American Ex-Prisoners of War 

By 

William Paul Skelton III, MD, FACP 

Ex – POW Physician Coordinator
 

Department of Veterans Affairs
 

Professor of Medicine
 

University of South Florida
 

College of Medicine
 

Department of Internal Medicine
 

James A Haley VA Medical Center
 

Tampa, Florida
 

Independent Study Course 

Released: April 2002 

Sponsored by 

Department of Veterans Affairs 

Employee Education System 

Employee Education System 

This is a Veterans Health Administration System-wide Training program, sponsored by 

Employee Education System. It is produced by Employee Education System. 

American Ex-Prisoners of War ii

Forward 

This Independent Study was inspired by the bravery and strength of character of the ex-POW’s I have known. 

I only hope that participating in this study will foster a deeper understanding of the hardships they endured in 

enemy hands. 

Among those captured by the Germans, I respectfully acknowledge the contributions of Donald Britt, Ross 

Coker, Glen Cleland, Harold Chesterman, Paul Dely, James Vogel, Frank Irizary, Eugene Nagy, Judson 

Luckhurst, Harley Burnett, Albert Bernard, Furman Davis, George Drew, Elonomac Creel, William Hooper, 

James Fulton, Richard Sprouse, Charles Stenger and Santos Santoni. 

Those captured by the Japanese whom I wish to recognize include Robert Horn, Joseph Moore, Owen 

Boothroyd, Charles Looper, Stephen Raymond, Antonio Delpino, Max Wilson, John Aldrich, Landys 

McClamma, Jasper Taylor, Henry Brunet, Jake Austin, Keith Johnson, Stan Sommers, Al Bland and 

Ralph Levenburg. 

From those captured by the North Koreans and Chinese during the Korean War, I would like to thank 

William Shaddish, Marvin Wallace, Joseph Spano, Robert Buzbee, Al Burton, Paul Lynch, Charles Davis 

and Wilmer Bartlett. 

I also wish to remember those captured by the North Vietnamese and the Vietcong during the Vietnam War, 

among them James Jackson, Everett Alvarez and Dick Stratton. 

I cannot adequately express the influence all these American men have had on my life; however, I especially 

want to recognize an ex-POW of Germany whose courage has inspired me throughout my entire life: my 

father, William Paul Skelton Jr. 

William Paul Skelton III, MD, FACP 
American Ex-Prisoners of War iii

Table of Contents Page
 

Message from the Under Secretary of Veterans Affairs .............................................................. i
 

Forward ...................................................................................................................................... ii
 

Independent Study Outline (Background, Purpose, Objectives, 


Outcome and Target Audience) ................................................................................................. iv
 

Program Description................................................................................................................... v
 

Program Development (Author, Planning Committee, Program Co-Directors, 


Project Support Assistant and Learning Technology and Medical Development).................. viii
 

Content Materials 

Chapters 

I. Background Information................................................................................................. 1
 

II. POW’s of Germany......................................................................................................... 5
 

III. POW’s of Japan............................................................................................................. 11
 

IV. POW’s of North Korea and Communist China............................................................. 29
 

V. POW’s of Vietnam ........................................................................................................ 36
 

VI. Presumptive Service Connected Disabilities ................................................................ 45
 

VII. Psychiatric Presumptive Service-Connected Disabilities ............................................. 69
 

Summary................................................................................................................................... 71
 

References................................................................................................................................. 72 


Appendix A – Federal Benefits for Ex-POW’s and Dependents .............................................. 81
 

Appendix B – Presumptive Diagnoses ..................................................................................... 86
 

Appendix C – Suggested Websites ........................................................................................... 93
 

Independent Study Questions for CME Credit ......................................................................... 94
 

Registration/Answer/Participant Satisfaction Form
 
American Ex-Prisoners of War iv

Independent Study Outline
 

Background	 This independent study module is being released as a part of the Veterans Health Initiative 

(VHI). The VHI is a comprehensive program of continuing education that recognizes the 

connection between certain health effects and military service and emphasizes better military 

medical histories for former prisoners of war and veteran patients in order to provide them 

with the best available care. 

Purpose	 Throughout the history of our democracy, members of our armed forces have served gallantly 

and often at great personal risk to further the cause of liberty. This independent study is to 

familiarize clinical staff with the kinds of experiences and resulting conditions that affect 

veterans who have been prisoners of war in the German, Pacific, Korean and Vietnam theaters 

of conflict. Furthermore, the health implications of such experiences are discussed and causes 

of disability are explored. Physical conditions, as well as mental health manifestations as a 

result of the POW experiences, also are reviewed. 

Objectives After completing this independent study, participants will be able to: 

•	 Describe the typical kinds of treatment POWs’ experienced in the German, Pacific, Korean 

and Vietnam theaters of conflict. 

•	 Identify the common medical conditions associated with imprisonment. 

•	 Describe psychiatric conditions that may occur as a result of the POW experience. 

•	 Develop an appreciation for what happened to veterans when they were imprisoned. 

•	 Assess for the sequelae of the POW experience in appropriate veterans. 

•	 Provide support and education to prisoners of war and their families. 

Outcome	 The expected outcomes of this independent study are to improve the quality and quantity of 

care provided to American former prisoners of war. 

Target This independent study is primarily designed for Department of Veterans Affairs clinicians 

Audience and other interested VA staff. Other health care providers, especially those in VA health care 

facilities, also are encouraged to complete the study. 
American Ex-Prisoners of War v

Program Description
 

Content Materials: 

•	 Introduction 

•	 Biostatistics 

•	 Morbidity and Mortality 

•	 Duration of Internment 

•	 Service Connected Disability Among Ex – POW’s 

•	 National Academy of Science Studies 

•	 POW’s of Germany 

–	 Camp Life 

– Nutrition
 

– Transfers
 

•	 POW’s of Japan 

– Women POW’s 

– Nutrition
 

– Working Conditions
 

•	 POW’s of Korea 

–	 Camp Life 

–	 Nutrition 

–	 Indoctrination 
American Ex-Prisoners of War vi

•	 POW’s of Vietnam 

– South Vietnam 

–	 North Vietnam 

•	 The Presumptive Service-Connected Disabilities 

–	 Post Traumatic Osteoarthritis 

–	 Nutritional Depletion 

–	 Marasmus 

– Kwashiorkor
 

– Trace Element Deficiencies
 

– Essential Fatty Acid Deficiencies
 

– Vitamin Deficiencies
 

– Beriberi
 

– Beriberi, B-1 deficiency
 

– Wet Beriberi
 

–	 Dry Beriberi 

–	 Cardiac Beriberi 

–	 Long Term Sequelae 

–	 Ischemic Cardiomyeopathy 

–	 Beriberi Neuropathy 

–	 Ariboflavinosis 

– Pellagra 

– Avitaminosis: B-2, 3, A, C and the Overlap Syndromes 

–	 Gastrointestinal Diseases 

–	 Irritable Bowel Syndrome 

–	 Peptic Ulcer Disease 

–	 Hepatitis 

–	 Helminthiasis 

–	 Strongyloides 

–	 Ascaris Lumbricoides 

–	 Ancylostomiasis 

–	 Salmonella Typhi 

–	 Shigella 

– Amebiasis
 

– Giardiasis
 

–	 Cold Injury and Frostbite 

–	 Peripheral Neuropathy 
American Ex-Prisoners of War vii

• The Psychiatric Presumptive Service-Connected Disabilities 

– Psychosis 

– Panic Disorder 

– Generalized Anxiety Disorder 

– Obsessive Compulsive Disorder
 

– Post-Traumatic Stress Disorder
 

– Atypical Anxiety Disorder 

– Depressive Neurosis or Dysthymia 

• Summary 

• References 

• Appendix A – VA Benefits 

• Appendix B – Description of Presumptive Conditions 

• Appendix C – Related Websites 

• Independent Study Questions for CME Credit 

• Independent Study Program Registration/Answer/Participation Satisfaction Form 
American Ex-Prisoners of War viii

Program Development 


Author 

William Paul Skelton III, MD, FACP 

Ex-POW Physician Coordinator 

Department of Veterans Affairs 

Professor of Medicine 

University of South Florida College of Medicine 

Department of Internal Medicine 

James A. Haley VA Medical Center 

Tampa, FL 

Planning Committee 

Mike Ambrose, MD, MPH 

Director 

Robert E. Mitchell Center for Prisoners of War Studies 

Pensacola, FL 

Walter H. Cox, EdD 

Program Manager 

VA Employee Education System 

Birmingham Education Resource Center 

Birmingham, AL 

Brian Engdahl, PhD 

Department of Veterans Affairs 

Minneapolis VA Medical Center 

Minneapolis, MN 

Eleanor J. Haven, RN, MEd 

Education Service Representative 

VA Employee Education System 

Birmingham Education Resource Center 

Birmingham, AL 

Jo L. Harbour, MD 

Assistant Chief of Medicine 

Ex-POW Physician Coordinator 

GV (Sonny) Montgomery VA Medical Center 

Jackson, MS 

Pamela Hebert, Dr. PH 

Program Manager 

VA Employee Education System 

Birmingham Education Resource Center 

Birmingham, AL 

Stephanie Larson, RN 

Nurse Practitioner 

Department of Veterans Affairs 

Seattle, WA 

Laurent S. Lehmann, MD 

Chief Consultant, Mental Health 

Veterans Health Administration 

Department of Veterans Affairs 

Washington, DC 

Thomas M. McNish, MD 

Colonel USAF (Retired) 

Chairman 

Advisory Committee on Former 

Prisoners of War 

San Antonio, TX 

Nancy Mullins 

Rating Specialist 

Department of Veterans Affairs 

VBA Regional Office 

Jackson, MS 

Amy F. Owen, MHA 

POW Coordinator/Administrative Officer for Ambulatory 

Care 

VA Medical Center 

Jackson, MS 
American Ex-Prisoners of War ix

Program Development continued 

Program Co-Directors Learning Technology and Media Development 

Walter H. Cox, EdD R. John Brix, BFA 

Program Manager Visual Information Specialist 

VA Employee Education System VA Employee Education System 

Birmingham Education Resource Center Minneapolis Education Resource Center 

Birmingham, AL Minneapolis, MN 

Pamela Hebert, DrPH Jeffrey L. Henry 

Program Manager Media Producer 

VA Employee Education System Employee Education System 

Birmingham Education Resource Center North Chicago VA Medical Center 

Birmingham, AL Chicago, IL 

Project Support Assistant 

Michael Dunn 

Project Support Assistant 

VA Education System 

Birmingham Education Resource Center 

Birmingham, AL 
American Ex-Prisoners of War 1

I. Background Information
 

Introduction 

American ex-POW’s are exceptional individuals, having experienced a bewildering spectrum 

of harsh circumstances. Many of them continue to suffer from unique medical conditions as 

a result of their internment. At one point, more than 144,000 were living. Today, fewer than 

fifty thousand remain alive. 

This publication will discuss in detail the American ex-POW experience in Germany, Japan, 

Korea and Vietnam. In addition, it will discuss the presumptive service-connected disabilities, 

how they were derived and the role they play in diagnosis. A bibliography is provided at the 

conclusion for further reading. 

Biostatistics 

Morbidity and Mortality 

In the World War II European Theater of Operations (ETO), only 1.2% of POW’s died in 

captivity. The low death rate reflects many variables, chief among them the fact that the 

Germans signed and ratified the Geneva Convention. 

The World War II Pacific Theater of Operations (PTO), specifically the Philippines, claimed 

many more POW lives. This high death rate is attributed to the fact that the Japanese, who 

signed but never ratified the Geneva Convention, mistreated the POW’s. Primary causes of 

mortality and chronic morbidity among PTO ex-POW’s were: (1) starvation; (2) infectious 

diseases; (3) hazards related to transportation to Japan; and (4) environmental exposure, 

particularly toward the end of the war when POW’s were used as slave labor in Northern 

Japan and Manchuria. 

Available data indicate that, as of the mid-1990’s, a greater percentage of ex-POW’s from 

the WWII PTO had died than those from other veterans’ groups. Ex-POW’s from the Korean 

Conflict have the second highest mortality rate to date, according to current information, 

followed by ex-POW’s from WWII ETO and Vietnam, respectively. 
American Ex-Prisoners of War 2

Duration of Internment 

The majority of World War II ETO POW’s were captured toward the end of the war, with the 

average internee spending less than one year in captivity. Their average age at capture was 

25 years, reflecting the fact that most ETO prisoners were draftees. 

The PTO prisoners, being Regular Army soldiers, were around two years older at the time of 

their capture. They were interned for a much longer period of time, since the vast majority of 

PTO prisoners were captured on Bataan and Corregidor at the beginning of World War II and 

were not released until the end of the war more than three years later. In the Korean Conflict, 

the average age had dropped to around 23 years of age, again due to the fact that these men 

were draftees. Their average length of internment was just over two years. Vietnam-era 

POW’s were around thirty years old at the time of their capture. They spent an average of 

five years in captivity. 

Service-Connected Disability Among Ex-POW’s 

An examination of the percentage of living POW’s compared to all living veterans receiving 

service-connected disability compensation reveals several differences. Based upon information 

available, the highest percentage receiving disability compensation is found among Vietnam 

ex-POW’s, nearly all of whom receive some degree of compensation. Around 60% of exPOW’s who served in the Korean Conflict are receiving service-connected disability compensation, 

as opposed to 5% of all Korean Conflict veterans as a group. While some 10% of all WWII 

veterans receive disability compensation, the percentage increases dramatically among ex-POW’s, 

with roughly half of PTO ex-POW’s and around 40% of ETO ex-POW’s receiving compensation. 

Average Degree of Service-Connected Disability 

Available data examining the average degree of service-connected disability indicate that the 

degree of disability among European Theater ex-POW’s is similar to that of age-matched 

controls from the ETO, whereas the Pacific Theater POW is, on average, around 13% more 

disabled. Among those who have accessed services through the Department of Veterans 

Affairs, the Korean POW is, on the average, 6% more disabled than other Korean Veterans. 
American Ex-Prisoners of War 3

Percentage Of Service-Connected Disabled Veterans Rated ≥50% 

As expected, the percentage of veterans whose service-connected disability has been rated at 

50% or greater is highest among WWII PTO POW’s, nearly half of whom suffered this degree 

of disability. The number of WWII ETO POW’s with ≥50% disability is roughly comparable 

to all WWII veterans, at around 20%. An estimated 35% of Korean ex-POW’s are rated ≥50% 

disabled, as compared to some 25% of all Korean veterans. All figures are approximate. 

Living Service-Connected Disabled Veterans Rated Unemployable 

Among living service-connected disabled veterans, the highest percentage of those rated 

unemployable is among WWII PTO ex-POW’s. Some 5% of all WWII veterans are rated 

unemployable due to service-connected disability. Similarly, around 5% of WWII ETO exPOW’s are rated unemployable. Some 10% of Korean ex-POW’s are deemed unemployable, 

as opposed to around 6% of all veterans of the Korean Conflict. Estimates are based upon 

available information. 

National Academy of Science Studies 

There have been several National Academy of Science and National Research Council-funded 

studies of prisoners of war. The first, by Cohen and Cooper, covering returning World War II 

POW’s and age-matched controls, encompassed the years 1945 to 1951. The second study, 

completed by Nefzger, included the Korean ex-POW’s and covered the period of 1953 to 

1965. The third study, completed by Beebe, covered 1946 to 1965 in further detail. The 

fourth study, by Keehn, encompassed 1965 to 1975. Lastly, Page, in 1992, analyzed 

self-reported questionnaires and compared these to the POW protocol exams. 

Cohen and Cooper 

Cohen and Cooper noted that, among the Pacific Theater repatriated POW’s, there was an 

increased incidence of death in the first two years of the study, tapering off in the last four 

years of the study. The difference was due to the high incidence of trauma, tuberculosis and 

cirrhosis. They felt the high rate of tuberculosis was secondary to the decreased immunity of 

the repatriated POW’s as a consequence of chronic avitaminosis as well as the high rate of 

infectivity that was prevalent in the camps. Cirrhosis was felt to be caused by a combination 

of both alcohol abuse upon repatriation and chronic liver damage from the malnutrition of the 

POW experience. The high incidence of death due to trauma was generally felt to be secondary to psychological difficulties in readjusting to United States culture. 
American Ex-Prisoners of War 4

Post-repatriation hospital admission rates for POW’s of Japan were greater than for controls in 

every category examined, including nervous system, circulatory system, genitourinary system, 

allergic disorders, psychiatric disorders, respiratory system and infectious diseases. 

Nefzger 

Considering percentages of men compensated by degree as a means of expressing morbidity, 

data by Nefzger reported quite significant differences for every organ system of POW’s of 

Japan vs. Control War Japan. For POW’s of European Theater, musculoskeletal, digestive, 

skin and psychiatric disorders are statistically significant when compared to Control War 

European Theater. For the POW’s of Korea vs. Control War Korea, the eye, systemic diseases, 

respiratory, digestive, skin and psychiatric diagnoses are all statistically significant. 
American Ex-Prisoners of War 5

II. World War II POW’s of Germany 


The military personnel of the European Theater of Operations (ETO) and the ex-POW’s therein fell into two distinct groups: (1) fliers and crew members; and (2) infantry soldiers, who 

were generally of lower rank. In most cases, the fliers and their crew members were captured 

earlier in the war and, more often than not, were interned in Lufts, camps that were generally 

operated by the Luftwaffe, or German Air Force. 

The vast majority of ETO 

ex-POW’s were in the second 

group, most of whom were not 

captured until after the Battle 

of the Bulge. Often, these men 

were housed in poorly maintained camps called Stalags. 

These Stalags, operated by the 

Wehrmacht, the German Army, 

did not afford sufficient shelter 

from the elements, especially 

during the bitterly cold winter 

of 1944-45. In addition, the 

captured infantrymen were not 

fed as well as the first group. These men also were subjected to long marches to retreat from 

the advancing American and Russian armies. 

Overall mortality in the ETO was approximately 1%, with 1,124 men dying out of 93,941. 

