118
119
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to use grass for cooking, a procedure which usually resulted in delayed and badly cooked meals. An inspection by the International Red Cross delegate, with Japanese officials, of a large kitchen, where damp grass was being deliberately used to emphasise the position, was rendered farcical by the density of the smoke and may have accounted for a mark improvement in firewood supplies during the final months of internment.
14. FOOD SUPPLIES
The diet in Stanley Camp was, without doubt, monotonous and unpalatable and unsuitable for Europeans. It was consistently lacking in quantity, and frequently in quality and at no time provided sufficient energy and essential food factors to meet minimum requirements. Much of the foodstuffs received was of very poor quality or had deteriorated in storage or during prolonged transport. It is, therefore, rather generous to calculate their food value, as has been done, on figures applicable to foods of average quality and with an average amount of unavoidable waste in preparation and cooking.
All rations were inspected on arrival by members of the health staff, a task which was fréquent y an unenviable one. Pre-war standards could not be maintained as rejected portions were not replaced and internees were living on a diet which bordered on starvation. The dividing line between what was fit and what was not fit for human consumption was very fine and risks were undoubtedly taken. But it was only on a few occasions that consumers were adversely affected and these were usually localised cases due to failure by kitchen staffs to follow medical recommendations. When food was rejected the Authorities were informed and a protest lodged which sometimes led to temporary improvement. Some of the meat received was found to be heavily infected with tuberculosis, showing signs of decomposition or so emaciated, as to be obviously from diseased animals, Fresh fish was often so delayed in transit that much of it was uneatable on arrival. Later on frozen fish was supplied and occasionally this led to difficulties as one could not convince the Japanese that fish which was partly decomposed when frozen was unlikely to improve in storage. Finally, when lack of coal and electricity made cold storage impossible, and transport difficulties ruled out fresh supplies, the camp was subjected to the ordeal of Chinese salted fish. Many refused it but those of us who consumed it survived, somewhat to our surprise, without ill effects.
Shellfish was provided on a few occasions but as such probably originated in Hong Kong harbour, where collection was forbidden in pre-war days owing to the danger of typhoid, the supply was stopped at our own request. The small food value of this delicacy did not justify the danger involved in handling it in improvised kitchens where supplies of hot water and even fuel for cooking were inadequate.
On a few occasions the rice provided consisted of godown sweepings, almost uneatable and of very little value as food. It contained such items as sand, small stones, cigarette ends, insects and their young, droppings, glass and once, at least, rat carcases. Protests regarding the quality of rice appeared to be more effective than those in respect of other supplies and, as a rule, rice was of good quality. Requests for a regular supply of part of our rice in unpolished form were unsuccessful.
Vegetables showed a seasonal variation in quality and quantity, being particularly poor during the summer months. Supplies were frequently old and deteriorated when received. Sweet potatoes, when issued, were often of an inferior quality. Some vegetables were hardly worthy of the name and when one recollects meals consisting of 4 oz. boiled rice with a small portion of boiled turnips, or boiled lettuce or boiled chrysanthemums, or boiled Chinese chives or boiled potato leaves, one may be forgiven for thinking of a stronger word than "austerity" to describe them.
The official rations were obviously inadequate for the maintenance of a reasonable degree of health and the results would have been very serious were it not for supplies received from other sources such as the Hong Kong Informal Welfare Committee, the Camp canteen and the International Red Cross delegate.
Some internees were fortunate in receiving regular parcels from friends in town but this benefited a comparative few and did not materially influence the health of the camp as a whole. On the other hand, marked improvement of the health of internees generally followed the receipt of food supplies from Britain and Canada in 1942 and 1944 respectively.
•
The Japanese Authorities failed throughout to provide milk and other foodstuffs to meet the special requirements of babies, children and invalids. Their plight would have been serious if Dr. Selwyn-Clarke had not managed to send into camp during 1942 sufficient supplies to meet such requirements for a prolonged period. Children over five years of age had to subsist almost entirely on the official rations, the help that it was possible to give them infrequently being so limited as to have but little effect on their health. Never- theless, apart from a high incidence of carious teeth and increased susceptibility to skin infections, the interned children were in a fair state of health on release and it is hoped that more serious manifestations of prolonged malnutrition will not arise.
