Consequences of captivity: health effects of far East imprisonment in World War II

Abstract

Though medical consequences of war attract attention, the health consequences of the prisoner-of-war (POW) experience are poorly researched and appreciated. The imprisonment of Allied military personnel by the Japanese during the World War II provides an especially dramatic POW scenario in terms of deprivation, malnutrition and exposure to tropical diseases. Though predominantly British, these POWs also included troops from Australia, Holland and North America. Imprisonment took place in various locations in Southeast Asia and the Far East for a 3.5-year period between 1942 and 1945. Nutritional deficiency syndromes, dysentery, malaria, tropical ulcers and cholera were major health problems; and supplies of drugs and medical equipment were scarce. There have been limited mortality studies on ex-Far East prisoners (FEPOWs) since repatriation, but these suggest an early (up to 10 years post-release) excess mortality due to tuberculosis, suicides and cirrhosis (probably related to hepatitis B exposure during imprisonment). In terms of morbidity, the commonest has been a psychiatric syndrome which would now be recognized as post-traumatic stress disorder--present in at least one-third of FEPOWs and frequently presenting decades later. Peptic ulceration, osteoarthritis and hearing impairment also appear to occur more frequently. In addition, certain tropical diseases have persisted in these survivors--notably infections with the nematode worm Strongyloides stercoralis. Studies 30 years or more after release have shown overall infection rates of 15%. Chronic strongyloidiasis of this type frequently causes a linear urticarial 'larva currens' rash, but can potentially lead to fatal hyperinfection if immunity is suppressed. Finally, about 5% of FEPOW survivors have chronic nutritional neuropathic syndromes--usually optic atrophy or sensory peripheral neuropathy (often painful). The World War II FEPOW experience was a unique, though often tragic, accidental experiment into the longer term effects of under nutrition and untreated exotic disease. Investigation of the survivors has provided unique insights into the medical outcome of deprivation in tropical environments.

Vincristine induced neurotoxicity in cancer patients

“…10,11 Further susceptibility to neurotoxicity may be associated with certain micronutrient deficiencies, which needs to be explored. 12,13 Based on these findings in a small group, it may be difficult to make significant suggestions. It would be pertinent to asssess the possibility of enhanced genetic or environmental susceptibility of Indian children to the neurotoxic effects of vincristine in a larger study.…”

The Utility of Iris-pupillary Area Ratio as a Non-invasive Index of Stress in Primates

“…The dilated pupil observed among zoo monkeys compared to wild monkeys reflects higher sympathetic activity, 24,28 which may be due to captivity-related stress. [30][31][32] Despite the best welfare measures adopted, nothing can fully replace a natural habitat, hence several studies have reported stress among captive exotic animals. [30][31][32] Furthermore, the reliability of pupil diameter as a reflection of autonomic system activity ( Figure 2) and mental stress has previously been demonstrated in humans.…”

“…[30][31][32] Despite the best welfare measures adopted, nothing can fully replace a natural habitat, hence several studies have reported stress among captive exotic animals. [30][31][32] Furthermore, the reliability of pupil diameter as a reflection of autonomic system activity ( Figure 2) and mental stress has previously been demonstrated in humans. 3,5,[24][25]27,33 The feasibility to non-invasively and objectively quantify stress based on iris/pupil area ratio in our opinion has potential to be of utility in personalised animal welfare measures.…”

Burning feet syndrome: An old tropical syndrome revisited

“…During the next 3½ years, the POWs were moved to various other locations, including Japan, to work in the dockyards and factories; and Thailand and Burma to construct the notorious "Death Railway". As well as undertaking hard physical work and exposure to tropical infections (e.g., malaria, dysentery, cholera, dengue etc), there was a universal shortage of food which was of poor quality and low in protein and vitamins.Overall, about 25% of POWs died in captivity, [10] and many survivors suffered persisting ill health -including post-traumatic stress disorder in about 35%, [11] and long-term infection with the nematode worm Strongyloides stercoralis in 15%. [12] Burning feet in captivity FEPOWs from all areas of incarceration frequently complained of burning feet.…”

“…In some locations, these were known as "electric feet" (to describe the shooting neuropathic pains) or "happy feet" (in relation to moving and stamping around to try to relieve the pain). Shortly after release in 1945, some POW medical officers recorded their experiences of the condition [9][10][11][12] in captivity. Later, BFS in FEPOWs was to be described as persisting many years after release.…”