There are several reasons for this low death rate: 

1.	 Unlike their Pacific Theater of Operations (PTO) counterparts, the vast majority of these 

men were captured toward the war’s end; therefore, even though they lost a great deal of 

weight acutely, they did not have to live with malnourishment under adverse physical 

circumstances for extended periods of time. 

2.	 In general, POW’s in Germany received somewhat better treatment at the hands of their 

captors than those captured by the Japanese. Among the reasons for this difference: the 

Germans were of the “western” mindset; i.e., they ceased fighting when a situation was 

deemed hopeless. On the other hand, the Japanese became more fanatical as the war 

neared its end. 
 

American Ex-Prisoners of War 6

3.	 Germany signed and ratified the 1929 Geneva Convention accords regarding treatment of 

Prisoners of War. While they did not abide by all the rules, many of the German camps 

did, at least initially, follow many of the guidelines set forth by the accords. For example, 

Germany frequently allowed Red Cross inspectors into some selected camps, while Japan 

never did. 

4.	 Even though several in the German political high command wanted all commandos, pilots 

and airmen killed, the regular Luftwaffe officers in charge of actually running the camps 

were usually much more sympathetic to the POW’s. Commander of the Luftwaffe 

Herman Goering had been a WWI pilot and felt a kinship to all airmen, believing that they 

were the last truly noble group. He constantly refused to have the airmen executed. 

5.	 Since America had captured several thousand German prisoners in the North African 

campaigns, it was in Germany’s interest to treat American POW’s as they hoped their 

own prisoners would be treated. 

6.	 On the whole, the diet among the POW’s in Germany was superior to that provided to 

PTO POW’s. As the Germany manpower pool shrank, POW’s were often recruited as 

farm labor in Germany and the POW’s often helped themselves to the fresh fruits and 

vegetables. The Germans also sometimes supplemented the POW’s potato soup and black 

bread with vegetables, providing much-needed vitamins. Finally, unlike their Pacific 

Theater counterparts, German POW’s sometimes benefited from the delivery of Red 

Cross parcels. 

Housing 

Barracks in the Lufts and Stalags were usually 40’ wide by 130’ long, each containing ten 

rooms leading from a central hallway that ran lengthwise. Each room in the barracks was 

approximately 15 x 23 feet. Rooms were designed to provide facilities for sixteen men with 

eight wooden, double-deck bunks. In a few instances, the bunks were triple-decked, increasing 

the capacity of each room to twenty-four men. Later, two or three men were forced to share a 

single bunk. There were generally two washrooms, each without running water. A pit latrine 

was located near the rear of the barracks for night use. 

Food 

Food in the camps was very diverse. In some of the Luft’s, so-called “show” camps, the food 

was of high quality. In fact, many prisoners in the Lufts lost no weight at all. In most of the 

Stalags, however, the food was poor in quality and the supply was unpredictable. 
American Ex-Prisoners of War 7

The average POW in the Stalags usually received no more than 700 calories per day. 

Breakfast usually consisted of a cup of ersatz coffee, which the prisoners frequently used as 

hot water for shaving. Lunch was a ladle of vegetable soup and a small portion of bread. The 

evening meal often consisted solely of one loaf of bread for six men. This bread was impossible to cut evenly, and few POW’s had knives, so many POW camps devised a system wherein 

the same six men would consistently eat together. Each would take a daily turn at cutting the 

bread, with the one who cut the bread having the last choice and the man after him having first 

choice. Rotating into first place became the main event to look forward to every six days. In 

all probability, intermittent Red Cross parcels kept the POW’s interned in the Stalags alive. 

Luft III — A Bold Escape Attempt 

Life in many of the Luft camps was tolerable, with gardening libraries and other recreational 

activities sometimes available. For example, Luft III at Sagan, which held British and 

American officers considered high escape risks, was ostensibly designed to be so pleasant 

that there would be no desire among the prisoners to escape. In reality, Luft III was a “show” 

camp for Red Cross inspectors. 

Even though Luft III was a true prison camp and not a concentration camp, the British devised 

an elaborate escape scheme. The purpose of this scheme was twofold — first, to escape, and 

second, to disrupt the Germans’ war effort by harassing them as much as possible. Every 

POW in the entire camp was sworn to secrecy and enlisted in the escape effort, which centered 

around digging three tunnels, code named Tom, Dick and Harry. Ingenious uses were found 

for everyday materials. Mattress slats were replaced with ropes so the wood could be used for 
American Ex-Prisoners of War 8

tunnel construction. Heels of shoes were carved into stamps to be used as passport verification stamps. Phonograph records were carved into small discs for use as compass bases. 

The scheme was interrupted in late 1943, when one of the tunnels was discovered just prior 

to its use. Despite the setback, work continued, and in early March 1944, seventy-two men 

escaped. Their freedom would be short-lived. The Germans diverted five million soldiers 

from the front lines to comb the countryside and retrieve all but three escapees who made it to 

foreign countries. Then Hitler himself ordered the execution of the escapees, fifty of whom 

were shot in the head by the Gestapo. The escapees’ remains were cremated and returned to 

the camp, where their fellow prisoners buried them with full military honors and erected a 

stone memorial engraved with all fifty names. 

Camp VII-A 

More often than not, life in the camps was miserable, with boredom punctuated by cruelty 

and starvation. POW Camp VII-A (1939-1945) was located north of the town of Moosburg, 

Germany. On September 22, 1939, Colonel Nepf visited the site. Noting the location’s poor 

ground, the closeness of a chemical manure plant, the fact that a marsh was adjacent, and 

the flatness of the land, Colonel Nepf determined the site was insufficient for a Stammlager 

(central camp) or Stalag. Despite his recommendation, the site was selected and construction 

workers were given fourteen days to prepare a camp for 10,000 internees. The camp soon 

became the major receiving area for thousands of prisoners. In fact, by July 1940, more than 

98,000 internees had passed through. 

The main camp, which 

comprised in excess of 

3,500,000 square meters, 

quickly transformed into the 

appearance of a town with 

tailor shops, carpenters, a 

blacksmith and a shop for 

watch repairs and electrical 

repairs. Thousands of cards 

and parcels arrived each week 

for the 80,000 POW’s, 80,000 

civilian prisoners and 8,000 

guards. Prisoners continued 

to pour in until the end 

of 1944. 
American Ex-Prisoners of War 9

Towards the end of the war, Hitler ordered that no prisoner fall into the hands of the enemy. 

The camp commandant, Colonel Burger, intervened through the Red Cross and the camp was 

not bombed. Later, in April 1945, the commandant tricked the local SS Commander into 

believing he would send soldiers off to fight. Instead, he secretly turned the camp over to the 

Americans, thereby avoiding complete catastrophe. Forward elements of General Patton’s 

Army reached the camp and liberated it before any injury could come to the prisoners inside. 

Stalag Luft IV 

Approximately 10,000 American Air Force (AAF) personnel were housed at Stalag Luft IV 

in Pomerania. The sick load here was tremendous. Five allied doctors imprisoned to handle 

the situation organized the sick into three groups: (1) those who were wounded, burned or 

otherwise injured in aerial combat; (2) the routine casualties; and, (3) the typical illnesses 

of overcrowding and malnutrition. 

Many AAF and Allied gunners received training on the scene to become medics. All learned 

fast and worked hard. They would change dressings, treat minor ailments and spot severe 

cases requiring a physician. 

At the prison hospital, vaccines from the Red Cross parcels were collected and stored. When 

they collected 300 doses of typhus vaccine, word was passed out that the vaccinations would 

be given — first come, first served. Hundreds of men stood in the bitterly cold January weather 

for the vaccine. The decision was made to give each man half an injection. This way, 600 

men were vaccinated. Despite this effort, hundreds were turned away. 

On February 2, 1945, 300 men, including most of the sick and wounded, were placed into trains 

and shipped out. Four days later, the remaining prisoners were marched out on a journey that 

would last for eighty-six horrific days during which aerial strafing was common and men 

were often forced to sleep in the snow. Frostbite affected virtually everyone and hunger was 

a constant companion. To add to the misery, diarrhea and dysentery were commonplace. At 

one point, fifty percent of the men soiled their own clothing. There was neither sanitation nor 

toilet facilities, and the only source of water came from ditches formerly used as latrines. A 

slimy trail of dysentery and blood was left across Germany. Yet after the group had marched 

from the eastern front to the western front, they were sent back to the eastern front. All the 

misery and suffering had been for naught. 
American Ex-Prisoners of War 10

Transfers 

Transfers in Germany were generally carried out by truck or train after the men were initially 

captured. This was especially true of fliers captured in the beginning of the war, when 

Germany had complete control of its own skies. By war’s end, however, when the Germans 

were retreating from the advancing American and Russian armies, transfers were often carried 

out via forced marches or cattle cars. It was during these later transfers that men succumbed 

to the natural elements of the winter of 1944-45. 

The German high command was in a state of disarray in the early months of 1945 and the 

treatment of allied POW’s was not a high priority; therefore, little food was provided and there 

was virtually no protection from the elements. As happened at Stalag Luft IV, entire camps 

were often evacuated in front of the advancing Allied Army and marched across Germany, 

passing several full camps. Then, they would be ordered back to their original departure point 

again. In addition to freezing to death and dying of dysentery, many were shot during forced 

marches. Since the allies controlled the skies, strafing attacks were commonplace. Often, 

horses would be butchered and fed to the hungry columns of POW’s. These horses were 

considered manna from heaven and thanks was given to the Flying Quartermaster Corps. 

As the end of the war became very obvious to the Germans, they began to treat POW’s better. 

For example, once-confiscated Red Cross parcels were distributed to those in need. Improvements in treatment were especially evident when the allied guns could be heard in the distance. 

Many times, the liberating forward allied units would sarcastically, echo the greeting of the 

former German captors, saying, “For you, the war is over.” 
American Ex-Prisoners of War 11

III. WWII POW’s of Japan
 

Japan captured several thousand Americans throughout the Pacific; however, the vast majority 

of prisoners were captured in the Philippine Islands. The overwhelming majority of these 

prisoners came from the fall of Bataan and later, Corregidor. The fall of Bataan alone gave the 

Japanese in excess of 75,000 troops to deal with — 60,000 of whom were Philippine nationals. 

The POW’s in the Philippines experienced a mortality rate of 40%, with approximately 

11,107 deaths out of the total 27,465 internees in the Philippines. Altogether, 12,935 out 

of the 34,648 total American POW’s died at the hands of the Japanese. 

On April 9, 1942, U.S. Major General Edward King surrendered to the Japanese 14th Army 

on the northern island of Luzon. The 14th Army was commanded by Lieutenant General 

Masaharu Homma, a British military school graduate. General Homma refused to meet 

General King and instead sent his senior operations officer, Colonel Motoo Nakayama, who 

demanded to meet General Wainright, who had been in overall command of the Philippine 

archipelago ever since General MacArthur left in January, 1942. 

Colonel Nakayama screamed for General King to “Go and get Wainright” as General King 

tried repeatedly to explain that he was there to surrender Bataan only and to request terms for 

surrender. He explained that he had no control over the rest of the Philippines nor had he any 

power to bring General Wainright to Colonel Nakayama. Additionally, he told Nakayama that 

he had enough fuel and vehicles for a rapid and orderly evacuation off Bataan to any area that 

General Homma chose. 
American Ex-Prisoners of War 12

Colonel Nakayama refused to make any concessions. Sternly, Nakayama told General King 

that since he did not speak for General Wainright and could not surrender all of the Philippine 

Islands, it was “absolutely impossible to negotiate for the surrender of Bataan.” Nakayama 

asserted the troops could give up if they wished, but it would be as individual units both 

“voluntarily and unconditionally.” He therefore refused to be bound by the Geneva accords 

regarding the humane treatment of prisoners of war and referred to the men as “captives.” 

Upon demanding General King’s sword, Colonel Nakayama became enraged to learn that the 

general had left it in Manila. He took General King’s pistol instead. After the war, Colonel 

Nakayama testified that the surrender was accomplished by the “voluntary and unconditional 

surrender of each individual unit. The negotiations for the cessation of hostilities had failed.” 

He said, “The Japanese Imperial Army are not barbarians.” 

Bataan Death March 

The men taken captive on Bataan were forced to undertake a 100-mile trek from the southern 

areas of Bataan to Camps O’Donnell and Cabanatuan. At this time, Americans made up less 

than 15% of the total U.S. force on the island. The rest were Philippine Nationals, 6,000-11,000 

of whom served as scouts in the U.S. Army. During the forced march, which later became 

known as the Death March, thousands of men died, mostly from beheadings and shootings. 

In all, 650 Americans and more than 16,500 Filipinos died. 

Reasons for High Mortality 

There were several reasons for the high mortality rate of the prisoners captured on Bataan and 

subsequently on Corregidor. 

• The Japanese greatly underestimated the eventual number of prisoners. 

• The Japanese indiscriminately killed captives. 

• The Americans and the Filipinos were in poor physical condition prior to their capture. 

• Little transportation was provided for the captured men. 

• Insufficient food, water, medical attention and shelter were provided. 

• Cruel treatment was rampant. 

Underestimation of the Eventual Numbers 

According to their Bushido Code, the Japanese felt that death in battle was the highest honor 

while surrender was the most abject disgrace. They did not recognize the concept of prisoners 

of war, and they believed that the Americans also would not recognize that concept and would 

die before surrendering. Augmenting the Bushido Code was the fact that the Japanese had 
American Ex-Prisoners of War 13

come to believe that their cause was just and pure and they viewed themselves as a racially 

pure Asian group self-appointed to rid the hemisphere of all other ethnic groups. 

The Japanese had contemplated only taking 10,000 or so captives. When they unexpectedly 

captured approximately 13,000 Americans, 60,000 Philippine nationals who were members 

of the military and 25,000 civilians, their ability to cope was grossly overwhelmed. 

Indiscriminate Killing Along Death Marches 

The Japanese soldier was trained to follow orders only and not to think for himself. He was 

the product of a stern and coercive society, with a hard and brutal military system in which 

physical punishment was routine and arbitrary. He endured his lot stoically and without 

question. Understandably, he treated his subordinates with similar brutality. Fanatically 

indoctrinated never to surrender, he held in contempt anyone who did. To this revulsion was 

added the Samurai tradition of revenge reinforced by the heavy casualties suffered by the 

Japanese in capturing Bataan. 

When a group of prisoners would walk slowly, or drop out of the line for a drink of water, the 

guards would often taunt and beat the prisoners. At other times, they would simply bayonet or 

shoot them. Many Americans lost their lives to beheadings, which were the favorite form of 

execution by the Japanese. 

Often, enlisted men would give all their possessions to their commanding officer in hopes that 

the Japanese would respect him and he would be able to protect their possessions. Unfortunately, 

the Japanese did not recognize the concept of either prisoners’ rights or the rank of a prisoner. 

All captives were searched for items of value. If an American were found to be in possession 

of anything of Japanese origin such as money, pictures or merchandise, the Japanese contended 

that the materials had been removed from the bodies of dead Japanese soldiers of the 14th 

Army. Immediately, the prisoner was thrown to his knees and beheaded. 

An incredible act of human cruelty was committed upon the members of the 91st Philippine 

Division. On April 11, 1942, the entire division was being marched northward when it was 

visited by 65th Brigade commander Lt. General Akina Nara, a graduate of the U.S. Army 

Infantry School at Ft. Benning, Georgia. Although Nara’s exact role was never known, all the 

privates were removed following his visit. After their removal, all the officers and non-commissioned officers had their hands bound behind them with telephone wire. Each man was 

then bound to the other by the neck and made to stand in four lines of one hundred men each. 
American Ex-Prisoners of War 14

The group was marched down into a large ravine and stood with their backs to their captors. 

Then, a Japanese civilian interpreter told them in Tagalog that they were being punished for 

siding with the Americans in the war. He further stated, “My friends, don’t take it so hard; 

you must be patient. Had you surrendered earlier, you would not have met this tragedy. 

We are doing this because many of our soldiers died fighting against you. If you have any 

requests before we kill you, ask it now.” 

Major Pedro Felix, the senior officer, requested that the men be killed by machine gun fire 

or at least be allowed to stand and face their executioners. Both requests were denied. 

Thereupon, a Japanese officer placed at each side began to decapitate the men one by one. 

The screams of the dying and terrified men continued for eight hours until the last man had 

been decapitated. 

As in all massacres, there were a few survivors who would later retell the gruesome story. In 

this case, Major Felix survived the night and chewed through his bindings. Felix, along with 

two other mortally wounded men, climbed out of the ravine and were met the next morning by 

other Filipinos to whom they told their story. 

Poor Physical Condition of Americans and Filipinos Prior to Capture 

Normal work in the Philippines at that time required at least 3,500 to 4,000 calories per day 

per man. The Morgan Board Debarkation Hospitals documented an average 15-20% weight 

loss among many POW’s prior to their capture. 

Due to severe food shortages on Bataan and Corregidor, General MacArthur had withdrawn 

all the U.S. forces into Bataan in January 1942, but he had only brought enough food for thirty 

days. Consequently, General MacArthur had put all troops on half rations, which provided 

each man with approximately 2,000 calories per day. 

In February, the daily food rations were cut to 1,500 calories and by March to 1,000 calories. 

The rations at this time were white, polished rice purchased from the natives. By late March, 

the 26th Calvary had eaten its 250 horses and fifty mules. Furthermore, the entire local population of dogs, pigs, water buffalo and monkeys in the surrounding jungle had been consumed. 

Approximately 70% of the men in the 31st Infantry on Bataan were on the sick list on the day 

of capture. These men were suffering from malaria, dysentery and malnutrition of various 

types. No provisions at all were made for assisting the sick and wounded. They had to be 

carried by healthier prisoners on blankets strung between poles. After the war, General 

Homma would testify that he had absolutely no idea of the condition of the American troops. 

