“One day I felt most peculiar and when I came back I could hardly stand. So I sent for a doctor, and he had a look at me and said, ‘You’ve got a dreadful temperature, you’re about 106, you’ve got malaria.’”
Gordon Smith was digging embankments to make way for the railway at Tamarkan in Thailand when he was struck down by his fever. The jungle prisoner of war camps of World War II exposed their prisoners to a variety of debilitating tropical diseases the likes of which these men had never seen. Chief among them was a disease still killing hundreds of thousands today: malaria, caused by the parasite Plasmodium.
There are several types of malaria, caused by different species of the parasite. Among them is Plasmodium vivax, which can kill but is not immediate in its effect. Then there’s Plasmodium falciparum, which is responsible for almost all malaria deaths, says Geoff Gill from the Liverpool School of Tropical Medicine. Its effects can be seen within hours, giving an extremely unpleasant and occasionally fatal feverish illness with high swinging temperatures and rigors – shaking and sweating, debilitation, inability to get out of bed. There was significant mortality from that affecting the brain, as cerebral malaria, and the kidneys, as blackwater fever – a serious complication that rapidly destroys red blood cells, turning urine dark red or black.
At the time, the best treatment for malaria was quinine, a compound extracted from the bark of the cinchona tree. Its fever-reducing properties meant that it was a popular treatment for the symptoms of malaria. But as with most medical supplies, quinine had to be strictly rationed. Smith was treated and his temperature subsided within a few days. Others, however, were not so fortunate.
“We had to try and limit the use of that as much as possible,” says Smith in an interview for the Captive Memories project. “We had to use the maximum dose for people with falciparum, the others could have a slightly smaller dose – and my job was to find out which one they had.”
Medical officer Jim Mark was lucky enough to have a microscope with him in the camp. Smith, who’d spent time as a medical student before the war, was put to work. Armed with this small microscope and a battered copy of Manson-Bahr’s encyclopedic manual of tropical diseases, Smith began examining blood samples, counting the number of cells per square millimetre and so forth. Once he had identified blood samples that didn’t contain the malaria parasite, he could attempt a blood transfusion.
Exchange transfusion – when uninfected blood is drawn from one person and given to another with active malaria – remains a controversial choice of treatment. With risks including fluid overload and infection transmission, it is only recommended for severe cases and those suffering from complications such as cerebral malaria.
“One of the doctors had heard that if you removed the clot before it was transfused then it would be perfectly alright,” says Smith. But with no anticoagulants available, there was a problem of how to prevent donor blood from clotting. “So what we did was we produced a thing, rather like an egg whisk with bits of bamboo,” says Smith. “And using this egg whisk gently stir round and round and gradually all the ligaments of the clots would wrap themselves around this thing, leaving quite clear blood, and then one could then pour it into the patient.”
“Sometimes people had slight discomfort when they had these transfusions and as they all had pretty dicky hearts with the life we’d been living, I thought I should try and find out why this should be. At first I thought that perhaps I’d mistaken the actual blood cells, the blood groups, but this is not true and eventually it came to me that in fact there were far more than four blood groups... you had these subsidiary groups which nobody would possibly transfuse without taking care.”
As well as the four main blood groups, the Rhesus factor – a protein found on red blood cells and discovered in 1937 – meant there were in fact eight common blood types. Smith’s solution was to get three or four people who were suitable donors, put their blood samples in a row and mix in a drop of blood from the recipient, choosing the one that “worked best”. It wasn’t perfect, but in the railway camps, faced with such high mortality, there was little alternative, says Smith. “If people had malaria and it wasn’t active we just had to transfuse it. We had to get blood in somehow.”
It wasn’t without significant danger, but Smith was able to provide effective exchange transfusions for his malaria patients. The technique was widely used in the camps, according to Meg Parkes, a research fellow at the Liverpool School of Tropical Medicine. She says transfusions were used to help men who were grossly debilitated, and over three-and-a-half thousand of these transfusions were performed in jungle camps in Thailand. Engineers helped by making sterilising units, charcoal braziers to heat up sterilisers to boil the equipment needed. And then an army of men made disposable bamboo whisks for whisking the blood when it was taken from the donor. Strips of stethoscope tubing were applied – in some cases the transfusions were done donor-to-recipient direct, in which case rubber tubing was used.
Through such methods were many saved. Despite the major threat to their lives, hundreds of prisoners of war survived to describe up to 30 episodes of malaria during their three-and-a-half years of captivity.