With thanks to
Michael Williams. (Captain-Retd-2KORR), 2nd Battalion, King's Own Royal Regiment, 111 Brigade
Courtesy of: St. Mary's Hospital, London.
May not be reproduced without written permission.

A man’s leg had been shattered just below the knee. There was no doctor nor medical orderly available. The young officer who had had wartime commando training which included some advanced first aid training realised he had to make some decisions. One of his men was already applying pressure at the pressure point in the groin to stop arterial bleeding and also a rather ineffective tourniquet had been applied. It was 1942 in Burma and his patrol was some three or four days from the nearest prospect of transport, let alone medical aid.

He reminded himself of his forefathers who had fought all over the world and, if wounded, had to bear rudimentary and drastic, but often effective, surgery on the spot. He committed himself to the memory of his great-grandfather who had lost a leg in the Ashanti War 60 years before, and got down to work. He gave the wounded corporal two shots 1/2 grain morphine, all he had in his emergency pack, and his men made some hot sweet tea laced with some brandy. One man of his patrol sat on each shoulder of the wounded man, and one on the undamaged leg, whilst two others, as best they could, held the right thigh to the ground still applying pressure, all on a dirty ground sheet.

The officer took a kukri and tried to slash the ligaments in one go. They were tougher than he expected and it took more than one cut. His batman, meanwhile, had extracted some cotton from the buttons of his shirt and soaked it in iodine. Mopping away the stump with some lint the officer found the arteries by telling the men on the pressure point to release the pressure so that he could see the pumping effect. He tied up these tough tubes of arteries with the iodine-soaked cotton and scattered sulphanilamide powder over the wound. He also tried to tie up any obvious veins that he could find. evacuationDakota.jpg

The men sitting on the wounded man's shoulders continually talked to him, sang softly and, at times, smacked or pulled his face to distract attention. The sergeant was out with the rest of the patrol to prevent any Jap interference.

The officer tried to blunt the sharp and jagged edges of the projecting thigh bone without much success. He then applied more sulphanilamide powder on gauze to the wound, being careful not to include any of the flies or insects which the smell of blood and salt sweat had attracted. There was no human habitation for miles so the flies would probably not have carried much dangerous infection anyway.

The officer instructed his batman (they were so much in each others' minds after long acquaintance that speech was hardly necessary) to make a sort of wide cup of six pieces of three-inch elastoplast and thickly line it with lint. He filled this with the remaining sulphanilamide powder and pushed the lot over the jagged stump, sticking it all on firmly to the upper leg with the remainder of the elastoplast.

The corporal was given some more hot sweet tea, the only antidote to shock that the officer knew and was available, laced with some Kachin rice liquor called ' zhu ' which one of the men produced, the brandy having run out. The wounded man was then carried back through the jungle during the next three or four days partly on a stretcher made of bamboo and a groundsheet, and partly on a mule, was fed as much tea, sugar and glucose as he could take en route, was evacuated and lived. A further operation was necessary as no extra skin was left to pull over the wound. The wounded corporal said that he preferred the first operation as it was not so gloomy and it felt more like a wake with everyone ^talking, making jokes, and singing to distract his attention, and with plenty to drink!

On the retreat from Burma in 1942 an Indian soldier was captured by a flying column of Japs, had his wrists tied tightly behind his back, was made to kneel down with his forehead on the ground (the position is important) with three hundred other Indian soldiers who had surrendered and, in order to save ammunition, was, with the others, bayonetted 5 times through the small of his back, in all instances (so a later medical report with diagram states) the bayonet passing through his body and emerging at the front. Subsequently interrogation and examination by medical authorities in India elicited the following story. As a layman I cannot remember the anatomical details. He must have lain where he was bayonetted for about three days in that doubled up position with his hands tied behind his back. During this period his wounds got maggoty which probably saved his life. On the fourth day he moved slightly to try and lap some water from a puddle, fell face foremost into it and nearly drowned. There were some marks on his back as if some vulture had tested whether he was carrion but had left him for more savoury meat nearby. He remembered regaining consciousness once or twice during the next two days and drank a little of the muddy water. On the sixth day he was found by some Burmese, the only one of the 300 still alive, who cut his thongs and carried him back to their village. Here they applied some leaves with a smear of cowdung to his wounds. After a week or two, when he felt better he walked over the 80 miles of jungle covered mountains to the British base at Kohima where he joined a sick parade and complained of diarrhoea! He lived.