He would say he had not been informed of the debilitated state of many of them. He said his 

only concern was to clear Bataan of non-belligerents in order to take control of Corregidor. 
American Ex-Prisoners of War 15

Little Transportation Provided for Bataan POW’s 

The Japanese wanted to accomplish the evacuation of the prisoners as soon as possible 

because General Homma was under tremendous political and military pressure back in Japan 

to complete the occupation of all the Philippines Islands by early April, 1942. The original 

Japanese plan was to clear the prisoners in phased movements from Bataan to central Luzon. 

The reality was that the plan was never enacted, as the Japanese were much less concerned 

with their new prisoners than with taking the island of Corregidor. The prisoners were simply 

obstacles to their scheduled takeover of Corregidor. 

At the most, only a few thousand captives were transported from the front lines in trucks. For 

the majority, the exodus from Bataan was anything but a carefully organized military movement. It was instead a series of tortuous marches, with needless exposure to the sun, crowded 

and filthy assembly areas, beatings, torture and arbitrary executions. 

The Japanese had anticipated the American forces would surrender approximately three weeks 

later than they did. They also believed the Americans would surrender in the northern instead 

of the southern region of Bataan to which they had retreated. This combination of the earlier 

capitulation and the farther distance, aggravated by the fact that the few vehicles that the 

Japanese had brought were being used to transport their own troops to the southern region of 

Bataan, led to their forcing the American captives to march for days on end in the hot sun with 

little or no protective gear. 

Insufficient Food, Water, Medical Attention and Shelter 

Along the march, a central collection point for all the prisoners was the town of Balanga, since 

the Japanese had reckoned that all the captives could walk there from whatever point they had 

been captured. No provisions were made for feeding the prisoners since the Japanese figured 

that the entire journey should take no more than one to two days. It was here in Balanga, a 

small town of 5,000 people with little infrastructure to handle mass numbers of prisoners, 

that the arriving captives were forced into small, crowded warehouses or animal stockyards 

and forced to lie beside dead and dying comrades. It also was in Balanga that the Japanese 

committed several of the horrors of the death march. For instance, it was here that so many 

stragglers in the march were simply buried alive. If they resisted, they were usually hit on 

top of the head with a shovel. 

Basic necessities were scarce. The Japanese confiscated the captured American medical 

supplies for their own use. The only food permitted to be distributed to the Americans was 

scavenged prior to the evacuation, and the only water along the route came from a few scattered artesian wells and water buffalo watering holes. This water, contaminated with parasites, 
American Ex-Prisoners of War 16

gave the men severe dysentery. Even so, thirst caused many men to break out of the lines and 

run toward the watering holes. The Japanese would either shoot them on the spot or bayonet 

them as they were drinking. 

From Balanga, the captives walked to San Fernando and boarded trains for the final thirty 

miles to Camp O’Donnell. The small, unventilated metal boxcars hadn’t been cleaned since 

being used for animal transport. Once the men were crowded inside, the doors were locked 

and did not open until the captives arrived at camp. Although this was usually a three-hour 

ride, the loading process often took hours. Throughout the loading and the journey, the men 

were forced to stand beside each other in the hot, filthy boxcars. Diarrhea and sweat permeated 

the air. 

The diet among the POW’s in the camps of the Pacific, particularly in the Philippines, was 

a very important factor in the deaths of so many prisoners. In general, the diet was poor in 

1942, better in 1943 and worse again in 1944. The daily ration consisted mostly of polished 

rice. Always of a quality far below that of the rice used by the Japanese, it was contaminated 

with trash and infested most of the time with insects, parasites and bacteria. The rice was 

essentially what the Japanese did not consider good enough for their enlisted men to consume. 

While the typical diet varied greatly among the camps, it was never adequate, even at the best. 

The Japanese often issued weeds as substitutes for vegetables. A half canteen cup, usually 

eight ounces, or 160 calories, of thin rice gruel (lugao) twice, and, on rare occasions, three 

times a day was the standard. At times, no food at all was available. About once a week, 

camp veterinarians slaughtered a single water buffalo to feed approximately 10,000 prisoners. 

Usually this meat supplemented the diet by only a few grams of protein per prisoner. 

Any evidence that the prisoners were supplementing their diets was dealt with very harshly. 

Usually, there was a beating with clubs until a bone was broken. Many times, the offender 

was simply shot. Thousands of Red Cross parcels were shipped to the men in the Philippines; 

however, the Japanese kept and ate most of them for themselves. As previously stated, the 

Japanese refused to allow any Red Cross observers into the camps. 

Rampant Cruelty 

Many times, captives, especially officers, walking down a road along which a convoy of 

Japanese soldiers was also traveling would be struck on the head with a bamboo pole or 

bayonet blade by a passing Japanese soldier. If the prisoner did not immediately get up and 

continue the march, he would be shot. 
American Ex-Prisoners of War 17

Cruelty seemed to be a common denominator among all of the guards and Japanese officers. 

Beatings and kicking were common to both officers and enlisted men. The captors would 

often administer the “sun treatment” in which POW’s were lined up in rows and forced to 

squat for hours on end in the afternoon sun. 

Military Field Code of Japan 

The Japanese War Ministry in Tokyo had issued directives throughout the war regarding the 

treatment of prisoners as well as their own soldiers who were about to fall into enemy hands. 

The Military Field Code issued in January 1941 made it clear to all Japanese soldiers that 

falling into enemy hands brought irrevocable shame to both the soldier and his family. It 

stated: “Have regard for your family first. Rather than live and bear the shame of imprisonment 

by the enemy, the soldier must die and avoid leaving a dishonorable name.” 

The Field Code directed the Japanese soldier to save the last round of ammunition for himself, 

or to charge the enemy in a suicidal assault. Armies of Western nations fighting in WWII 

had a ratio of four soldiers captured to every soldier killed on the battlefield. In the Japanese 

Army, the ratio was one soldier captured for every 120 deaths. 

Corregidor 

The island fortress of Corregidor surrendered on May 5, 1942, one month after 

the fall of Bataan. Besides the constant 

shelling, one of the main problems for 

Corregidor defenders was that of no 

fresh water. Because it was the dry 

season in the Philippines and there had 

been no significant rain for months; the 

reservoirs were nearly dry. The combination of no food, little water, dwindling 

supplies of medicines and munitions 

forced General Wainright to meet with 

General Homma to discuss peace terms. 

General Homma was enraged to hear General Wainright came only to surrender the Fortress 

Island of Corregidor and not the entire Philippine Islands. There was still a significant force on 

the southernmost island of Mindanao. General Homma then demanded unconditional surrender, 

and the American POW’s held on Corregidor were used as hostages to guarantee General 

Wainwright’s ability to persuade the troops to surrender in the southern Philippine islands. 
American Ex-Prisoners of War 18

POW’s captured on Corregidor were given extremely harsh treatment after their surrender. 

For 18 days, they were confined to a concrete area of about 20 acres known as the “92nd 

Garage Area.” This site, which consisted of a peacetime truck parking area and a seaplane 

ramp, had no shade and only a meager, intermittent supply of very bad-tasting “gyppy” water. 

Here, they remained in the open sun, without protection from the elements. General Homma 

had hinted strongly that if the southern forces did not surrender, these men would be massacred. 

The only food available was that which the troops had managed to gather after the surrender, 

and that was very limited since not much was available before the surrender. Fortunately, the 

Philippine national civilians were removed from the island during the first two days after its 

surrender or the situation would have been catastrophic. 

The American captives from Corregidor were eventually transferred by ship across Manila 

Bay to Manila, where they were put ashore and forced to walk down Dewey Boulevard to 

Bilibid Prison in an effort to disgrace them in front of the local Philippine civilians. In Manila, 

the Americans were separated from the Filipino POW’s and, over the few next days, were 

moved by rail to the town of Cabanatuan. From here, the Americans were marched to 

Cabanatuan Camp III, formerly a Philippine Army cantonment area. The Philippine nationals 

were moved to other camps. 

The Camps 

Camp O’Donnell 

For the men who survived the Death March, life in the internment camps was a horrible experience. Camp O’Donnell was a partially completed American airfield eight miles west of the 

Manila railroad at Capas. It had been nearly destroyed by the Americans during their retreat 

and had only two poorly functioning artesian wells to provide drinking water for thousands 

of men. 

Each group of internees arriving into Camp O’Donnell was greeted by the Camp Commandant, 

Captain Tsuneyoski, who informed them in a screaming voice that Japan had occupied all the 

Allied possessions of the U.S. and Great Britain in Southeast Asia. He also declared that the 

U.S. and Great Britain were Japan’s eternal enemies and would remain so forever until the 

influence of the Occident was completely wiped out in Asia. With a sneer, he told the men 

that they were captives, far below the dignity of prisoners of war, and that they owed their 

lives to the generosity of the emperor. 
American Ex-Prisoners of War 19

Under Tsuneyoski’s direction, all insignia of rank were to be removed, no American uniforms 

were allowed and all captives were to wear a loincloth. Also, all captives were to bow to any 

Japanese, regardless of rank, and all captives were to speak Japanese only. Failure to do so 

would result in a beating, he warned. 

The men were arranged into groups of 10 each, termed “blood brother groups.” The entire 

group would be punished for any infraction committed by any member. Minor offenses such 

as not bowing soon enough to a Japanese were often punished by the “sun treatment,” in 

which the entire group of 10 were forced to squat or kneel in the sun for two to three days and 

not move at all or partake of food or water. Major infractions such as stealing or escape were 

punished by group decapitation. 

All foods were considered property of the emperor, and to eat anything without permission 

was considered the same as stealing from him, a crime punishable by death. Prior ranks 

of Americans were not to be acknowledged either by the Japanese or by the Americans. In 

fact, any show of respect for an American officer would result in a beating, which was accomplished with a club, a rifle butt or a tree limb. Many times the beating was continued until the 

captive either passed out or suffered a broken bone. Because the Japanese were much shorter, 

the Americans were forced to stand in a hole during the beating so that their faces could be hit 

with maximum force. 

It was at Camp O’Donnell that the American captives first learned that they would not be 

protected by the Geneva Convention accords of 1929 since, although the Japanese government 

had allowed its representatives to sign it, the accord was never ratified back in Japan. Given 

the hatred of the Japanese for the Americans, it is understandable that the death rates soared. 

The primary causes of death during the first six months of internment were malaria, dysentery 

and starvation. The Japanese organized the Americans into grave details for the purpose of 

burying the large numbers of daily dead. These grave details were composed of two sections: 

those who dug the graves and those who buried the corpses. Each morning, a large hole was 

dug for the 30 to 50 Americans who had died the previous day. The carriers had the additional 

gruesome task of straightening out the twisted bodies in order that they could be stacked on 

top of each other to create room for more dead prisoners. 

The Japanese continued to inform the Americans that they did not care if they lived or died 

and many guards told the prisoners they hoped they would all die. The Japanese were very 

successful in their desires. Fifteen hundred out of 8,000 Americans and 22,000 Filipinos died 

at Camp O’Donnell in the first six months, primarily due to starvation and neglect, coupled 

with the withholding of basic medical care. 
American Ex-Prisoners of War 20

Cabanatuan I and III 

On June 6, 1942, the Americans were transferred to Cabanatuan I. This was a complex of 

camps, the worst being Cabanatuan I, where 2,700 out of the 6,500 American internees died in 

the first year. Most of the deaths could have been prevented by providing such basic necessities 

as food, shelter and minimal medical supplies. In June 1942, the hospital had 2,300 patients. 

Here, the “Zero Ward” was created. Men considered too sick to survive were sent there to die. 

Five hundred Americans died there in June 1942; 800 died in July. In contrast, Cabanatuan 

Camp III held the healthier Corregidor survivors and its death rate was much less. 

Initially, camp life was typified by boredom and starvation. Later, the Japanese learned they 

could use the prisoners as slave laborers. In October 1942, 1,500 men from Cabanatuan 

Camps I and III were assigned to a work detail to be sent somewhere to the north of the 

Philippines. Most would later be sent to Mukden, Manchuria. Another 1,000 were later sent 

to the southern island of Mindinau to work in the Davao penal colony. No accurate counts 

were kept about the eventual numbers of Filipinos who died, but estimates were at least 10 

times that of the American numbers. 

Bilibid Prison 

Bilibid Prison was used as a hospital and as a stopover point for POW’s who were being 

shipped to other islands or to Japan, China or Manchuria. Conditions inside the hospital were 

pathetic, with fewer calories provided than in the camps. Any POW sent to the hospital for 

treatment of an illness or waiting transportation was automatically given half-rations. 

Death on Unmarked Japanese Ships 

The war dramatically cut the Japanese labor supply, and Japan looked to all its conquered 

territories to provide a labor supply. The healthiest of the American POW’s were chosen for 

transfer to work in Japan and occupied China. They were held in Bilibid prison until a transport 

ship could be arranged. The ships, which came to be known as “hell ships,” were large converted cargo and animal transport vessels that were often loaded in Manila Bay and prevented 

from sailing until the Japanese felt the waters were safe from American submarines. 

Conditions inside the ships were deplorable, with no respite from the sweltering heat. The 

POW’s were packed tightly into the hold, crowded so closely that they could lie down only 

with great difficulty and much cooperation. They were forced to lie here for the entire trip 
American Ex-Prisoners of War 21

across the South China Sea and/or the Yellow Sea. Ventilation was nonexistent and refuse, 

which was kept in a bucket raised only once a day, often spilled into the faces of the men 

beneath. Episodes of madness were common during the voyages, as were displays of valor 

among those keeping the calm. Death was a constant companion. Corpses were piled up at 

night and tossed overboard the following morning. 

• Tottori Maru 

On October 1, 1942, the Tottori Maru departed with 1,992 Americans, British and Canadians 

loaded into three holds. It arrived in Formosa on October 11, 1942. There, the men were 

given a fire hose bath. The Americans were then reboarded and kept for 19 days on the 

ship. On November 8, 1942, the ship docked in Pusan, Korea where 1,200 prisoners were 

sent to Mukden. The others were sent to Osaka, Japan on November 12, 1942. 

•	 Arisan Maru 

One of the most pitiable examples of the loss of lives involving POW’s in the Philippines 

occurred on the Arisan Maru, which carried 1,800 American POW’s in its hold. American 

submarines patrolling in the South China Sea spotted the unmarked ship on October 19, 

1944, and torpedoed it. As a result, 1,792 American POW’s lost their lives. The American 

POW’s who survived this terrible ordeal rode to China in a lifeboat. These men then 

walked across China and India and were eventually able to brief the State Department about 

the little-known conditions concerning our men held by the Japanese. 

•	 Shinyo Maru 

The Arisan Maru was not the only ship on which so many died. On September 7, 1944, the 

Shinyo Maru was torpedoed, resulting in 668 American deaths. 

• Oryoku Maru 

In December 1944, 1,619 POW’s were collected at Bilibid prison for transport to Japan on 

the Oryoku Maru. The men were placed in the ship’s front and rear holds, which were 40 

by 80 feet each. While 3,200 square feet would allow 250 men sufficient room to lie down; 

the Japanese placed 800 men into each hold, leaving them there until the Japanese felt it 

was safe to head for the open sea. No food was provided at all for three days and the water 

was rationed by the teaspoonful. The combination of no ventilation and extreme heat generated from the 800 bodies inside made the overall living conditions intolerable, and several 

men crammed into the corners died of suffocation. Mr. Wada, a Japanese guard called “The 

Hunchback” by the POW’s, continually threatened to shoot any and all POW’s who moved 

or asked for water or assistance. 

On December 12, 1944, the Oryoku Maru was sunk in Subic Bay and the weakened, starving 

and dehydrated POW’s had to swim 300 yards to shore. Many drowned along the way in 
American Ex-Prisoners of War 22

the waves. The Japanese, enraged at the bombing, took out their anger on the defenseless 

survivors. Even though they were not directed where to come ashore, all those who exited 

the water outside boundaries the Japanese considered acceptable were machine-gunned. 

The Japanese offered no medical assistance to the wounded who remained on board and Lt. 

Toshino killed the wounded and helpless POW’s with what he later termed “mercy shots.” 

Only 1,341 of the 1,619 originally on board survived the bombing, the swim ashore and the 

shootings, but more was to come. The prisoners were forced to crowd into an abandoned 

tennis court for several days. Only one water spigot was available and the line for water 

was six hours long. No food was provided; the men had to sit one next to another; and there 

was no room to sleep, lie down or get out of the hot sun. At night, the men were subjected 

to the cold winter air. 

On December 28, 1944, 581 survivors of the Oryoku Maru were transferred into the Brazil 

Maru, and 1,070 into the Enoura Maru. These two sister ships then set off together to 

Japan. 

•	 Brazil Maru 

The Brazil Maru was an animal transport ship that had not been cleaned before POW’s 

were crowded into the two holds for the trip to Japan, which took several weeks as the ship 

dodged roving American submarines. The lack of food, near total darkness and lack of 

fresh air drove many to madness. Screams often filled the holds at night. Many of the men 

would cannibalize the weak or dead, and bloodsucking was commonplace. 

Once a day, a pot of rice and seaweed soup was lowered to the prisoners. The soup usually 

spilled and the men would desperately scramble for the dropped rice which had fallen into 

the animal manure on the floor. Only a few men got any food at all; most got nothing. 

Water was again rationed by the teaspoonful. 

Each morning, the Japanese dropped ropes to haul up the corpses of those who had died 

during the night. Usually the bodies of the 30 to 50 who died were simply thrown over 

the sides. 

As the ship drew farther north, the warm tropical air gave way to freezing temperatures. 

Many times, a daily high of 20 degrees was recorded. The men would huddle together and 

remove the clothes from the dead, as well as the sick and dying. 

The mood inside the holds was one of isolation and hopelessness. Of the original 16 chaplains, 

only four were still alive by the time the ship arrived in Chinese waters. These chaplains 

could offer only a brief escape from the specter of a lonely and useless death. 
American Ex-Prisoners of War 23
American Ex-Prisoners of War 24

The ship was attacked several times by American Navy planes. On January 8, 1945, more 

than 300 men were killed by explosions. Only the four chaplains and 497 POW’s survived the 

trip to Moji on the Island of Kyushu. Even when the men arrived in Japan, the humiliation 

was not over. A Japanese medical officer who went aboard smelled the dysentery and 

ordered an examination. The POW’s were forced to publicly strip naked on the open docks 

and bend over poles so that Japanese medical personnel could insert rods into their rectums 

in order to examine them for parasites. 

