engineers, to artists, mathematicians, carpenters and doctors and many collaborated to produce remarkable results. Even a former cat-burglar was able to contribute, by using his expertise to steal drugs and equipment from the Japanese. Camp medical officers had an unenviable task in the camps. The Japanese held them responsible for the health of all prisoners and they would be beaten when daily quotas of men fit for work were not met. After the war, records created by artists such as Jack Chalker helped the broader medical community to understand illness originating from Far East camps. Many of the artworks created in POW camps show the life-threatening levels of malnutrition amongst the men in captivity. The average POW was consuming less than a cup of filthy rice per day, with limited amounts of vegetables and occasionally meat or fish.

Near the start of the war, Meg Parkes’ father, Captain Andrew Duncan, was senior cipher officer at British Headquarters in Java before he was captured. After 3 and a half years in captivity, according to the weight chart in his diary, he weighed just six and a half stone."

Meg Parkes, Author of 'Captive Artists' and Honorary Research Fellow at LSTM: "It had such a profound psychological, physical and mental effect on them. As children, we would be told repeatedly we had to eat everything on our plates. That wasn't uncommon in the 50s and 60s, but with him it was obsessive and it caused a lot of tension around the dinner table." 

Voice over: "Japanese supply lines were devastated during the Second World War, so the Japanese were, themselves, short of food. They viewed surrender as dishonourable and their Allied prisoners as nothing more than slaves. Feeding them sufficiently was not a priority. The Far East POW diet was notoriously meagre, deficient in calories and vitamins. 

Oral History - Robert Brazil, British NCO and POW: "At first the food was alright but that ran out and the Japs didn't produce any. Eventually they were persuaded by some officials to give us some food. So they gave us some sacks of condemned rice - a mix of rice and weasels." [laughter]

Voice over: "During the first year of captivity, a condition called ‘Beriberi’ had become a pressing concern. Caused by a deficiency in thiamine, one of the B vitamins, it could lead to heart muscle weakness, fluid retention, as well as damage to the nerves in the legs. The lack of other B vitamins could also cause blindness and painful feet." 

Meg Parkes: "A former flight lieutenant, Leslie John Audus had been a botanist and he was also a gifted, untrained artist, and his skill base was to come in extremely handy in captivity. They had realised early on that the diet being predominantly rice with very little else - They were going to have problems with vitamin B deficiency and that was going to lead to men having excruciatingly painful feet and also losing their sight, and Leslie knew that he was beginning to lose his sight." 

Voice over: "Camp medical officers struggled at first to find solutions. But in March 1943, a fresh intake of Dutch prisoners brought with them stories of a potential cure from their previous camp. The answer, it seemed, was yeast."

Meg Parkes: "So he and this fellow scientist, a Dutchman, worked out how they could make yeast in camp because yeast is rich in vitamin B. And they perfected it secretly and produced yeast as a supplement that people could take as a liquid on a spoon." 

Voice over: "Fermentation techniques have been practised for centuries. British troops were even issued Marmite rations during the First World War, after the discovery of B vitamins in the product in 1912. POWs with expertise, like Leslie Audus, were able to come up with a customised solution. Although POWs had limited produce to work with, they could buy maize with their small camp funds and they also had rice rations. They were able to set aside a small amount of maize, rice or fruit as a substrate from which to grow their yeast."

Oral History - Leslie Audus, British Officer and POW: That was the basic principle. The yeast was synthesised fairly high levels of the beta vitamins and that’s what we were deficient of, in our normal diet from the Japanese."

Voice over: "Audus and Alston raided rubbish tips for saucepans and containers and incredibly, they managed to build sophisticated distillation apparatus, from discarded items such as kerosene and molasses tins."

Meg Parkes: "They made a Bunsen burner. They needed it and they made it. They had a gas supply. I mean, it honestly defies belief, but they were very, very resourceful from very early on."

Voice over: "Audus and Alston spent one month experimenting in pursuit of optimum germination conditions. They even made their own thermometer out of glass capillary tubing and mercury. The first recipe involved soaking maize for 2 days in water and keeping it damp until, after 4 days, inch-long shoots appeared. This was then ground into a paste and mixed with water and kept at 55 degrees for 15 hours, until 60 per cent of the starch in the malt had converted to sugar. The residue was then strained through cloth and sterilised before inoculating with a yeast culture. A beer substance was syphoned off, and the remaining starch and yeast was bottled as the miracle vitamin B supplement. When maize became scarce, they switched to growing yeast from rice.