In Burma, whilst dysentry, scrub typhus, hookworm, jaundice, dengue and various types of skin diseases including jungle sores were a constant threat and active debilitant to the troops of both sides fighting in the jungle, malaria; including forms previously unknown, was the major source of casualties. In 1943 disease accounted for a hundred times more casualties, and greater than a hundred times more hospital beds than battle wounds. Just as in the last war it was necessary to win the air battle first before troops could operate, in Burma it was necessary DeathBurial.jpg to win the medical battle before an advance could be made. It had happened before. In about 1000 A.D. the Chinese had sent an army into the northern jungles of what i s now VietNam and Thailand and, the story goes, none ever returned. They were destroyed by disease. There are many other similar instances in history where armies have tried to fight in tropical jungle. Disease has been an efficient protective minefield to those small tropical countries.

Major-General Orde Wingate was one of the first combatant generals to face up to this disease problem and its effect on operations. In his first Chindit operation he insisted on having twice the normal proportion of medical officers and orderlies. In fact his Brigade was used as an experimental unit to test out various methods of combatting disease and finding means to evacuate the inevitable casualties. A Captain G. V. Faulkner, I.M.S., a Canadian, and Senior Medical Officer on Wingate's staff, a man of magnificent physique and realistic brilliance, went in on the operation marching 1,500 miles or so behind the Jap lines in the jungle, and wrote a report on the expedition which helped revolutionize the attitude throughout the Burma Army to disease and casualty treatment and problems of evacuation. It would take too long to detail his views which had the active support of General Wingate, but the author, who commanded a Gurkha Column in the first Chindit operation and a glider-landed Brigade in the second, is grateful for this opportunity of stating before a medical audience that Wingate paid more attention to the medical care of his troops and helped institute more modern methods of preventive medicine and evacuation of casualties than was ever thought of or attempted by any other senior officer on the Burma front, or any other front for that matter. We were the first to receive wholesale mepacrine protective treatment. Our rations before operations were designed to build up our resistance to disease and hardship, full well knowing that we were bound to lack adequate rations on operations. Our clothing, boots and rations with extra vitamin pills were similarly designed to be light and withstand heat, rain, insects and general wear and tear. The results of these experiments were later incorporated into the rations and equipment of the whole army. It was Wingate who insisted on and obtained light planes for evacuation of wounded, who tested them out on very rough strips as a passenger himself, and was sitting in the first glider to be snatched off the ground in Asia by a 90 m.p.h. Dakota aircraft. He himself sat in front of the Gurkhas, who, at that time, thought it was necessary to cook rice for a whole company in 2-1.2 hours in a huge iron pot, lit a small wood fire and showed them how to cook it in a billycan in twenty minutes and made them eat it with him. This naturally increased the mobility of the column. He taught us to look after, load and groom mules and swim across rivers with them. I could go on.

But it is necessary to say this as it has been reported in some quarters that Wingate appeared callous to the sufferings of his own troops. The opposite was true. But you cannot fight wars without casualties and there were some senior medical officers who, presumably, considered a battle so unhygienic that they tried to stop any offensive action against the Japs on medical grounds unless quite unpractical medical precautions were taken. They would be the advocates of a submarine towing a hospital ship marked with a Red Cross on the surface in case anyone in the submarine got ill. We were the submarines in the jungle and, once an operation is considered necessary, taking everything into account, the medical advisers must give the ' optimum ' advice and assistance possible without insisting on so many precautions that these precautions themselves threaten the safety of the operation and may be the cause of more casualties

However, it must always be remembered that the Japanese had as much, if not more, trouble over disease and evacuation of wounded as the British/Indian Armies. The idea that the Japanese soldier could exist on a sockful of rice for a week at a time is a stupid fallacy. We often captured excellent Japanese rations which certainly in their rear areas were better than ours and which we ate gratefully. The Japanese tended to suffer more from deficiency diseases than we did mainly because, in spite of all their campaigning in China, they had not evolved a balanced ration and their communications were more often interrupted by both air attack and our Chindit depredations.