•	 Enura Maru 

From December 28 until December 31, 1944, the Enura Maru sailed to Formosa, where it 

remained docked until January 13, 1945, when more prisoners were added. It was attacked 

several times while docked and full of prisoners. On January 9, 1945, the Enoura Maru was 

attacked with 300 killed and 250 wounded. On January 10, 1945, it was attacked again, 

and most of the doctors on board were killed. The survivors were forced to remove 300 

mangled bodies of their comrades from the metal girders inside the bombed-out ship. Of 

the original 1,311 on board, only 619 survived, and on January 13, 1945, all were transferred into Brazil Maru. 

•	 Nissyo Maru 

Beginning on July 17, 1944 and continuing over several days, 1,539 men were loaded into 

the holds of the Nissyo Maru. With no food and unbearable heat, fainting was common. 

Yet, because the men were crammed into the small spaces and forced to stand with arms to 

sides, there was no place to fall. The men became crazed: pushing, screaming and swearing 

at one another. To make matters worse, most had dysentery and there were no toilet facilities. 

Seasickness and vomiting also were common, caused by the rough waters of the China Sea. 

For sustenance, rice was lowered twice a day to those fortunate enough to be standing 

directly under the hold opening. 

Ultimate Death Toll 

Despite the senseless and tragic loss of life, the Japanese still refused to mark the ships as 

carrying POW’s. In all, 25 unmarked ships transporting Allied and American POW’s were 

verified as having been sunk. Of the 18,901 men transported, 10,853 died due to submarine 

and air attacks. 

Slave Labor Pools 

Once the POW’s arrived at their end point destinations, they were forced, along with other 

foreign nationals, into slave labor pools and used in such projects as clearing and building 

railroads through jungles in occupied Southeast Asia. Here, the sanctity of life had very little 
American Ex-Prisoners of War 25

meaning; thousands died during railroad construction. POW’s also were sent deep into 

Manchuria to work in mines. In Japan, the POW’s were forced to work in factories, on docks 

and in coal and copper mines. No protective gear was ever provided for their skin or lungs. 

Typical Barracks 

The typical POW barracks in Japan was primitive. There was usually only one coal or woodburning stove kept in the center of the room, which was supposed to be used only for heating 

tea. There were several double bunks in a row. The men were given three woolen blankets, 

which they wove together into a bag to keep out the freezing air. No latrine was provided in 

the barracks. 

War’s End 

When news of the war’s end reached the camps and the emperor told his soldiers to cease all 

hostilities, the camp commanders opened up the storehouses and allowed the prisoners to eat 

as much as they could. The Japanese, who feared vengeance by the Americans, were hopeful 

that the prisoners would gain weight and therefore not appear to have been badly treated. 

As stated previously, the Japanese feudal military code of Bushido allowed the torture and 

mutilation of unarmed and defenseless prisoners. In addition, the code allowed for revenge to 

be taken out upon the prisoner in order to have the offended person not lose face. Such was 

the case at the end of the war. In August 1944, the War Ministry in Tokyo issued a directive 

to the commandants of various POW camps, outlining a policy for what it called the “final 

disposition” of prisoners. A copy of this document fell into American hands and became 

known as the “August 1 Kill All Order.” It stated: “When the battle situation becomes urgent, 

the POW’s will be concentrated and confined in their location and kept under heavy guard until 

preparations for the final disposition can be made. Whether they are destroyed individually 

or in groups, and whether it is accomplished by means of mass bombing, poisonous smoke, 

poisons, drowning or decapitation, dispose of them as the situation dictates. It is the aim not 

to allow the escape of a single one, to annihilate them all, and not leave any traces.” 

Atrocity at Puerto Princesa 

In no instance during the war was this taken to such great lengths as at the Puerto Princesa 

Prison Camp in Palauan, Philippines. There, the Japanese had seen American surveillance 

planes flying overhead several times. A few days later, on December 14, 1944, one of the 

greatest massacres in the history of WWII occurred. The American POW’s were forced to dig 

long pits, which they were told were to be used as air raid shelters. Coverings were then 

placed over the top of the pits, ostensibly to protect the men from bomb blasts. 
American Ex-Prisoners of War 26

The Japanese military commander in charge was Lieutenant Sato, who is described as a “cruel, 

hateful man.” On the morning of the fourteenth, Sato ordered all 150 American POW’s into 

the pits. Once they were inside, Japanese soldiers emerged from hiding and doused the 

POW’s with high-octane aviation fuel. Within seconds, the trenches exploded in flames. 

Most of the men were trapped like termites in a nest; although a few, with their clothing on 

fire, managed to scamper out the sides. The Japanese were waiting with swords and swiftly 

decapitated the escapees. Throughout this grisly massacre, Sato laughed and ordered his men 

to toss grenades into the pits. As soon as he felt that all 150 POW’s were dead, the general 

ordered his men to throw gasoline on the bodies. Amazingly, a few POW’s escaped through 

a small hole in the back of the trench, ran unnoticed down a mountainside and swam across 

Manila Bay. The obvious fact that all the POW’s would be executed prompted the Americans 

to launch a raid on Cabanatuan, freeing all 500 U.S. POW’s there. 

Most of the highest-ranking military officers demanded to the emperor that they fight to the 

last man. Furthermore, they wanted all POW’s executed, especially after the first atomic 

bomb had been dropped. 

On August 11, 1945, an American B29 Superfortress bomber was shot 

down over Fukuoka. Eight crew 

members were taken out of their jail 

cells, severely kicked and beaten. 

They were forced to watch as shallow 

holes were dug to receive their bodies. Then, they were decapitated one 

by one in retaliation for the atom 

bombing of Nagasaki. 

American Women as Prisoners of the Japanese 

The Japanese capture of Corregidor on May 6, 1942 yielded 66 Army nurses, one civilian 

dietitian and one civilian physiotherapist. Eleven Navy nurses were captured in Manila and 

later transferred to Corregidor. No nurses were captured on Bataan, as they all had previously 

been evacuated to Corregidor. At the time of capture, most were undernourished, as were 

the male defenders of the Philippines. In January of 1942, half-rations were in effect, and in 

February of 1942 one-quarter rations were being issued. It was during these hard times that 

the nurses were dubbed “The Angels of Bataan and Corregidor.” 

After capture, all the Army nurses were allowed to continue their work in the hospital wing 
American Ex-Prisoners of War 27

of Malinta Tunnel on Corregidor for two additional months; the hospital then was moved to 

an old school on the outskirts of Manila. The 11 Navy nurses eventually were transferred to 

Los Banos Camp with 400 civilian internees. 

Due to their status as volunteers in the Army, the nurses were believed to be dangerous and 

were housed at the Santa Catalina girls’ dormitory across the street from the Santo Tomas 

University Campus in Manila. Here they were kept in two large rooms with child-sized beds 

for seven weeks, enduring daily anxiety as to their possible future at the hands of the Japanese. 

At that time, they were not allowed to engage in nursing duties of any kind, and were allowed 

to go downstairs to eat only during the daytime. 

By the end of August 1942, all the nurses were transferred to nearby Santo Tomas University 

Internment Camp, where they were housed with the civilian internees. During this time, the 

nurses persuaded the Japanese to convert the Santa Catalina girls’ dormitory into a 150-bed 

hospital. Here, they were allowed to live and care for non-Axis civilians until they were freed 

by United States forces on February 3, 1945. 

According to their Bushido Code, the Japanese respected the women under their control, so 

the nurses were not beaten. Neither were there any documented or reported cases of rape by 

the Japanese soldiers during this period. The Japanese tolerated no displays of affection, however. If a man were caught in the company of a woman, even if she were his wife, he would 

be punished by a 60-day jail term and the others in the internment camp would be placed on 

half rations. 

After 8 to 12 months in captivity, all of the nurses failed to menstruate. The mechanism here 

is similar to that seen in anorexia nervosa wherein there is an impaired release of LHRH in the 

hypothalamus. Baseline LH and FSH are low, resulting in low estrone, estradiol and progesterone levels. The low estrogen and failure to ovulate seem to be solely due to gonadotropin 

deficiency. The exact mechanism involved in the failure of the hypothalamus to release 

LHRH is unknown. Menses and ovulation will return with weight gain, and several of these 

nurses had children after release. 

The death rate among the male military POW’s was 40% during their internment period 

under the Japanese. In contrast, not one nurse died during this time. Nevertheless, the 

average weight loss was 30% and death would have been inevitable had the nurses been 

rescued much later. 
American Ex-Prisoners of War 28

Data Analysis 

Through interviews with survivors, phone calls to VA central office and researching old references, 79 unique names were identified as those of women who had been prisoners of war 

of the Japanese. Furthermore, we found that no study had been undertaken to analyze them. 

Using the HINQ (hospital inquiry) data verification method, all 79 unique names were 

entered. We were hindered by the fact that only a few names had social security numbers 

available and many were hand-written and likely misspelled. Nevertheless, of the total 

requested via the HINQ verification method, 41 of the 79 (52%) were retrievable, while 38 of 

the 79 (48%) had no record matches at all. The latter group could be explained in that the 

names may have been initially loaded incorrectly into the system, the individual may never 

have used the VA health system or the veterans’ benefits or we were looking for an incorrect 

file. Nevertheless, our research and data analysis covered the 41 retrieved files, and it is from 

this universe that our results and conclusions are drawn. 

Service Connected Disability Among Women POW’s 

In the group of 41, 21 (51%) had an accessible disability rating, and 20 (49%) had no compensation and pension record found, indicating that these latter individuals had gone to the VA 

hospital or used VA benefits but had never filed a disability claim. Also, two of the latter 

group had sensitive records and were therefore not accessible. Overall, 39 files were available 

for analysis and 21 (54%) of these women had a service-connected disability, which is virtually 

the same as the 50.6% of all male ex-POW’s of the Pacific Theater of Operations who have 

service-connected disabilities. Among the verified women, the average degree of serviceconnected disability was 37%, again virtually the same as the male ex-POW’s of the Pacific 

Theater of Operations, who had an average degree of 40%. 

Incidence of Disease 

Among the 21 women with service-connected disabilities, diseases of the digestive system were 

the most frequent, with 11 out of the 39 (28%) receiving service-connected compensation. 

The next most frequent were the avitaminosis (including beriberi and pellagra) and neurologic 

disorders, each with 10 subjects out of the total of 39 (26%) receiving service-connected 

compensation. Thereafter, in order of decreasing frequency, 9 (23%) were service-connected 

for musculoskeletal disorders (including degenerative joint disease and Post-Traumatic 

osteoarthritis), 9 (23%) for malaria, 3 (8%) for systemic conditions and 3 (8%) for respiratory 

conditions (including 1 each for asthma, bronchitis and emphysema). Finally, there were 2 

(5%) for each of the following: amoebiasis, blood condition, flat foot, sinusitis, peripheral 

nerve damage, varicose veins and gynecologic conditions. 
American Ex-Prisoners of War 29

MFUA Statistics 

When comparing the data with the Medical Follow Up Agency (MFUA) studies, it is quite 

interesting to note that the data for the men and the women is virtually the same as far as the 

percentage of individuals with service-connected disabilities, average degree of disability 

among the disabled, the incidence of service-connected disability for digestive disorders, 

avitaminosis, neurotic disorders, musculoskeletal disorders, malaria and systemic conditions. 

These percentages deviate significantly in the percentage of service-connection for pulmonary 

pathology, however. Among males, tuberculosis was very frequent and was one of the prime 

causes of death in men for the first 7 years after repatriation, whereas no cases appeared 

among the women POW’s. Also, no complaints of peptic ulcer exist in the women as opposed 

to the men, among whom it was so common as to be a presumptive service-connected disorder. 

These differences are likely attributable to the fact that the men experienced a bimodal death 

rate curve. Deaths were high within the first 6 months of captivity due to the harsh treatment, 

poor diet and poor sanitation. Also, death rates were high again in the last year due to transport 

by cargo ships, which were often torpedoed, and working in coal mines and factories without 

protective gear. 
American Ex-Prisoners of War 30

IV. POW’s of North Korea and Communist China
 

In the Korean Conflict the mortality rate was 38% with 2,700± confirmed deaths out of 7,140. 

There were several reasons for this high mortality rate: 

•	 the Koreans never recognized the concept of prisoners of war; 

•	 they had not ratified the Geneva Convention accords regarding the humane treatment of 

prisoners of war; and 

•	 they regarded all forces hostile to their cause as war criminals, and they would treat them 

as such. 

North Korea became a Communist nation in 1946. They would spend the next four years 

indoctrinating and reeducating their people as to the Communist ideology. They also used this 

time to develop a highly trained and indoctrinated army in order to invade their ancient southern foe. At 4 a.m. on June 25, 1950, near Kaesong, Communist forces pushed across the 38th 

parallel and invaded South Korea, thereby pursuing North Korea’s goal of spreading communism as well as ending the civil war between the Korean people. Six days later, a battalion of 

the U.S. 24th infantry division was rushed to Korea from Japan. The first units to reach Korea 

were not well prepared for combat. They had been informed that the North Koreans would 

run away after learning of the American presence. The Americans soon found out how wrong 

they were. 

By July 1950, Seoul had fallen to the Communists. Thousands of civilians and foreign nationals 

were trapped in Seoul and force-marched out. A few miles below Seoul, the American Army’s 

24th Division was trapped and annihilated. Furthermore, of the four regiments contained 

therein, only 700 men were captured. Included in this group was their commander, General 

Dean. 

The North Koreans were particularly brutal. Many POW’s were executed on the spot. The 

ones who were captured were forced to take off their shoes and most of their clothes. Over 

and over the North Koreans repeated to the captured Americans, “We want you to die. You 

came over here to kill us; now we are the boss!” 

The American captives were force-marched into North Korea, along with civilian non-combatants from all over Seoul. There were diplomats and religious peoples, along with South 

Korean civilians. No help at all was allowed to be given to the injured. If a person was unable 

to walk under his own power, he was shot on the spot. Many of those stopping to relieve 

themselves from diarrhea were shot. 

On the death march through Manpo, many were executed for not being able to keep up. In 

one particular column of military POW’s, diplomats, journalists, missionaries, women and 
American Ex-Prisoners of War 31

children, the North Korean man in charge was known as “The Tiger.” There was light snow 

and sleet at the time. As the march proceeded, and more and more fell out due to exposure 

and neglect, The Tiger became angrier and angrier. He ordered the man in charge of the group 

with the most dropouts to step forward. Lt. Cordus Thornton of Longview, Texas stepped 

forward. “Death penalty for disobedience in wartime,” screamed The Tiger. “Is that not true 

for the American Army, as well?” 

The lieutenant responded, “In America, I would get a trial.” The Tiger then looked around to 

see a column of retreating North Korean soldiers and asked their verdict. “Shoot him,” they 

all shouted in unison. “There, you have your trial,” said the Tiger. The Texan calmly replied 

“In Texas, sir, we would call that a lynching.” The Tiger then asked him if he wanted a blindfold to which Thornton replied, “Yes.” He was then blindfolded; his hands were tied behind 

him and he was shot by the Tiger in the base of the head. 

Escalation 

Under the blessing of the United Nations, the United States began a massive military buildup 

in Japan and reinvaded the Korean peninsula. Most of the reserves flown from the U.S. were 

veterans of WW II, and were not as familiar with their weapons as the highly trained North 

Koreans; however, by November 1950, the U.S. forces had completely beaten the North 

Koreans and their lands and capital were in U.S./U.N. possession. 

By late November, American forces had reached the border of Chinese Manchuria along the 

Yalu River. Just as the Americans felt the war was over and the problems all settled, the 

Communist Chinese sent millions of soldiers across the Yalu River against the U.N. forces. 

It was during this horrible time of fighting in sub-zero temperatures with little food and provisions when most of the 7,190 American POW’s were captured. Of the total captured, 6,656 

were Army troops; 263 were Air Force; 231 were Marines and 40 were Navy men. 

Generally, after a while in the hands of the North Koreans, the prisoners were turned over to 

civilian authorities, who forced prisoners to sleep on the floor. No beds or clean clothing were 

ever provided. Nor was medicine provided. The prisoners were not allowed to shave their 

beards or to cut their hair. Finally, after China entered the war in late 1950, the prisoners were 

given over to the Chinese authorities. Thousands of Americans who were captured were later 

reported missing by the Chinese. It is believed that these men were sent off to slave labor 

camps, where they eventually died. 

Three Phases of Captivity 

There were three phases of captivity during which the POW’s were forced to endure extremely 
American Ex-Prisoners of War 32

different circumstances. Most of the deaths during the Korean Conflict came during the first 

phase of the hostilities. The Department of Defense Reports of 1955 revealed that 500 out of 

the 700 POW’s captured in late 1950 were forced to march into North Korea and died either as 

a result of execution or exposure to freezing temperatures. 

Phase I 

The American Army had expected victory over the North Koreans by Christmas, and therefore 

had not issued winter clothes. No one had seriously expected the Red Chinese to enter the 

war on the side of the North Koreans in the winter of 1950. Because they did, the captured 

American troops had to walk in the brutally cold winter with high snowdrifts and blowing 

winds with little more than jackets. Few had protective headgear. 

The Korean soldiers were brutal and shot several American POW’s in the heads or backs after 

tying their hands behind their backs. American officers were placed in charge of small groups. 

Any infraction by a group member was met by beating of the guilty individual and execution 

of the officer. 

For those marched off to “Death Valley,” the march took 25 days. The men were forced to 

walk two to three hours at night, then take a half-hour break. This made the situation worse 

because the three-hour march left them tired and sweating and the break left them very cold. 

During the day, the men stayed in Korean mud huts. Often, 25 men were crowded into an 

8' x 10' room, which forced the men to literally sleep on top of each other. They ate in the morning approximately an hour after stopping and again in the evening an hour before departure. 

The food was four ounces of cracked corn. No utensils were provided, and the drinking water 

was melted snow. 