This crucial dietary supplement that the men affectionately called their ‘Camp Marmite’, soon became widespread. The results spoke for themselves. A deficiency disease, ‘Pellagra’, was eradicated after just 3 months of doses, and many reported improved eyesight. From this yeast, they could also make surgical alcohol, distilled water, bread and saline solutions, useful for surgery and medical procedures. One assumes that the last place a surgeon would want to conduct surgery is in the unsanitary conditions of a POW camp. But there was a huge need for surgery in the camps, particularly along the Thai-Burma railway, where men were forced to work unprotected in the jungle. 

A small scratch from bamboo often turned into a tropical ulcer and when infected, could spread to the deep tissues and sometimes as far as the bone. Dead tissue was removed by either scraping it off with a sharpened spoon, without anaesthetic, or the dead flesh could be eaten away by introducing maggots or submerging the limb in the river so that certain fish could nibble at it. Tropical ulcers could be extremely painful and many required amputation to avoid loss of life. But how could surgery be performed in such an unsanitary and ill-equipped environment?"

Oral History - George Weetman, Australian Seaman and POW: "There was no anaesthetic or anything like that, four guys would hold A fella down and off would come his leg, Throw it in a 44 gallon drum, That was it. It was pretty ruthless But it saved a lot of lives.   

Meg Parkes: "If they hadn't had them amputated it would have killed them. They would have died of gangrene or of blood poisoning. They performed miracles. It's the ingenuity that is so awesome. For people who had nothing, to have been so resourceful."

Voice over: "Much of the medical equipment was created in the camp workshops by people with metal work and mechanical skills. They repurposed kitchen knives, tin cans and scissors into medical instruments such as surgical forceps and scalpels."

Oral History - Philip Meninsky, British NCO, POW and Artist: "They had so little to dress the wounds with and most of the dressings were torn up shirts and things. Every morning when the dressings were taken off, they were put into a biscuit tin and boiled. So you had a sort of stew of dressings and they were then taken out and put into another lot of water and they were reused."

Voice over: "Blood transfusion and donation presented their own challenges, as there were very few needles. But Prisoners of War skilfully made their own needles from thin, hollowed out bamboo shoots or by adapting glass droppers. In 1945, Captain Markowitz reported that a staggering 3,800 blood transfusions had been carried out in Nakom Paton POW Hospital alone. There was never a shortage of blood donors. Despite their predicament, many POWs were keen to volunteer. For larger items such as operating tables, raised beds and dentists chairs, bamboo seemed to be the ideal option as it was straight, sturdy, lightweight and readily available. Bamboo also came in handy for more personal items."

Oral History - Philip Meninsky: "The ingenuity that was used in Chungkai was absolutely incredible. Chaps made a rib sheer out of a kitchen tap. There was fellows making artificial limbs"

Voice over: "Amputations at thigh level were particularly common and this presented a difficult challenge. However, they were able to come up with creative solutions and over time, more and more sophisticated designs came out of the workshops. A dedicated 'Prosthetic Limb Factory', run by POWs at Changi Camp, even utilised salvaged sheets of aeroplane fuselage metal."

Meg Parkes: "The bamboo peg legs were preferable to many men because they were so lightweight and very strong but they also became hiding places, these peg legs, for one or two of the artists who would actually be able to slit the bamboo and slide paper in."

Voice over: "Sergeant Barber, was an amputee who had worked on the infamous Burma Railway. This prosthetic leg and harness were built for him at Chungkai, by British and Australian POWs, from hollowed out teak and tamarind. The hinges were made from the metal of a camp bed, donated by another POW. Further elements were fashioned out of an army issue water bucket, the leather from the hide of a bullock, killed in the camp, as well as army issue webbing. These are just a few examples of the many innovations born out of necessity, that helped improve chances of survival for POWs during the Second World War. These were unprecedented circumstances. A group of this scale has never before or since been exposed to years of extreme malnutrition and disease, as was seen in the Far East during the Second World War. Being able to observe former POWs over an extended period, has greatly informed the medical community, leading to revisions in how we understand vitamin deficiency syndromes, long-standing tropical infections and PTSD. The resourcefulness of prisoners of war not only provided immediate solutions, but also paved the way for advancements in the post-war era and beyond."