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Repeated requests for improvement of the diet were made to the Japanese authorities throughout the whole period of internment but after 1942 the diet steadily deteriorated. While the rations provided might have been justified towards the end of the war owing lack of supplies and land and sea transport, and a very effective blockade, there was no excuse at the beginning when large supplies of suitable food were available in the Colony and even in large godowns inside the camp.
The figures for nutritional diseases given in Dr. Smith's report show that nearly all internees suffered at some time from malnutrition in one form or another and this, with other factors such as overcrowding, discomfort, confinement and anxiety makes more remarkable the grim determination and consistent good humour with which the large majority of internees endured and survived such a long period of strain and hardship.
(15) INFECTIOUS AND INSECT-BORNE DISEASES
The diseases under this heading of chief concern to the camp were dysentery, diarrhoea, typhoid, tuberculosis, typhus and malaria.
Diarrhoea and Dysentery.--In the early days of the camp conditions favoured the spread of fly-borne disease and the prevalence of diarrhoea and dysentery at that time was not surprising, particularly as many people had been infected in the Chinese hotels where they had been confined before entering Stanley. A large number of diarrhoea cases could be attributed to an unsuitable and unaccustomed diet and possibly to bad cooking. And, in the absence of laboratory facilities, it is likely that many cases diagnosed as bacillary dysentery on clinical grounds were, in fact, cases of acute enteritis. The situation was at first serious with 350 cases of dysentery in the first three months of internment but Xconditions improved and the total for the year was 410. Figures for 1943, 1944 and 1945
(eight months) were 191, 172 and 67 respectively. severity it responded rapidly to treatment with drugs of the sulphonamide group, of which Although the dysentery was of some there were limited supplies in camp. Only two deaths were certified as directly due to dysentery. Outbreaks of diarrhoea were fairly common particularly in the spring and autumn but only on a few occasions was it possible to determine the causative factor. Certain foods, either in themselves or by the nature of their cooking, occasionally accounted for these outbreaks but flies from the prison and Stanley village were probably responsible for many of them.
Typhoid-Internees were inoculated against typhoid either before arrival in camp or shortly afterwards and again in 1943 and 1944. with one death,
Fourteen cases of typhoid occurred
Tuberculosis.-Thirty-three cases were registered during the first year but many of these were old cases. Spread of this disease was favoured by malnutrition and overcrowding but this was largely balanced by a good climate and an open air life. Only a comparatively small rumber of new cases were diagnosed and at the time of release only 15 cases were receiving hospital treatment. There were seven deaths, That undernourishment was largely responsible for the steady deterioration of these patients' condition was clearly demonstrated by their rapid improvement on an adequate diet following the Japanese surrender. For most of the time tuberculous cases were treated in the general hospital wards as separate accommodation was not available; in June, 1944, however, a small building, used in pre-war days as a ward for leprous prisoners, was allotted for use as a sanatorium. This proved a relief to the hospital and beneficial to the patients concerned.
Diphtheria.-One case diagnosed as diphtheria occurred late in 1942. The authorities promptly provided anti-toxin. The source of infection could not be traced and it is remarkable that the patient's two children escaped infection although they were at a very susceptible age, lived in a small room with her and no protective treatment was given. The diagnosis was confirmed by a Japanese-operated laboratory in town but its work was not reliable as it similarly diagnosed a smear from an ordinary septic throat a few days later. I was unconvinced that the case was, in fact, diphtheria. Its treatment however, demonstrated the necessity for isolation facilities in camp; the hospital outpatient department had to be closed to make the room used as such available for the patient.
Typhus. There were nine cases of scrub typhus with four deaths. The severity of these cases and the high mortality rate suggest the possibility of Japanese River Fever. Cases occurred in late summer or early autumn and the evidence available indicates transmission by mites. Several cases amongst troops on manoeuvres occurred in Hong Kong in 1941 and it is possible that incidence may increase as a result of the Japanese occupation. Full investigation of the true nature and mode of transmission of the so-called scrub typhus as met with in Hong Kong appears to be necessary.