Over two-thirds of the group developed bloody dysentery during the march. Those too weak 

to walk were left behind with an enemy guard. Soon, shots were heard, and the guard who 

had been left behind would catch up to the group. Fifty men were lost on the march. The 

survivors arrived in “Death Valley” the day after Christmas in 1950. 

“Death Valley” was divided into two sections approximately two miles apart. The officers were 

placed in the south section. In the officer’s section, the barracks-like area held 25 men each. 

At night, two-thirds of the group had to sit with their chins on their knees so the remaining 

one-third could lie down. After awhile, the men would rotate positions. Food was 400 grams 

of cracked corn per day. Prisoners were dying at the rate of two to seven daily between 

December 26 and January 24. On January 21, all but 300 of the sickest were marched out 

to Camp #5. There were about 200 prisoners in Camp #5. 
American Ex-Prisoners of War 33

Virtually all deaths during this time were due to starvation, exposure or harassment. In the 

first month of captivity, most POW’s died as a result of untreated wounds incurred around 

capture. In the third to fifth month, most deaths were due to dysentery and pneumonia. 

Injuries resulting from cold exposure were common. After five months, most of the deaths 

were due to beriberi and pellagra. In one camp, there were between five and 28 deaths per 

day. In all the camps, only Chinese doctors were permitted to treat patients. 

Phase II 

The second phase of captivity was characterized by deprivation of the necessities of life. The 

diet was totally inadequate and there was almost no sanitation. Men were overcrowded into 

small rooms in Korean farmhouses with neither bedding nor toilets. Clothing was insufficient. 

These temporary camps were used from July 1950 to February 1951. Uniformly, the POW’s 

in these camps received worse treatment than those housed elsewhere. Constant beating, 

mental harassment and forced participation in parades were the norm. 

Unlike POW’s in earlier wars, the POW’s in Korea experienced sophisticated brainwashing 

techniques. The Korean Conflict was, after all, a United Nations war against Communist 

aggression and ideology, so the Communists understandably attempted to indoctrinate the 

American POW’s with their philosophy throughout the entire conflict. Few North Koreans 

could speak English, therefore, the indoctrination sessions were conducted by the Chinese, 

most of whom had been educated in California Universities. Their knowledge of America and 

our way of life were extensive, and they often used that knowledge against our men. 

The indoctrination program had a two-fold purpose. The first was the selection and conversion 

of the susceptible person. The second was group neutralization. During the first year of captivity, there was a total regrouping of prisoners in an attempt to isolate all resistance groups. 

In fact, the North Koreans sent several “re-educated” or indoctrinated Americans back into the 

American lines in hopes that they would be able to cause dissension among the troops. 

Predictably, this endeavor never succeeded. 

Weakening the physical resistance of the American POW’s by exposing them to cold, torture 

and hunger accelerated the brainwashing. In addition, the Communists rewarded POW’s who 

cooperated with gifts such as extra food, better housing and less torture. 

The North Koreans, with the aid of their American-educated Chinese allies, uniformly broke 

down the military organization’s groups and separated individuals according to race and rank. 

The purpose of doing this was simple: to attempt to heighten any difference among the prisoners. 

For more than one year, most of the waking hours of the POW’s, were spent in study. They 
American Ex-Prisoners of War 34

were told, “We are your friends. Your conditions of living are bad now, but we will work 

together to improve them. We will correct the errors in your thinking. Once you have learned 

the truth, we will send you back to your families.” 

The American POW’s also were repeatedly told that the United States was an imperialistic 

government run by and for the rich. They were told that the Communist system reflects the 

aims and desires of all peoples and is the only real democracy. 

For years, the Soviets had denied any involvement in North Korea or China as far as the war 

was concerned; however, the techniques used by the Chinese were exactly those used by the 

Russians against their Japanese and German POW’s during WW II. The overall goal of the 

brainwashing was to re-educate and indoctrinate the POW’s and then to send the individual 

back to his homeland in order to spread communism. Later, it would be learned that although 

the direct handling of the POW’s was by the Chinese, the treatment was directed by the 

Soviets. 

By the end of the war, 21 American POW’s had refused repatriation back to the U.S. Most 

later returned. By comparison, over one million North Koreans had refused repatriation into 

North Korea by the end of hostilities. 
American Ex-Prisoners of War 35

Phase III 

The third phase of captivity was characterized by the permanent camps used from March 1951 

until October 1953. Essentially much better conditions were available due to the fact that the 

armistice negotiations had begun to make progress and physical and psychological harassment was greatly decreased 

From November 1951 until repatriation in 1953, there were fluctuations in the captors’ attitudes 

toward the POW’s reflecting the progress in the armistice negotiations, but generally there 

were improvements in the diet and clothing. 

The North Koreans totally ignored all aspects of the Geneva Convention. Executions and 

severe punishments were the norm for trivial offenses. With the North Koreans, the incident 

was forgotten as soon as the punishment was over; however, the Chinese were different. Under 

the Chinese “lenient policy,” notes were taken about a prisoner’s behavior. Then suddenly, 

the Chinese would say, “Take all and come with.” This meant the POW was facing solitary 

confinement and intense interrogations. 

Although the Chinese did not commit many war crimes, they did not follow the rules of the 

Geneva Convention. While Red Cross parcels sometimes made it to the camps, the Chinese 

steadily refused to allow any Red Cross inspections. In addition, all interactions with western 

media were closely monitored under the direction of two western journalists with Communist 

sympathies. These “journalists” only would release information that was damaging to U.N. 

forces and beneficial to Communist forces. 

Show camps were opened up to international observers during the war to counter the belief 

that the prisoners were mistreated. Some POW’s in these camps were allowed to write home. 

Others were given better food so they could appear healthy in order to be photographed by 

outside inspectors. Despite the presence of the show camps, most internment facilities were 

barbaric, brutal and uncivilized. 

The “Bean Camp” near Suan, “Death Valley” near Pukchin and “The Valley” near Kanggye 

were among the worst camps; however, the two worst of all were “The Interrogation Center” and 

“The Caves,” both near Pukchin. In “The Caves,” the men were confined in hillside caverns; 

they were forced to sleep without blankets; their food was thrown to them and there was no 

sanitation. In fact, there were no latrines at all and the men had to live among their own excrement. POW’s sent to “The Caves” were those accused of insubordination, repeatedly breaking 

camp rules, attempting to escape or refusing to talk with Chinese military interrogators. 
 

American Ex-Prisoners of War 36

One particularly brutal interrogation center was “Pak’s Palace,” which was located in a brickyard flanked by houses near the city of Pyongyang. The chief North Korean interrogator was 

Colonel Pak, a sadist. A cruel man known as “Dirty Pictures Wong” assisted him. “The 

Palace” was operated to obtain military information. When a POW refused to talk, Colonel 

Pak would use violence, such as kicks, cigarette burns and torture. Several U.S. Army officers 

went through “The Palace,” and most Air Force officers went through it. They all were beaten. 

Many of the prisoners found ways to avoid the continual beatings. If you could convince the 

guards that you were stupid, crazy or the 

lowest graduate in your class, they often 

were not interested in you. A prisoner 

who refused to cooperate would be 

called a “reactionary” and sent to a bad 

camp, while prisoners who were docile, 

seemed to cooperate, were polite and 

read the Communist literature were 

called “progressives.” These “progressives” graduated to “Peaceful Valley,” a 

Communist show camp where POW’s 

were given better food and even tobac­
American Ex-Prisoners of War 37

co. 

Food 

The diet in Korea was mainly of a corn or millet variety. The average weight loss confirmed 

by the debarkation hospitals was 40-50% per man from the pre-internment weight. 

Repatriation 

Operation Little Switch, which 

took place April 20-May 3, 1953, 

was the exchange of sick and 

wounded Korean War POW’s. 

From August 5 through December 

23 of 1953, Operation Big Switch 

took place. Operation Big Switch 

was the final exchange of prisoners of war by both sides. Both 

operations were marked by controversy over voluntary repatriation. 

Repatriation procedures were initiated 

to handle the numbers of POW’s who 

would be returning. For the “Little 

Switch” POW’s, this medical survey 

was to be accomplished by U.S. military hospitals in Japan. The “Big 

Switch” procedures required that 

returnees would be given immediate 

first aid, followed by a triage which 

would sort out the POW’s requiring 

movement by ambulance and those 

POW’s who could be moved by truck 

to the reception center. 

Once at the center, the POW’s were 

disinfected by spraying. They then would proceed in robes from the showers to the reception 

hospital, where a medical record was to be initiated. Laboratory tests, a dental examination, 

chest X-ray and physical examination were then 

performed. Based upon these tests, the POW’s were classified as patients and non-patients. 

Patients were flown to military hospitals in Japan. Non-patients were then placed aboard ships 
American Ex-Prisoners of War 38

returning to the U.S., where intelligence and processing took place. Once home, the former 

POW’s were given a 30-day rest period for recuperation and recovery, prior to reassignment 

or discharge. 

V. POW’s of Vietnam 

Vietnam had a presumed mortality rate of 114 out of 772 confirmed captured men. This war 

had two separate theaters. In South Vietnam, the soldiers who were involved with the Viet 

Cong generally were U.S. foot soldiers (77 Army and 26 Marine). Twenty-five percent of 

these captured men died. There was generally less torture and fewer interrogations here than 

in North Vietnam; however, since the Viet Cong themselves were poorly fed, the Americans, 

who were at the end of the food line, suffered from a chronic food shortage. 

North Vietnam was very different. Most were kept in Hanoi, literally, “ha noi,” meaning 

“inside the river,” so named because the city sits on the delta of the Red River, 60 miles from 

the port of Haiphong. The POW’s here were mostly downed aviators, 5% of whom died. They 

were often used for psychological and propaganda purposes, and there was severe physical 

and mental torture, with somewhat inadequate food. 

The “Hanoi Hilton” 

Many prisoners were kept in Hoa Lo prison, built by the colonial French near downtown 

Hanoi. Hoa Lo was sarcastically renamed the “Hanoi Hilton” by the Americans in a mock 

tribute to the quality of life within its walls. Regular cells measured 7' x 7', contained two 

beds and enough room to pace off three steps. Solitary confinement cells were 4-foot cubes, 

with no space to stand or lie down. 

In August 1964, the Hanoi Hilton received its first U.S. prisoner, Navy Lieutenant Everett 

Alvarez. Lieutenant Alvarez was an A-4 pilot stationed aboard the U.S.S. Constellation and 

was one of two pilots shot down August 5 when the U.S. launched its response to the Gulf of 

Tonkin incident. Said Lieutenant Alvarez, “They had everyone in there. They brought in 

droves of kids. They brought in women, too. I could hear then screaming at night.” 

Air Force Colonel Jack Bomar says, “We were criminals, and we had bombed those people 

without a declaration of war, and that’s the way we were treated.” 

Lt. Colonel Richard Kiern, who endured prison in both WW II and Vietnam, compared the two 

experiences thusly: “Captivity in Germany was rough, but at least I was treated like a human 

being. Captivity in North Vietnam was unreal, unbelievable, not of this world.” 
American Ex-Prisoners of War 39

Pilots at the Hanoi Hilton were kept alive because they had a special value to their captors. 

The North Vietnamese saw them as hostages. Because no communication was allowed 

between the prisoners and the U.S. government for several years, information on the total 

number of prisoners was unavailable. A young seaman was to become instrumental in providing this information, however. 

Douglas Hegdahl 

On April 6, 1967, 19-year-old Douglas Hegdahl was below deck on his ship, the USS Canberra, 

which was cruising the waters in the Gulf of Tonkin. Without authorization, Hegdahl went 

topside to witness a night bombardment. When the guns opened fire, their concussion 

knocked him down and the 6’ 2”, 225 pound Sailor fell into the ocean, losing his glasses. 

Since he was a powerful swimmer, he was able to spend ten hours in the water before being 

found by the North Vietnamese. 

At first, Hegdahl was felt to be a spy or infiltrator. After several days of interrogation, he 

was believed to be just a common sailor unknowledgeable of any useful military secrets. The 

Vietnamese thought of him as a fool for falling into their hands. When the prison staff began 

to treat him like an ignorant country boy, he recognized what they were doing and played the 

role to the hilt. The loss of his glasses and inability to see accurately made the role even more 

believable. 

Throughout his imprisonment, he capitalized on his role as the village idiot, often displaying 

seemingly erratic behavior. For example, Hegdahl hummed the tune of “Old MacDonald’s 

Farm” continually. He was used by the Vietnamese in their propaganda shows as a “poor 

defective peasant.” The Vietnamese could not wait to get rid of him, because they thought he 

was stupid, ineffective and unthreatening; however, he was actually highly intelligent. He did 

not want to leave, because, using his guise, he was able to assist his fellow POW’s. 

Hegdahl was removed from the country in 1969, however, after making an obscene gesture 

during a propaganda photograph with peace activist Tom Hayden, throwing away extra food 

given him and refusing to write a public amnesty request to Ho Chi Minh. The Vietnamese 

forcibly moved Hegdahl ahead of others on the “early release roll” and he was released in 

1969, four years ahead of the remaining prisoners. 

In failing to observe Hegdahl’s intelligence, the North Vietnamese had allowed him to move 

freely around the compounds. Hegdahl used this freedom to communicate with the other 

prisoners. In doing so, he became a valuable reconnaissance worker in the POW resistance 

network. For example, when he hummed “Old MacDonald’s Farm,” he was actually using the 

tune as a mnemonic device for remembering the names of his 250 fellow American prisoners. 
American Ex-Prisoners of War 40

While in the Plantation POW complex, Hegdahl had been placed in a cell with Dick Stratton 

and the two became great friends. Stratton ordered Hegdahl to accept early release if it were 

available in order to inform Washington about the situation. Upon his release, Hegdahl was 

immediately debriefed and the information he provided to intelligence authorities was of inestimable value. Up to that point, there had been no accounting of many of these men. 

The Zoo 

Close by the Hanoi Hilton was Cu Loc, affectionately called “The Zoo,” where there was the 

infamous solitary confinement area known as “the gatehouse.” Here, troublesome POW’s 

were tortured by the Vietnamese, as well as Cubans, for hours on end for false confessions. 

A favorite technique was to hang the POW’s for hours by ropes with their hands behind their 

backs. Another ploy was beating them with rubber hoses. Withholding of food and especially 

water was common. In addition, guards at The Zoo often gave the POW’s boiling soup and 

forced them to drink it quickly before it would be taken away. 

Skid Row 

Very troublesome prisoners were taken 

later in the war to “Skid Row,” a maximum-security prison that had been built by 

the French 10 miles southwest of Hanoi. 

The Plantation 

“The Plantation” was a show camp primarily designed for peace delegates to view 

the overall good conditions of the 

American POW’s. Many POW’s here 

were specifically chosen for their willingness to talk to the peace delegates. 

Physical and Psychological Tortures 

POW’s of North Vietnam experienced a variety of physical and psychological tortures. When 

the pilot was initially shot down, the local captors and then the jail guards would usually beat 

him. The downed pilot then would be quickly transported to an interrogation center, where he 
American Ex-Prisoners of War 41

routinely would be forced to undergo a morning, afternoon and evening medley of questions, 

lectures, indoctrination and bullying. The same questions would be asked over and over in 

hopes of tricking a prisoner into divulging a different bit of information. Typical questions 

included the following: 

•	 Who were the members of your squadron? 

•	 What were your air tactics, roll in altitudes, dive angles and air speeds? 

•	 What defensive altitudes were used to avoid the North Vietnamese MiGs or Surface-to-Air 

missiles? 

•	 What were the offensive maneuvers for attacking the North Vietnamese? 

Many times, medical treatments were withheld in order to force the men into writing confessions that they were, in fact, war criminals. The prisoners would be publicly displayed and the 

crowd would be excited into frenzy, often attacking and beating the prisoners. 

Physical torture was common well after all useful information had been extracted. This was 

done in order to break the morale of the men and to use them for propaganda purposes. The 

prisoner’s body would often be tied into various contortions in which bones would not be 

broken, but great pressure would be placed on the ligaments. Sleep deprivation was another 

commonly used tactic. The prisoner would be kept chained to a stool in a bright room awaiting 

his confession. For days at a time, he would not be allowed to sleep. If he were to drift off, 

he would be hit with a thick pole. 

John McCain 

Navy Lieutenant Commander John McCain III, who had volunteered to stay in combat after 

his ship was assigned to go home, was captured in October 1967, when his plane was shot 

down over Hanoi. McCain landed in the middle of the dried-out bed of Sword Lake. He 

sustained a broken leg and other severe injuries, yet he was offered no medical treatment. 

Soon thereafter, the North Vietnamese captors learned that his father was Admiral John 

McCain, Jr., Commander in Chief of U.S. forces in the Pacific, whom they called the “Chief 

War Lord in the Pacific.” Knowledge of McCain’s identity thrilled the Vietnamese, who 

quickly dubbed him the “Crown Prince.” 

The year following his capture, McCain was offered an early release ahead of his fellow prisoners, but, since accepting the early release would have been a violation of his personal code 

of ethics, McCain refused the offer. Enraged and furious about his refusal for the release, his 

captors stated: “They have taught you too well, McCain! They have taught you too well!” 

The North Vietnamese then rebroke his leg, broke his arm, and knocked out his front teeth. 

McCain was tortured for over a year and was finally forced to sign a confession of criminal 
American Ex-Prisoners of War 42

wrongdoing and apology. The North Vietnamese got little more from McCain, however, as he 

swamped them with useless information, once listing the offensive line of the Green Bay 

Packers as members of his squadron. Others offered early release literally stepped over John 

McCain’s stretcher on their way out. 

McCain, who was considered an inventive resister and a master at interfering with propaganda 

broadcasts, was referred to by the Vietnamese as a “black criminal.” 

In 1970, McCain further enraged his captors by refusing to meet with a group of “peace 

delegates,” self-appointed diplomats who traveled regularly from the United States to North 

Vietnam for talks. His punishment was to spend the entire summer locked in a 6 by 2 foot cell. 