The Burma war was very much a medical war and was fought as such. When General Slim decided to send a West African division through the notorious cerebral malaria-ridden Kabaw valley against the advice of his medical advisers he accepted twenty per cent. non-recoverable malarial casualties as being worth the consequent outflanking of the Jap forces. But he took every medical precaution beforehand and this percentage was very much reduced.

woundedevac.jpg The hygiene discipline of the Romans, on the other hand, was superb and, according to De Saxe, accounted for their ability repeatedly to destroy many times their number of brave barbarians. Vinegar, for instance, was used instead of our chlorine to purify the water in their waterbottles, and was for the same reason applied to fresh vegetables as we do today.

In recent times I was most impressed by the same excellent hygiene discipline of the Malay Communist 'bandits'. In their more permanent camps deep in the jungle they had built covered earth latrines, hygienic cooking arrangements, permanent running water led to the camp in bamboo channels from small sweet streams, and an efficient waste disposal system which was necessary as they had remained in some camps since the war years. There were no flies on a 'Chinese Communist Camp! I have not seen the Viet-Cong arrangements but presume that the same attempts at a high standard of hygiene prevail amongst all Asian Communist Guerrillas, and this must be a major factor in their successes and in their ability to keep an army in the field for a long time.

In the 1944 Chindit Campaign a great friend of mine, Major Geoffrey Lockett M.C., raided a Japanese Ordnance Depot and, after killing the guards, found himself in wide expanse of ' open' jungle (no shrubbery between the tall trees) and surrounded by lines and lines of ammunition dumps suitably spaced so that one lot exploding would not set off its neighbours. He had 80 Ibs. of explosive and about 20 men. There were hundreds of armed Japs in the vicinity. He discovered the Jap medical store complete with hundreds of cases of quinine, a medicine lost to the Allies since the fall of the Dutch East Indies which had had the world monopoly. Lockett had himself known the year before what it was like to be without protection against malaria in the jungle. He laid his charges and effectively destroyed all the Jap medical supplies. These turned out to be the sole supplies of the newly arrived Japanese 53rd Division. Japanese documents, interrogation reports and histories show that this division suffered more than any other from malaria which brought its operations nearly to a standstill. It was a brilliant quick appreciation on Lockett's part to destroy this one vital store and is a fine example of a small force applying pressure at a decisive point.

In 1943 after crossing the mite-wide Irrawaddy River whilst being attacked by the Japs and at the same time having to swim half our mules across, I was faced with the problem of what to do with the wounded. We were 200 miles from any regular formation of Allied troops. I still had 370 men left in my column and an offensive task to perform against the Japanese lines of communications. Carrying wounded with us would handicap our movements and could easily be the cause of many more casualties. In that year there were no helicopters or light planes available to evacuate wounded. Also the range was too great and we had no intermediate Dakota strip behind the Jap lines as we had the following year to which any light planes could take casualties. I had to make a decision by myself. There was no one to ask. I also had to consider the morale of the men.

Fortunately I bad had some dealings with the Japanese Army in China before the war. I knew that the one thing that they admired above all was courage. I ordered the wounded to be taken to the nearest Burmese village. I called up the headman and the villagers. I told them that I was leaving our wounded in their care and was leaving a written message for the headman to give to the. senior Japanese officer. This read:

To the Japanese Commander Katha Garrison. " Greetings. I have left my wounded in your care. These men have been fighting courageously for their King and Country just as your men have. They have been bravely wounded in battle. I am certain that with your fine traditions of' Bushido you will look after them, tend to their wounds and see that they are evacuated to hospital as soon as possible, and in all ways give them the honours they deserve as brave men." Signed J. M. Calvert, Major.