Peace Delegates 

None of the prisoners was forced to meet with the war’s best-known delegate, actress Jane 

Fonda. Instead of meeting with POW’s, her time in North Vietnam was spent making propaganda films to be shown to the prisoners. In one film, she is standing beside a dam that had 

been bombed, weeping bitterly. Most of the POW’s felt as though her performance was of 

academy award caliber. Her most notorious film was one in which she crawled into a North 

Vietnamese anti-aircraft battery placement and pretended to be taking aim at her fellow 

Americans who were bombing North Vietnam. For these reasons, she was reviled by most 

of the POW’s and anyone who met with her was considered a collaborator with the enemy. 

Jane Fonda continues to be looked down upon by living POW’s. Says Everett Alvarez, “No 

matter what your political beliefs, there is still a basic faith in your young men out there. 

These are your own people. You can’t do that to your own people.” 

For all of the POW’s, the arrival of the peace delegations was dreaded. Their presence placed 

the men in a state of conflict. On the one hand, if they met with the delegates, they would be 

permitted to speak English openly, would be served good food and cookies and possibly 

would be allowed to send a letter home to loved ones. On the other hand, the POW’s knew 

they were being used as propaganda tools. The Vietnamese required that they pose for photographs with the delegates and often, they were made to give staged confessions concerning 

America’s use of force. 

One encounter with the peace delegates did not proceed as planned. POW Larry Carrigan had 

agreed to meet with members of the Women’s Strike for Peace. Yet not only did he admit to 

war crimes and the bombing of women and children, Carrigan vigorously defended the U.S. 

air strikes, informing the delegates that the U.S. airmen had been disciplined from straying 
American Ex-Prisoners of War 43

away from military targets. The furious Vietnamese had 

him pulled from the room and sent back to the Hilton for 

correction. He was beaten with sticks and fists for days. 

Then he had his hands tied behind him and was lifted to 

the ceiling, where he was left to dangle in pain. At times 

he would be lowered and allowed to stand on a chair. Then 

the chair would be kicked out from under him, again forcing him to dangle in excruciating pain. 

Communication — Outwitting the Captors 

The American POW’s felt it was vital to maintain contact 

with one another in order to provide moral support. 

Because talking among themselves was strictly forbidden, 

the prisoners developed elaborate methods of communication. Hand signals were common, as was tapping on the 

walls. 

While public displays of the American POW’s for propaganda purposes were commonplace, the POW’s had the upper hand and made their captors 

look foolish more often than not. Such was the case with Navy Commander Jeremiah Denton, 

Jr. who blinked T O R T U R E in Morse code. When put on display for cameras, most POW’s 

simply sat expressionless and spoke one word answers, which indicated they were being 

forced to participate. Others, such as Paul Galanti, were photographed making obscene hand 

gestures to their captors. The picture of Galanti giving the Vietnamese the finger was 

airbrushed and appeared on the cover of Life; however, an untouched version appeared in a 

West German newspaper, which infuriated the Vietnamese. 

Metheny, Overly and Black (M.O.B.) - POW’s Held in Contempt 

In an attempt to break up any communication and cohesiveness among the POW’s at the 

Plantation, the North Vietnamese were able to persuade three POW’s to accept early release on 

February 16, 1968. This was meant both as a propaganda ploy as well as a morale breaker to 

the remaining POW’s. Three prisoners, Ensign David Matheny, Captain Norris Overly and 

Captain Jon Black were released to the peace activists. Their release was a carefully staged 

event with foreign journalists, party officials and distinguished guests in attendance. Cameras 

and taping devices recorded the entire proceedings. Although Douglas Hegdahl was able to get 

Overly to memorize the names of 70 POW’s, which was of immense benefit to Washington, 

the immediate effect to POW morale was devastating, both at the Plantation and throughout 
American Ex-Prisoners of War 44

the POW system. The trio was referred to as MOB, an acronym for the first letters of their last 

names (Matheny, Overly and Black), and their fellow countrymen left in confinement held 

them in disdain. 
American Ex-Prisoners of War 45

Dick Stratton 

Similarly, Commander Dick Stratton was held in contempt for mimicking the robot-like actions 

of filmdom’s Manchurian Candidate when he bowed 90 degrees to 

all in the room, including the wall, four times. He also read a written confession and apology 

to the Vietnamese people for the U.S. bombing of their country. Along with seven 

photographs of somber pilots, Stratton’s picture and story were published in the April 7, 1967 

edition of Life Magazine with the title “North Vietnam Under Siege.” The images caused an 

uproar in the United States. When the North Vietnamese learned that they had been tricked, 

they beat Stratton badly. Stratton feels the episode saved his life, because, as he said, he had 

become so famous “the Communists had to keep me alive.” 

Although it was meant as a parody, Stratton’s behavior was never forgiven by many hardline 

American officers who viewed his actions as dishonorable and against the code 

of conduct. U.S. Ambassador-at-Large Averell Harriman took a different view, though, saying, “From the photographs, videotapes and descriptions that I have seen of the so-called 

“news” conference at which Captain Stratton was exhibited, it would appear that the North 

Vietnamese are using mental or physical pressure on American POW’s. Hanoi has refused to 

allow the International Committee of the Red Cross or any neutral intermediary to visit the 

prisoners, a right required by the Geneva Convention to which Hanoi has adhered. Without 

such independent verification, North Vietnam’s professions of ‘humane treatment’ cannot be 

accepted.” 

Dick Stratton was kept in a variety of facilities over the years. After he was separated from 

Hegdahl, he was required to copy in his own handwriting material that POW’s at the Zoo had 

been forced to write under pressure. He refused to do so and was placed into a room in the 

Warehouse of the Plantation in total darkness. For seven weeks, he battled roaches, rats and 

loneliness. As expected, he lost all track of night and day. 

The 4th Allied POW Wing 

By 1971, the POW’s had organized themselves into the Fourth Allied POW Wing with 

Colonel John Peter Flynn, the highest ranking captured officer, as their commander. The 

wing’s motto was “Return with Honor.” The Hoa Lo authorities placed each senior officer 

into a single large cell in an attempt to isolate them from the other prisoners. This was an error 

as the senior 

officers were now able to communicate even easier. The senior officers offered blanket 

amnesty to any prisoner who might have collaborated to any degree for whatever reason. 

The offer remained open until the war’s end. 
American Ex-Prisoners of War 46

Countering Propaganda 

On the Fourth of July, 1969, three U.S. POW’s, Navy Lt. Robert Fishman, Air Force Capt. 

Wesley Rumble and Douglas Hegdahl were released. Once back in the U.S., they were 

allowed by the Nixon administration to go public with word of the torture and humiliation 

forced upon the U.S. POW’s. It was a calculated campaign by the administration to counter 

the Communist propaganda. 

Operation Homecoming 

Operation Homecoming was carried out at Clark Air Base in Luzon in the Philippines in 1973. 

The first to arrive on February 12, 1973 was Navy Captain Jeremiah Denton, senior officer 

among the first group of prisoners out of Hanoi. His first words upon landing were, “We 

are honored to have had the opportunity to serve our country under difficult circumstances. 

We are profoundly grateful to our Commander in Chief and to our nation for this day. God 

bless America.” 

Thirty-nine fellow POW’s accompanied Denton. Another 473 American prisoners were evacuated by the end of March. Operation Homecoming contained built-in safeguards, carefully balanced diets and total security from the press. An escort officer, a man of equivalent rank, 

service branch, background and experience, greeted each POW and served as a buffer 

between the POW and the New World. The escort carried in his briefcase up-to-date information about the world and the POW’s family. 

Of all the Americans missing or captured in North Vietnam, 76 prisoners had been released 

prior to Operation Homecoming, 34 had managed to escape from North Vietnamese prisons, 

and 1,948 soldiers still are considered missing in action. 
American Ex-Prisoners of War 47

VI. The Presumptive Service-Connected Disabilities
 

Public Law 97-37 established the Presumptive Service-Connected Disabilities, which are 

Arthritis (traumatic), Avitaminosis, Beriberi (including Ischemic Heart Disease with a history 

of Wet Beriberi or edema), Chronic Dysentery, Frostbite, Helminthiasis, Malnutrition, 

Pellagra, any other nutritional deficiency, Psychosis, Panic Disorder, Generalized Anxiety 

Disorder, Obsessive Compulsive Disorder, Post-Traumatic Stress Disorder, Atypical Anxiety 

Disorder, Depressive Neurosis or dysthymia, Peripheral Neuropathy, Irritable Bowel 

Syndrome and Peptic Ulcer Disease. 

Disruptive Articular Trauma (Post Traumatic Osteoarthritis) 

In 1954, Cohen and Cooper showed that POW’s from the Pacific theater of action have an 

incidence of post-traumatic Osteoarthritis of 3.3% compared to 1% in Control War Japan 

(WJ), and POW’s from the European Theater of Operations (PWE) have an incidence of 2.3% 

compared to 1% for Control War Europe (WE). Also, per Nefzger as of 1965, the hospital 

admission rate per 1000 was 2.5 for POW’s captured by the Japanese (PWJ) vs. 0.5 for 

Control War Japan (WJ), and 0.4 for POW’s from the Korean War (PWK) vs. 0.2 for Control 

War Korea (WK). Among those service-connected for disease of the musculoskeletal system, 

PWJ was 25.9%, WJ was 11.9%, PWE was 22.4%, and WE was 16.4%. 

There are three types of joints in the body, any of which may be involved in disruptive articular 

trauma. The first type includes the amphiarthrosis as seen in the parietal bones in the skull 

characterized by tight fibrous bands connecting these bones. The second type is the synarthroses 

characterized by the bones of the spinal column with flowing fibrous sheets and tight, almost 

immovable joints. The third type, and the most severely and commonly affected are the 

diarthroses, characterized by the joints of the long bones of the body possessing two distinct 

movable areas. 

The diagnosis of post-traumatic osteoarthritis is difficult to make in retrospect. In general, 

however, the following points are helpful: The joint had to be normal prior to the injury; an 

effusion or structural damage had to occur after the injury; and similar disease is not present 

in other non-traumatized joints. This is the difference between post-traumatic osteoarthritis, 

which is a secondary form of osteoarthritis, and primary, or degenerative joint disease which is 

a diffuse disorder affecting joints symmetrically. 

Other points favoring a traumatic origin are that the affected joint is localized to either a mono 

or pauci articular location and significant osteoarthritis is seen in a joint not usually severely 

involved with degenerative joint disease such as the ankle, wrist, elbow or metacarpophalangeal 

joint. Finally, X-rays may be helpful in demonstrating healed fractures or foreign bodies near 

the joint in question. 
American Ex-Prisoners of War 48

Nutritional Depletion 

Nutritional depletion likely accounted for more deaths in POW camps and more morbidity and 

mortality upon repatriation than any other single cause, because as individuals are malnourished, 

they are predisposed to the development of several different disease states. Recognized 

nutritional deficiency states may take the form of vitamin, protein, essential fatty acid or 

mineral deficiency. 

Marasmus 

Generalizations always are difficult to make; however, if one wishes to look at a global picture 

among the European Theater ex-POW’s, these individuals suffered primarily from a lack 

of sufficient calories throughout and especially towards the end of the war. This produced 

Marasmus, a deficiency of total calories in the absence of other deficiencies, which produces 

a thin and weakened individual often without long-term sequelae. 

The lack of calories especially was true of the Soldiers and Airmen who were captured in the 

latter months of the war in Europe, were not fortunate enough to be placed in any controlled 

prison setting. 

Virtually all POW’s in the European Theater had low but minimally sufficient vitamin intake, 

primarily due to intermittent dietary vitamin supplementation with potatoes, cabbages, turnips 

and any other of a variety of vegetables, as well as intermittent Red Cross parcels which also 

provided some protein supplementation. This explains the paucity of cases diagnosed with 

avitaminosis upon repatriation. When comparing European Theater POW’s to those of all 

three Asiatic Theaters, the dietary nutritional differences are striking, particularly in the Pacific 

and Korean theaters of action. 

The Pacific and Korean War POW’s had, primarily in the early months of captivity, a virtually 

total lack of vitamins, which was in some cases not only a hypovitaminosis but an actual 

avitaminosis, or absolute lack of vitamins. This was primarily of the B complex vitamins and 

vitamin A. These individuals also were fed a very low number of calories in the diet. It was the 

total protein, energy and carbohydrate starvation diet imposed on these prisoners in the early 

months of capture which killed so many and predisposed the survivors to several problems 

later. 
American Ex-Prisoners of War 49

Kwashiorkor 

Kwashiorkor, an African word meaning an individual with characteristic body appearance, 

results from a total deficiency of protein in the diet. 

The loss of protein in the diet yields a decreased plasma albumin, which manifests itself clinically as dependent edema. In addition, there is a decrease in plasma transferrin, which is the 

protein responsible for the transfer of iron in the circulation from the intestinal lumen to the 

liver and bone marrow. Without this transport protein, hypochromic microcytic anemia results 

due to lack of incorporation of iron into the hemoglobin. Lack of protein in the diet also 

affects hemoglobin production, as protein is needed for the globin portion of the hemoglobin. 

The immune system is especially involved in Kwashiorkor. Initially the lymphatic tissues 

begin to atrophy; there is decreased activity in the polymorphonuclear cells and a failure of 

maturation of the T-Cell division. The inevitable sequence of events is an increased morbidity 

and mortality from common infections, as well as opportunistic organisms such as viruses, 

fungi and parasitic diseases not normally seen in healthy people. This, in effect, would present 

quite similarly to an acquired immune deficiency syndrome. 

In an individual on a progressive protein and vitamin deficient diet, the B-complex vitamins, 

responsible for energy production, are primarily involved. Several adaptive physiologic 

changes occur when the body is exposed to starvation, including decreased insulin secretion, 

increased levels of glucagon and cortisol, and decreased peripheral production of triiodothyronine 

(T3) from thyroxine (T4). The result of the decreased insulin levels is mobilization of free 

fatty acids from adipose tissue for utilization, allowing glucose to be utilized by the brain. 

Ketone-induced diuresis occurs, accompanied by loss of magnesium, phosphorus and calcium. 

This becomes especially important, as lack of phosphorus decreases the ability of the body 

to produce adenosine triphosphate (ATP) and further prevents energy production by the 

inability to convert thiamine into thiamine pyrophosphate (TPP). A 5% weight loss occurs 

in the first week of total starvation. The gastrointestinal tract, liver and skeletal muscle lose 

considerable mass during this time. Skeletal muscle is the primary reservoir for TPP in the 

body. Gastrointestinal mucosal loss is enormous during the first week of starvation, with 

marked atrophy of the villous projections, thereby largely decreasing the absorptive surface in 

the gastrointestinal tract. Cardiac muscle atrophies at a much slower rate. Hypoalbuminemia 

leads to small bowel edema, resulting in malabsorption. Continued protein deficiency has 

disastrous effects on the hematopoietic and immune systems. Decreased hemoglobin, hematocrit, total lymphocyte counts, albumin, and transferrin result from severe protein depletion at 

five weeks of starvation, with an average weight loss of 15 percent. Cell-mediated immunity 

is altered and the bactericidal activity of polymorphonuclear leukocytes is reduced. T-cell 

defects result from loss of thymic hormone and deficiency of zinc and Vitamin C. 
American Ex-Prisoners of War 50

Within one and one-half months anemia becomes manifest. Hypoalbuminemia follows shortly 

thereafter. By two months, there is a decrease in T-Cell function, which is manifested by 

depressed cell mediated immunity, and the individual at this time becomes susceptible to 

opportunistic infections. By two and one-half months broncho-pneumonias begin to become 

commonplace. Death is inevitable if protein energy sources are not quickly restored. 

Total starvation in the first week produces a weight loss of four to five kilograms. Twenty-five 

percent of this is from adipose tissue, 35% is extracellular fluid loss and 40% is protoplasm 

loss, primarily from skeletal muscle. Accompanying this is a loss of nitrogen from the body 

with associated depletion of other electrolytes such as magnesium, phosphorus, calcium and 

selenium. This becomes especially important, as lack of phosphorus decreases the ability of 

the body to produce adenosine triphosphate and further prevents energy production by not 

being available to convert thiamine into its active form, thiamine pyrophosphate (TPP). 

Also noted during the first week of starvation are huge skeletal muscle losses, much greater 

than cardiac muscle losses. What is especially bothersome about this is that skeletal muscle 

is the primary reservoir for thiamine pyrophosphate in the body. If skeletal muscle mass is 

decreased, then thiamine pyrophosphate will have very few storage sites. Gastrointestinal 

mucosal loss is enormous during the first week of starvation, with marked atrophy of the villous 

projections, thereby decreasing, to a large extent, the absorptive surface area in the small intestine 

and colon. Renal parenchymal loss is minimal. The central nervous system is not affected at 

this time. This individual represents the Musselman Syndrome in which there are decreased 

but adequate sources of protein and vitamins to sustain life, but a virtually total deficiency of 

calories, primarily carbohydrates, in the diet. This presents with severe wasting of the extremities. 

Individuals with the Musselman Syndrome are not overly susceptible to opportunistic infections, 

in contrast to those with protein deficiency or vitamin deficiency states. 

Trace Element Deficiencies 

Zinc deficiency is manifested by acrodermatitis, poor wound healing, decreased taste and 

worsened immune function. Copper deficiency is manifested by hypochromic microcytic 

anemia. Chromium deficiency is manifested by encephalopathy and peripheral neuropathy. 

Selenium deficiency produces a peripheral unresponsiveness to the actions of PTH, causing 

a hypocalcemia which is unresponsive to treatment until the magnesium is replenished. 

Hypophosphatemia produces rhabdomyolysis. 
American Ex-Prisoners of War 51

Essential Fatty Acid Deficiencies 

Essential fatty acids include linoleic acid, deficiency of which was manifested by dry scaling 

dermatitis, coarse hair, alopecia and diarrhea; and linolenic acid, a deficiency of which was 

manifested by numbness, paresthesias, weakness and blurred vision. 

Vitamin Deficiencies 

A cruel and agonizing cause of death in the camps was to suffer from a vitamin deficiency 

syndrome. 