I counted on the Burmese headman seeing that the message was translated into Japanese and that, at any rate in front of the Burmese, the wounded would be treated well. In fact these men were so well treated that eventually when those who survived joined the prison camps, their compatriots, who had been there for a year or so, suspected them of giving away information in order to obtain soft treatment. This was not so. They had no information to give as by the time they met the Japs we had moved well away.

tendingwounded.jpgThis medical aspect of manoeuvering in war is nothing new. I had always wondered, when reading military history, at the marching and countermarching in Marlborough's days, until I read the writings of Marshal De Saxe ' On War'. Evidently at that time hygiene discipline was so bad that, if you could get your opponent by some threat to concentrate his forces, and to remain concentrated for over five days, allowing time for a new generation of flies to be hatched on the army's excreta, you could rely on destroying up to 20 per cent. of your opponents forces by dysentry and other fly-borne diseases without a shot being fired. In spite of precautions malaria was always a menace. In the 14th Army, Forward Malarial Treatment Centres were formed so that malaria patients could be treated on the spot and not sent back and thus avoid extra transport and reinforcement problems.

With us in column a man with a temperature of 101 °F had his pack carried on a mule. Over 103°F he himself was put on a mule or horse. Four years after these operations it was found in a hospital in Trieste that I still had malaria, hookworm and amoebiasis. At that time there were so many active malarial cases in Britain from the Middle and Far East that East Anglia and the Thames Valley, both of which still breed anopheles mosquitoes, were declared malarial areas. I often wondered after my experience whether when, say, a reticent ex-Lancashire Fusilier living in Rochdale and, at the repeated insistence of his wife, had reported sick to his busy National Health doctor, he would be given the necessary tests to find out if he was still suffering from any of the insidious diseases he might have picked up in Burma?

Personally I completed the war in North-West Europe where a battlefield was quickly cleared up, the wounded and dead were efficiently hidden away, and there was little or no disease. With us in Burma it was totally different. For instance at our "White City" Block deeply dug in across the main Jap lines of communications we were permanently kept company by hundreds of rotting Jap corpses stuck on our formidable booby-trapped perimeter barbed wire. Flame throwers and quicklime dropped from the air did little to reduce the flies, the smell and the modernistic sculptures on the skyline as these twisted corpses disintegrated into skeletons.

The wounded also had a less easy time than in Europe. The present General Manager of the factory that makes "Tuf" shoes was wounded quite severely four times in different parts of his body over a period of weeks before he was forcibly evacuated. He was no exception. My Brigade Major, Major Francis Stuart, M.C., was dying, unknown to me, of tuberculosis and was carried on a stretcher into the last Battle of Mogaung determined to see our final victory before he died in Calcutta a fortnight later.

At one point during the monsoon at Mogaung we had 170 battle casualties awaiting evacuation by light plane lying on parachute cloth beds under white parachute cloth shelters, and tended by a surgical team parachuted in. We were annoyed to find at this time that penicillin was reserved for the European Front, presumably because they had a greater voting value, and our "low priority war" was not issued with it, except to the Americans, from whom sometimes we got supplies on the sly. But our unit medical officers and the parachute team worked wonders and earned our unalloyed admiration, thus maintaining morale under difficult conditions.

The Japs, on our approach to Mogaung, used a unit formed of hospital patients to delay our advance. We were then also very short of men and tired by nearly five months of fighting so that, when we overran their hutted hospital hidden in the jungle, we did not at first bother to clear it as we were fighting by this time against infantry and artillery units to our front. Later I sent some men to these huts. The Japanese patients shot them from their beds as they entered. Our men threw grenades inside the wards with some smoke and entered. The Japanese in one ward, most of them already deficient of a limb or two, put their heads together around one of their own grenades pulled the string and saved us some trouble. However we needed prisoners as once a Jap was taken prisoner he had lost his nationality and would then say all he knew in expiation. After the fall of Mogaung, three weeks and a 1,000 battles casualties later, we found innumerable more wards to this hospital tunnelled into the hillside. The majority of a couple of hundred Japs were now lying dead on the wooden racks in various stages of decomposition. About twenty were still alive. There were numerous signs of cannibalism in the dark. And who can blame them?.

Leave in Calcutta in the previous year, 1943, had also not been a picnic and certainly was not the beautiful picture painted by novelists of war- time days in Alexandria, Cairo and Naples. 4,000,000 people died at that time in Bengal from famine and cholera. As you walked down Chowringhee, the main street of Calcutta, to get to the drinking bars, you stepped over the dead and dying lying on the pavement, threw your loose change to the starving beggars, brushed away the flies, and drank deeply the Indian gin and Indian whisky and what little beer there was. Mr. Casey, now Lord Casey, Governor-General of Australia, was brought in and cleared matters up as far as was possible.

But death, disease, insects and smells tended to play a large part in our daily lives and perhaps made some of us morbid and with a tendency to hypochondria. This doleful aspect naturally impressed young soldiers' minds deeply, but being young and resilient, most of them soon got over it. But a by-product of this period can still be seen in the writings of many ' liberal' and ' anti-imperialist' writers and commentators of today, a surprising number of whom appeared to have served in India and Burma as young men at that time.

Gurkhatreatment.jpg I have used some of the space that I have been allowed in your journal to express mild criticism of some medical officers, just as they have, from their point of view, criticised General Wingate in the Medical History of the War in Burma, a tome well worth reading. But I should state quite categorically without going into details that I myself owe my life and health again and again to the medical profession. And that is the proof of the pudding. But I would like to make one last point.

Just as some civil engineers trained to perfectionism in Britain are appalled at the thought of building a bridge overseas where the soil composition and meteorological conditions and records are unknown; and there are factors of heat, dust, floods, below standard aggregate, saline water, unskilled machine operators and the drawing offices, consultants and libraries are a thousand miles away; so I think some young doctors are so appalled at unhygienic conditions away from the operating theatres, anaesthetists, consultants and clean young nurses, that there is a tendency to say, " It is impossible. I cannot operate under such conditions.", and leave the patient to die rather than take a career risk and operate. Another analogy is that of a Kent farmer put on to a 20,000 acre sheep station in New South Wales with tractors, a workshop and shearing shed, a landrover and one man, a boy and a dog. Unless he adopts the Australian attitude " I'll have a bash ", he will do nothing and the land will die. I think that the medical profession must be prepared to " have a bash " when it cannot get all that is desirable.

In 1950 I formed the 22nd Special Air Service Regiment for operations against the Chinese Guerillas in the deep jungles of Malaya. I had emphasized the importance of medical personnel, being used to win over the aboriginal tribesmen who were at that time dominated by the guerillas for whom they were the " eyes " and " ears ", by curing them of such complaints as yaws. Penicillin cures yaws in such a miraculous manner in such a short time that its use is liable to win over any superstitious tribesmen very quickly. It is the Boys' Own Paper principle of curing the headman's son and thus winning over the tribe. It works.

Operating in deep jungle where the guerillas had their main base camps we formed trading and medical centres to gain contact with the aborigines. These were a great success and this was the forerunner of the " Hearts and Minds " policy later used in Borneo.

However my first young doctor was filled with disapproval of the unhygienic attitude to the whole affair, especially the idea of unqualified medical orderlies administering penicillin, and worried me with complaints. Incidentally I had based my headquarters on a sulphur spring spa so that patrols away for a month or two could recover in the hot springs which helped cure their inevitable fungoid skin infections. It was amusing to see their posteriors painted with gentian violet or yellow aquaflavine like a new species of baboon. .Later I thought it silly to paint peoples’ bodies after infection and, taking a tip from the Ancient Britons, I took a patrol out with all of us painted from neck to toe. We returned free from fungoid infection and virgin white.

However my doctor, whom I thought would be delighted at having all these wonderful opportunities to practise his profession in a wide and new field, was always moaning about the conditions. So I applied for a replacement from the Director of Medical Services, Singapore, who himself had carried out a Hearts and Minds policy in West Africa in 1908 and was enthusiastic about the way the Medical Profession could help defeat the communist bandits. I suggested that the type required was a Hospitals Cup Rugby Football Forward and to hell with wonderful medical qualifications. He sent me two immensely powerful R.A.M.C. Captains and very soon a whole tribe of aborigines deserted the Chinese Guerillas and joined us. These two young doctors were said to have been seen each carrying half-a-dozen pigmy negritos under their arms to the medical centre to undergo treatment.

Perhaps "Health through Strength" would be a good motto for Jungle Medicine