Deficiency of the B complex vitamins was the most lethal of all the vitamin deficiencies, if 

individuals were so unfortunate as to lack supplementation with these vitamins. This vitamin 

complex is divided into two groups. Group A is represented by: thiamine, also known as 

Vitamin B-1; riboflavin, also known as Vitamin B-2; nicotinic acid or nicotinamide, also 

known as Vitamin B-3; pantothenic acid and biotin. Group B is composed of: folic acid, also 

known as Vitamin B-9, and cobalamin, also known as Vitamin B-12. 

Within group A, the B vitamins are amines responsible for the intracellular metabolism of 

carbohydrates, fats and proteins and are responsible for the production of adenosine triphosphate for the maintenance of the respiratory chain. They are the energy releasing vitamins, 

and a deficiency of any of these vitamins manifests itself in tissues with the highest metabolic 

activity and turnover rate. These amines are present in every cell of the body and are vital, 

hence the name vitamin. They all are water-soluble. 

Among group B, The B vitamins are vital for red blood cell production and are termed the 

hematopoietic vitamins. They also are water-soluble. Vitamin B-12 is bound to protein in 

the liver, and a deficiency takes three to five years to develop. 

Syndromes: Several physicians who were themselves prisoners of war later wrote about their 

observations and experiences in Japanese POW camps. Beriberi was seen and written about 

by Doctors Hibbs, Lewis and Nardini, physician POW’s in the Philippines. The castration 

syndrome was identified and written about by Dr. Jacobs, as was the oculo-oro-genital syndrome. Pellagra was seen with great regularity in many of the camps. Strachan’s Syndrome 

was a deficiency syndrome different from the above and spinal spastic syndrome was seen 

with regularity in some camps. Dr. Gottlieb noted malnutrition liver diseases. 
American Ex-Prisoners of War 52

Beriberi 

In all likelihood, beriberi was the most devastating of all the vitamin deficiency states, as it not 

only had immediate side-effects but also severe chronic sequelae. 

Beriberi is the Singhalese word for weakness. It is caused by a deficiency of the water-soluble 

Vitamin B-1, thiamine, in the diet. The body is able to store only a total of 30mg of this vitamin. 

With food ingestion, one can only absorb five milligrams of Vitamin B-1 in any one day. 

Therefore, one can manifest total body thiamine deficiency within only a few days on a deficient 

diet. Virtually all POW’s were at least somewhat thiamine deficient. Thiamine is necessary in 

the diet at roughly 0.33mg per 1,000 calories consumed. Normal individuals consume 0.50mg 

per 1,000 total calories per day, while POW’s consumed many less mg per 1,000 calories per 

day. In addition, the higher the carbohydrate load ingested, the more thiamine is required. 

Also, polished rice adds a nutritionally empty carbohydrate load, which further depletes 

thiamine stores. 

The best sources of thiamine are pork, organ meats (primarily liver, heart and kidney), leafy 

green vegetables, nuts and legumes. These foods were not common in any of the POW diets 

that have been described. Therefore, many POW’s were, in essence, living in areas of endemic beriberi. 

Since thiamine is stored throughout the entire body, one would expect its depletion to present 

as a multi-system disease, but in fact the cardiovascular system and the nervous system are the 

predominant ones affected in beriberi. The presenting clinical manifestations often overlap but, 

for purposes of description, are termed cardiac beriberi, dry beriberi (affecting the peripheral 

nerves only), wet beriberi (affecting the peripheral nerves and the heart) and central nervous 

system beriberi. 

A brief review of biochemistry is essential before proceeding. Dietary thiamine enters the 

body and is phosphorylated into its active coenzyme form, thiamine pyrophosphate, by the 

addition of two adenosine triphosphates. If phosphorus is also lacking, the body will not be 

able to form the adenosine triphosphate necessary to make thiamine pyrophosphate (T.P.P.). 

Thiamine pyrophosphate is an important coenzyme to release energy from carbohydrates and 

form adenosine triphosphate. In addition, thiamine pyrophosphate itself is necessary in two 

other steps to form ATP. Pyruvic acid, which is in equilibrium with lactic acid, enters the 

Krebs cycle. If thiamine pyrophosphate is not present, pyruvic acid and lactic acid levels 

build up in the body. This is extremely important in the pathogenesis of beriberi, as pyruvic 

acid 

is a neurotoxin. When it is withheld from the diet of experimental animals, the ability of the 

different tissues to utilize pyruvate does not decline uniformly. This indicates that in some 

tissues, the bound thiamine pyrophosphate is tenaciously retained, whereas in others, it is more 
American Ex-Prisoners of War 53

readily lost through metabolic degradation or excretion. 

Dr. Ralph Hibbs made perhaps some of the most detailed observations about patients affected 

with beriberi in Cabanatuan Prison Camp. Hibbs made notes on the effect of the deficiency 

disease on the nervous system, eyes, skin and heart. He noted that most POW’s in his camp 

were affected either by dry or wet beriberi. It is unknown why some individuals develop dry 

beriberi, while others develop wet beriberi. Inactivity and a relatively low-carbohydrate diet 

possibly enhance the development of dry beriberi, which is characteristically associated with 

aphonia or hypophonia, foot and wrist drop and extremely weak muscles. Symptoms were 

frequently noted after a malarial chill, diarrhea, vomiting or heavy work. Dependent edema 

rarely responded to supplemental thiamine therapy. The first symptoms of peripheral neuritis 

were stiffness, heaviness or a tired feeling in the arches of the feet. If left untreated, these 

symptoms proceeded to a shooting, burning type of pain. 

On the other hand, individuals with wet beriberi are in general a bit more active and ingest 

higher amounts of carbohydrates in their diet. It is this high carbohydrate diet which accelerates 

the use of thiamine and its depletion. Painful edema, some cyanosis and dyspnea characterize 

wet beriberi. Also seen with wet beriberi is an increased cardiac silhouette. Both wet and dry 

beriberi can progress to central nervous system beriberi. 

Dr. Hibbs noted a tremendous amount of visual pathology associated with beriberi; most 

patients developed retinal degeneration with contraction of the visual fields, an enlarged blind 

spot and central scotomata. Hibbs termed this syndrome beriberi amblyopia. With time, 

there was a progressive visual disability, a temporal pallor with macular degeneration and 

associated poor pupillary reflexes. Hibbs noticed that beriberi amblyopia did not respond well 

to replacement therapy with thiamine. Additionally, he noticed that among the patients with 

peripheral neuritis, 50% had visual complaints. Of these, 10% had an associated severe 

diminution in vision. It would stand to reason that if visual cranial nerves were affected in 

beriberi amblyopia, the auditory system would be affected also; however, Dr. Hibbs noted no 

impairment or demonstrable loss of auditory acuity. 

Skin changes associated with beriberi were common. Frequently seen were beriberi spots 

which were lesions similar to erythema nodosum. Also characteristic in beriberi skin 

changes were an erythema in the palms of the hands and soles of the feet associated with 

excessive sweating and pronounced dermatographia. 

In July 1942, Hibbs wrote that the highest incidence of acute beriberi heart disease occurred 

at 3 months. This, no doubt, reflected the poor diet, which consisted primarily of polished rice 

and was practically devoid of thiamine. Acute cardiac beriberi presented a major problem in 

the camps. In 95% of the individuals, it took a mild form, characterized by dyspnea and non­
American Ex-Prisoners of War 54

fatal cardiac arrhythmias. On physical examination, the heart was usually hyperactive with 

heart rates between 130 and 140. An irregular rhythm was usually present, but due to the lack 

of monitoring devices, the assumption was atrial irregularities. Additionally, the patient was 

usually hypotensive with BPs in the 80/40 to 100/60 range. There was no evidence of cardiac 

decompensation or heart failure. For those who died, an autopsy revealed a heart of normal 

size and anatomy. 

The moderate form was somewhat more aggressive. Affected individuals were extremely 

short of breath. Physical examination revealed hepatomegaly, edema, cyanosis and ventricular 

failure, rales in the lungs and tachycardia. Most of these individuals died within the year. 

Autopsy revealed an enlarged heart. 

Finally, shoshin, or acutely pernicious cardiac beriberi, is an acute right and left ventricular 

failure, with death occurring in minutes to days. Either unaccustomed high caloric intake or 

sudden work may precipitate this, as both quickly consume thiamine stores. 

Pathologic examination of the heart of an individual who has died of beriberi reveals edematous 

myocardial cells, loss of intracellular protoplasm, a decreased number of fibrils intracellularly 

and virtually no other pathological findings. 

Acute beriberi heart disease is characterized by high output cardiac failure with the virtual 

sine qua non of associated lactic acidosis, again involving the equilibrium of lactic acid with 

pyruvic acid. For some unknown reason, the sympathetic ganglion cells develop lesions in 

the nuclear regions, possibly predisposing the individual to peripheral vasodilatation, which 

is the first of three major pathophysiologic steps in the development of beriberi heart failure. 

Peripheral vasodilatation results in a high-output state associated with increased antidiuretic 

hormone secretion. This results in a ruddy skin discoloration, primarily involving the feet and 

hands. The kidney interprets the peripheral vasodilatation as decreased total intravascular 

blood volume and increases aldosterone production. Hemodynamically, these individuals 

present with very low systemic vascular resistance. Cardiac output can be 5 to 10 times normal 

and stroke index may be enormous. Total blood volume and heart rate are increased. If left 

untreated, moderate bi-ventricular heart failure develops. Finally, massive retention of sodium 

and water occurs, with painful dependent edema. Face and arm edema are characteristic 

after remaining supine overnight. The combination of high-output congestive heart failure, 

decreased systemic vascular resistance, increased cardiac index and heart rate and lactic acidosis 

often is present in acute beriberi heart disease. Physical examination often reveals low systolic and diastolic pressures, elevated jugular venous pressure and dependent edema. The 

heart rate is usually rapid; S3 and S4 gallops are common. The EKG may reveal sinus tachycardia, S-T segment changes or low QRS and T-wave amplitudes. 
American Ex-Prisoners of War 55

There is no agreement as to the long-term effects of thiamine deficiency on the heart. Several 

large retrospective studies have demonstrated no association, while a few small studies have 

suggested an association between thiamine deficiency and ischemic heart disease (IHD). Also 

seen is an increase in antidiuretic hormone production. Hemodynamically, these individuals 

present with a very low systemic vascular resistance. Their cardiac output can be 5 to 10 

times normal and their stroke index may be enormous. Total blood volume, as well as heart 

rate, 

is increased. 

Ischemic Cardiomyopathy 

Ischemic cardiomyopathy is among the newer presumptive service-connected disabilities. 

For service-connection, ischemic heart disease may be established by such findings as the 

presence of characteristic EKG changes, a documented history of myocardial infarction, etc. 

The evaluation level for disability compensation currently is based mainly on the level of 

exertion that produces angina, the type of employment that is feasible and whether there has 

been a myocardial infarction. 

The four oldest Medical Follow Up Agency (MFUA) studies were all American, and were 

retrospective as well as prospective. Of these studies, Cohen first demonstrated a higher 

number of deaths than expected among ex-POW’s. 

In contrast, the foreign cardiovascular studies were all retrospective. Richardson found a 

higher number of cardiovascular deaths than expected among ex-POW’s. 

Page analyzed the self-reported questionnaires as part of the POW protocol analysis of the 

most recent NAS/NRC study. His report dealt only with the survivors; only 50% of all invited ex-POW’s chose to participate and only 20% of controls participated. He noted through his 

analysis that the prevalence of ischemic heart disease was 1.7 times higher among ex-POW’s 

who reported edema in prison camp than in ex-POW’s who did not report it. Until recently, 

the VA allowed presumptive service-connection for heart disease in former POW’s on the 

basis of a history of beriberi only when beriberi heart disease was specifically diagnosed. As 

of August 1993, “beriberi heart disease” includes ischemic heart disease when there was a 

localized edema during captivity. 

Beriberi Neuropathy 

The hallmark of the neurologic pathology of beriberi is axonal and myelin sheath destruction. 

Thiamine is essential for the formation of acetylcholine. Acetylcholine is formed in the spinal 

cord and transported down the axon. It is an essential nutrient and neurotransmitter and is 
American Ex-Prisoners of War 56

vital for the maintenance of both the axon and myelin sheath. Thiamine deficiency leads to 

decreased acetylcholine levels and, as already discussed, increased pyruvic acid levels. It is 

believed that this combination of decreased levels of acetylcholine and increased levels of 

pyruvic acid is responsible for the characteristic destruction of the nerves seen in beriberi, and 

results in weakness, pain and central nervous system manifestations. 

The neuromuscular symptoms of thiamine deficiency are the first to be manifest. In virtually 

all individuals, weakness is the initial presentation. Characteristic is a difficulty rising from a 

sitting to a standing position, which is what the term beriberi means in Singhalese. In 25% 

of the individuals, however, the first symptoms are paresthesia and pain. These are initially 

worse distally but will proceed proximally if left untreated. The legs always are affected earlier 

and more severely than the arms. These symptoms are insidious and relentlessly progressive 

unless adequately treated. In POW camps, the most important differential test performed by 

the camp physicians was the ability of the patient to perform the squatting test. In this test, the 

patient was asked to place his arms over his shoulders and his hands on the back of his head. 

He was then asked to do a deep knee bend and attempt to raise his body into an upright position. 

If he could not perform this test, he most likely had early beriberi. 

A recent study of thiamine deficiency revealed the immense peripheral neurologic variability 

of this disease. Of 189 patients presenting with leg symptomatology, 45 revealed loss of 

reflexes alone, 10 revealed loss of sensation alone, 2 had weakness and sensory loss, 40 

revealed reflex and sensory loss and 66 revealed sensory, motor and reflex loss. This incredible 

heterogeneity in the presentation of the neuromuscular involvement of this disease is truly 

unique. In the same individuals, only 57 had arm involvement. Of these, 6 had loss of reflexes 

alone, 10 revealed loss of sensation alone, 5 weakness alone, 10 weakness and sensory loss, 

2 reflex and sensory loss, and 17 sensory, motor and reflex loss. 

Destruction of the myelin sheath is a non-inflammatory and segmental process. As the 

segmental destruction proceeds proximally, the axons begin to die. Normal impulses are 

carried in a rhythmic fashion back to the brain. With the loss of the myelin sheath and the 

axon, impulses are erratically generated, propagated up the spinothalamic tract, erroneously 

registered in the thalamus and interpreted by the brain as pain, even though noxious stimuli are 

not actually present. The end result is initially dorsal foot pain. The S1 dermatone innervates 

the sole and lateral aspect of the feet, and therefore, it is the first affected. Followed closely 

thereafter is the L5 dermatone, which innervates the medial aspect of the dorsum of the foot. 

The pains are on a continuum from a dull, constant ache in the feet or the legs, as seen in most 

individuals, to sharp, severe, piercing fleeting pains. A cramping, tight sensation in the feet or 

the calves is virtually characteristic of this disease, as is tightness and tenderness of the calves 

upon palpation. 
American Ex-Prisoners of War 57

Lewis made several clinical observations regarding thiamine deficiency, noting the development 

of a hyperesthesia and hypersensitivity of the feet, primarily on the dorsum and soles, with most 

prominent painful sensations presenting from June to August 1942. Wet beriberi appeared 

most frequently by September 1942, according to his observations. 

Nardini noted that 90% of American POW’s in his section of Cabanatuan had some type 

of Beriberi. The best type to have had was a numbness and hyperesthesia of the feet and 

anterior aspect of the legs. The worst type involved painful burning feet accompanied by the 

Cabanatuan Shuffle, or gait, in which the affected POW’s would walk on the lateral aspects 

of their feet and fling their arms upward in an attempt to relieve the pressure resulting from 

walking. 

The motor system reveals symmetrical pathologic involvement that is definitely worse distally. 

Absolute paralysis is rare. Hibbs noted that only two percent of the individuals affected with 

beriberi in his camp manifested paralysis which, when present, only involved the limb musculature. Thoracic muscles, due to the short length of their nervous innervation, are virtually 

never involved. 

In this setting of peripheral neurologic damage and painful polyneuropathy, nerve conduction 

studies and electromyography reveal a demyelinating process early in the course of the disease. 

Either a decrease in nerve conduction velocity, or more commonly, a decrease in amplitude of 

the motor and sensory-evoked responses, suggesting a demyelinating process and axonal loss 

characterizes this process. Electromyography findings reveal mild to moderate slowing of the 

motor and sensory conduction and marked reduction in the amplitude of the sensory axon 

potentials. In addition, the conduction velocity is usually reduced in the distal dermatomes, 

but is normal proximally. 

In a recent study conducted at the Livermore VAMC, 32 former POW’s of the Japanese with a 

history of beriberi neuritis were evaluated. Upon entry into the study, seven individuals had 

no neurologic complaints, while 25 individuals were symptomatic. Among the seven 

ex-POW’s with no symptoms, three had both abnormal EMGs and abnormal nerve conduction 

studies, and one had abnormal nerve conduction studies only; hence four out of the seven 

asymptomatic individuals had abnormal electrodiagnostic studies while only three were normal. Among those with symptomatic peripheral neuropathy, 14 had abnormal EMGs and 

abnormal nerve conduction studies, 10 had abnormal EMGs and only 1 was normal. In summary, in this study, 28 out of the 32 individuals with a history of beriberi neuritis had abnormal 

electrodiagnostic studies. 

Recently, a large non-controlled study was conducted in England of nutritional neuropathy 
American Ex-Prisoners of War 58

symptoms among 898 Far East POW survivors examined 23 to 36 years after captivity. This 

was not a controlled study, but rather, the individuals examined were all willing participants. 

Among individuals with definite neurologic symptoms, 24 had evidence of peripheral neuropathy, 

19 had evidence of optic atrophy, 13 had evidence of sensorineural deafness and 2 had evidence 

of myelopathy. This total of 58 abnormalities among the 49 symptomatic Far East POW’s 

represented a prevalence of 5.5% in the 898 individuals studied. 

In the same study of possible neurologic diseases, 21 had impaired deep tendon reflexes, 13 

had impaired sensation, five had optic atrophy, one had fasciculations, one had muscle wasting 

and one had spastic monoparesis. This total of 42 abnormalities among the 38 Far East POW’s 

represented a prevalence of 4.2%. 

There are several avenues to which this disease may turn: dry beriberi, with its weakness and 

aphonia; wet beriberi, with its dyspnea and cardiac irregularities; and CNS beriberi with its 

cranial nerve abnormalities and dementia. 

Concerning the effects of thiamine deficiency on the CNS, alcoholics are at increased risk for 

Wernicke’s encephalopathy. Initially, mild disorientation, drowsiness and inattentive responsiveness characterize this thiamine deficiency dementia. Later, the full-blown triad of cerebellar 

ataxia, oculomotor disturbances and mental confusion develops. The most common ocular 

abnormalities are horizontal and vertical nystagmus and bilateral cranial nerve III, IV, VI and 

X involvement producing abducens and conjugate palsies. If not diagnosed and treated quickly, 

Wernicke’s encephalopathy is potentially fatal, with an estimated acute mortality rate of 17 

percent. Stupor and coma are common in patients presenting to emergency departments. 

Confabulation with retrograde and antegrade amnesia are frequent symptoms. In more than 

50 percent of cases, recovery is incomplete despite thiamine replenishment. In the noninstitutionalized elderly with vitamin deficiency, oral thiamine has been demonstrated to 

improve cognitive function. 

Ariboflavinosis 

In order to prevent riboflavin deficiency, the body needs between 1.2 and 1.6 mg of riboflavin 

per day. 

Primarily seen in this disease is a sometimes sore, non-painful tongue. The tongue takes on a 

magenta hue and becomes edematous and inflamed, making it difficult to eat and swallow. 

Also characteristic of this disease is stomatitis, an inflammation of the lining of the mouth, and 

cheilitis, an inflammation of the lips. The cheilitis may be unilateral, but is usually bilateral. 

This inflammation at the corners of the mouth is very painful and the affected individual has 
American Ex-Prisoners of War 59

a difficult time fully opening his mouth. Secondary bacterial infection is common. The 

inevitable result of cheilitis is scarring and strictures at the corners of the mouth, which cause 

a decrease in the buccal aperture, termed microstomia. The normal buccal aperture in a man is 

5.8 cm + - 0.4 cm. Anything less than this, with evidence of scarring, may represent a history 

of ariboflavinosis. 

In addition, the facial skin may take on a roughened or shark-like appearance, termed 

icthyosis. The patient may have a sore throat with hyperemia and edema of the pharyngeal 

and mucous membranes. The cornea also is a target of the epithelial changes. The capillaries 

proliferate, exudates form and ulcerations of the cornea are common late in the course of an 

untreated case. 

Finally, a pure red cell aplasia develops in many patients and is manifested by a normocytic 

normochromic anemia. Cognitive dysfunction has been correlated with low levels of Vitamin 

B-2. 

Pellagra 

Pellagra is a disease recognized in ancient writings in the Middle East caused by a deficiency 

of the water-soluble Vitamin B-3, niacin, in the diet. Deficiency of niacin or nicotinic acid 

in the diet produces pellagra, Italian for pelle, meaning skin, and agro, meaning rough. The 

disease was first seen in Europe after the importation of maize from the New World when corn 

became the primary caloric source. It was common in the American South due to a diet heavy 

in the three M’s: meat, meal and molasses. Dr. Goldberger of the U.S. Department of Public 

Health was the first to recognize it as a deficiency rather than infectious disease based upon 

his study of orphanages in rural Mississippi. 

Excellent sources of niacin are yeast, beef, pork, fruit, most vegetables and grain cereals. 

Niacin is needed in the amount of 12 to 18 mg per day. Human intestinal bacterial flora can 

convert tryptophan into niacin in the presence of Vitamin B-6 (pyridoxine), if B-6 is present. 

The disease of pellagra was unknown in Europe until corn was imported from the Americas. 

Once it was recognized, it was felt for centuries to be an infectious disease. Refined and 

milled maize contains less tryptophan and nicotinic acid than whole meal maize flour obtained 

from pounding the maize into flour. Although maize contains more nicotinic acid than oats, 

rye and some wheats, most is in a bound form unusable to the patient. Furthermore, zein, the 

protein of maize, is deficient in tryptophan. Corn also is high in leucine, which further antagonizes the body’s ability to absorb niacin. 

The disease also is seen in patients with carcinoid syndrome, as the tryptophan is used by 

the carcinoid cells and converted to serotonin. Secondary pellagra is occasionally seen in 
American Ex-Prisoners of War 60

patients on poor diets who are given isoniazide and not supplemented with pyridoxine. 

Herein isoniazide antagonizes pyridoxine necessary for the conversion of tryptophan to nicotinamide. Finally, pellagra is seen in poorly fed dialysis patients on no B vitamin supplements 

In addition to the numerous cases of pellagra among ex-POW’s of the Japanese, pellagra also 

was especially prevalent in the POW’s in Korea, where the diet was primarily corn, millet or 

sorghum, all of which are practically devoid of usable niacin. 

For simplicity’s sake, pellagra is known as the disease of the three D’s — diarrhea, dermatitis 

and dementia. Often the fourth D, death, was a complication. Both riboflavin and niacin are 

needed by the body for the electron transport chain in respiration and in the generation of 

water and carbon dioxide. As opposed to many other of the vitamin deficiencies, pellagra 

does not seem to cause anemia. 

The diarrhea results from pathologic changes involving primarily the esophagus, stomach and 

colon. The changes here are very similar to those found in the skin, namely erosive, weeping 

lesions in affected areas. These ulcerations further decrease the absorbtive surface area for 

what little nutrients are in the diet. 

The dermatitis is symmetrical with sharply demarcated borders, and worse on the sun-exposed 

or trauma-exposed areas of the body. Initially the dermis becomes erythematous, hyperemic and 

thickened. Later, there is a desquamation of the epidermis, with denuding of the superficial 

layers and ulcer formation underneath. The chronic effects of this are strictures, chronic 

infection and hyperpigmentation in the affected areas of the body. 

The tongue also is involved in pellagra. It may appear deeply fissured and scarlet and raw 

and very painful. 

The skin is involved in niacin deficiency, with the characteristic sharply demarcated margins 

of prior sun exposure assisting in the diagnosis. Initially, the skin is erythematous and has a 

thickened, scaly appearance. Later, chronic inflammation and edema result in desquamation 

or ulceration yielding hypopigmentation. Finally, the skin thickens as a result of subcutaneous 

fibrous deposition and becomes hyperpigmented. The changes in the anterior neck look as if 

the patient has a necklace, termed Casal’s necklace, named after the Spanish physician who 

first described it. The chronic dermatitis in the hands is known as pellagrous glove. 

The central nervous system effects are consistent with a central neuritis, primarily affecting 

large cells of the motor cortex. Also seen is a symmetrical degeneration of the dorsal column, 

with effects very similar to B-12 deficiency, namely loss of position and vibratory sense. 

In addition, cortico-spinal tract and spinothalamic tract involvement occurs as would be 
American Ex-Prisoners of War 61

seen in beriberi, producing sensations of numbness and dysesthesias. In fact, the neurologic 

manifestations of this disease are quite indistinguishable from beriberi. Some authors state that 

the peripheral neurological sequelae of pellagra are present in about 75% of the individuals 

involved. Early on, the central nervous system manifestations affecting the brain consist 

of psychoneurosis, insomnia, irritability, anxiety and depression, which are all reversible if 

adequately treated. Later, the Betz cells are affected, with central nervous system neuritis, 

producing a psychosis that is irreversible despite supplementation with massive doses of niacin. 

Nicotinic acid deficiency encephalopathy presents with an impaired consciousness progressing 

to coma, extra-pyramidal rigidity, tremors and uncontrollable grasping and sucking reflexes, 

representing frontal release signs. 

The treatment is niacin replacement. The skin is generally quite responsive; the strictured and 

hyperpigmented areas from long-standing niacin deficiency do not respond to therapy, but the 

early lesions do. The gastrointestinal tract at least superficially completely regenerates, often 

leaving scars. The glossitis dissipates and finally disappears. The sensory system, at least 

partially, recovers peripherally and the patient regains much sensation. However, there often 

are residual peripheral sensory defects. In general, the dementia is unresponsive to therapy 

and the affected individual usually succumbs to starvation and disease. In many POW 

camps, no work meant fewer rations, just the opposite of what was needed for recovery. In 

the Philippines, the American physicians would grow cultures of yeast from the air and give 

affected patients a spoonful daily with excellent results. Since only a small amount was 

available on a daily basis, only the most severely affected patients were treated. 

Folate Deficiency 

Deficiency of folic acid, Vitamin B-9, is common among all malnourished people. The vitamin 

is present in ample quantities in leafy green vegetables, nuts, legumes and fruits. Human 

intestinal flora also synthesize a tremendous amount. Unfortunately, folate is very heat labile 

and cooking food will destroy the ability of the vitamin to work. It is necessary for the synthesis 

of purines, and its absence hinders DNA production and maturation, hence the RBCs produced 

by the bone marrow are immature, large and easily burst when introduced into the peripheral 

circulation. Folate deficiency causes no long-term sequelae. 

Scurvy 

Scurvy is a deficiency of ascorbic acid, Vitamin C, which is a water-soluble and heat-sensitive 

vitamin. Scurvy was seen regularly in the concentration camps of Europe and in some POW 

camps, primarily in the Pacific. The need for this vitamin in daily life is becoming increasingly 

obvious. This vitamin is essential for the formation of collagen, ground substance, osteoid, 
American Ex-Prisoners of War 62

dentine and intercellular cement substance. Cooking food to any degree destroys the usefulness 

of this vitamin. Humans lack the ability to produce the vitamin and therefore, are wholly 

dependent on fruits, vegetables, fish and dairy products. Deficiency occurs mainly in the 

elderly on poor diets, breast-fed infants ages 6 to 12 months, the malnourished, the critically 

ill and alcoholics. 

Vitamin C is rapidly absorbed in the intestines and therefore deficiency usually represents 

malnutrition rather than intestinal pathology. Because the vitamin is ubiquitous in most fruits 

and the body retains a large supply, clinical deficiency suggests a long period of deprivation. 

Vitamin C is susceptible to heat, cooking in water and extended exposure to room temperature. 

The major signs of deficiency are nosebleeds, melena, hemarthrosis, subperiosteal hemorrhages, 

loose teeth, bleeding gums and ecchymoses. Eighty percent of patients with scurvy are anemic. Blood loss is thought to occur primarily through lesions in the gastrointestinal tract. The 

anemia is in addition to blood loss alone; hematologic studies reveal variable presentations in 

both the peripheral smear and the bone marrow. 

Lipid Soluble Vitamins 

Vitamins A, E, D and K are lipid-soluble. Their transportation across the intestinal mucosa is 

extremely decreased in steatorrhea, a common occurrence in gastrointestinal infections. 

Vitamin A Deficiency 

Vitamin A deficiency is the most common nutritional cause of blindness in the world. Vitamin 

A is needed in relatively small doses in the diet, around 5,000 IU per day in the average adult. 

Vitamin A is tenaciously stored in the liver and a deficiency in the primary state takes months 

of no vegetables and no dairy products to become manifest. It is seen more frequently as a 

secondary condition due to malabsorption 

The first alteration in vision is a decrease in dim light acuity. This is associated with dryness 

and ulcerations of the cornea. Skin changes resembling goose bumps also appear; these will 

not disappear when rubbed. 

After dim light acuity is altered, later changes in the conjunctival mucosa are seen, referred 

to as Bitot’s spots. These are keratin debris deposited on the limbal conjunctiva. As these 

aggregate, total blindness ensues. 
American Ex-Prisoners of War 63

Most individuals with Vitamin A deficiency develop a hypochromic, microcytic anemia. 

Plasma levels of Vitamin A correlate with hemoglobin concentration. In general, the lower 

the level of Vitamin A in the serum, the lower the hemoglobin level. In developing countries, 

Vitamin A deficiency is thought to be as common a cause of anemia as iron deficiency. 

In addition, the cells in the body’s linings and coverings undergo a squamous metaplasia. The 

result is xerophthalmia of the conjunctiva, keratomalacia of the cornea, follicular hyperkeratosis 

in the skin, loss of cilia in the bronchial tree later predisposing to infections, ureteral colic and 

possibly development of calculi in the urinary tract. Bitot’s spots affect the limbal conjunctiva. 

Overlap Syndromes 

Gottlieb’s observations of malnutrition-related liver disease in Cabanatuan were as follows: 

this entity initially begins as a fatty liver and later predisposes individuals to infectious hepatitis. 

Cirrhosis also commonly developed in men with no prior alcohol history. Affected individuals 

often developed gynecomasta, as well as loss of the characteristic male hair pattern. 

Jacobs described the oculo-oro-genital syndrome in his POW camp in Cabanatuan. This 

constellation of symptoms, affecting 75% of his 8,000 fellow internees, consisted of amblyopia 

accompanied with a scrotal dermatitis manifested by erythema and pruritis, and later an exfoliative dermatitis with ulcerations and painful glossitis,. He felt that this syndrome was likely 

due to a combination of deficiencies of Vitamin A and Vitamin B-3. 

Jacobs also described the castration syndrome, a set of conditions afflicting some men with 

the oculo-oro-genital syndrome and consisting of loss of libido, total loss of body hair and 

loose, dry skin. 

Strachan’s Syndrome was seen with some regularity in POW’s of the PTO. The primary 

symptoms are amblyopia, painful neuropathy, vertigo and orogenital dermatitis. 

The spinal spastic syndrome was seen in many camps, with symptoms of mental and emotional changes, dimness of vision, and later widespread muscular rigidity, delirium, coma and 

death. In all likelihood, it is a combination of deficiencies of Vitamins A, B-1 and B-3. 

Other identifying features germane to the spinal spastic syndrome include weak legs, clonus, 

extensor-plantar responses, absent abdominal reflexes, increased deep tendon reflexes, and 

loss of position and vibratory sense. Muscle pain, myocardiopathy and hemolytic anemia due 

to selenium deficiency are very common in Asiatic theaters. 
American Ex-Prisoners of War 64
American Ex-Prisoners of War 65

Gastrointestinal Diseases 

Gastrointestinal diseases were extremely common in all of the POW camps. This was primarily 

due to the lack of hot running water and unsanitary conditions, such as open pit latrines and 

contaminated drinking water. 

Irritable Bowel Syndrome 

Irritable bowel syndrome is a complex mixture of organic disease with psychological overlay 

affecting one in five Americans. It is defined as a variable collection of chronic (greater than 

three months) and recurrent symptoms not explained by structural or biochemical abnormalities. 

The disorder may affect anywhere in the GI tract, from the mouth to the anus. However, it 

primarily affects the large and small intestines. 

Irritable bowel syndrome is a diagnosis of exclusion. Affected patients often present with 

lower abdominal pains, disturbed defecation, alternating diarrhea and constipation and bloating. 

In the U.S. general population, 15% of people are affected. There is no universal agreement as 

to the exact pathophysiology, however altered intestinal motility is common. Stress seems to 

promote an exaggerated response in susceptible individuals. Also, visceral hyperalgesia a 

feeling of discomfort in the colonic areas with painful provoking stimuli, is more pronounced 

in these individuals. Also, there seems to be less cortical control over painful stimuli traveling 

up the midbrain nocioceptive fiber tracts. Among patients tested with the Minnesota Multiphasic 

Personality Inventory (MMPI), 35% show hypochondrical tendencies, 25% reveal depressive 

tendencies and 25% reveal hysterical tendencies. 

Three different types appear to be present. The first, known as spastic colitis, has increased gas, 

constipation and abdominal pain as the primary symptoms. The second consists of chronic 

intermittent diarrhea possibly related to the ingestion of foods or increased psychological 

stress. The third is a mixture of the two, with alternating symptoms of constipation and diarrhea. 

Peptic Ulcer Disease 

Peptic ulcer disease is defined as any ulceration along the esophagus, stomach or duodenum 

caused by the actions of both hydrochloric acid, secreted by the stomach, and the enzyme 

pepsin. This was very common in many of the POW camps and had a very high incidence in 

the post-repatriation period, as well. 

According to data assembled by Nefzger regarding peptic ulcer disease, the hospital admission 

rate per 1,000 was 1.6 for PWJ versus 0.4 for WJ, 1.7 for PWE versus 0.0 for WE. For those 

service-connected for peptic ulcer disease, the figure is 4.2 for PWJ vs. 0.6 for WJ, 1.5 for 

PWE vs. 1.0 for WE and 4.0 for PWK vs. 0.7 for WK. Retrospective Canadian studies verified 
American Ex-Prisoners of War 66

the American findings. They analyzed all hospital admissions between 1946 and 1964 involving 

100 Far East POW’s and found 4 had had gastric ulcers and 13 had duodenal ulcers. This was 

twice the Canadian rate for age-matched populations. Australian studies also revealed higher 

prevalence rates. 

In general, this disease may be considered an infectious etiology with the causative agent, 

helicobacter pylori, identified in the drinking water of these men. Anyone with a symptomatic 

infection has the characteristic endoscopic finding of the surface epithelial layer of the stomach 

becoming irregular with a cobblestone-like appearance. Usually seen is an active chronic 

gastritis, primarily involving the antrum, but also the fundus of the stomach. Seventy to 80% 

of people with gastric ulcer are Hp+, whereas 90% to 100% with duodenal ulcer are Hp+. A 

typical ulcer has a crater with a necrotic covering over the crater. If not treated, some ulcers 

may continue burrowing through the muscularis and erode into an artery, at which time the 

individual can exsanguinate. 

Helicobacter pylori, a micro-aerophilic aerobe, is spread by the fecal-oral route, with the major 

risk factors for spreading being a lack of soap, a lack of hot water and crowding and sharing 

of beds. Even under the same conditions, Blacks and Hispanics are more susceptible than 

Caucasians to have symptoms from infection with the bacteria. Therefore, any infected 

Caucasian should raise the suspicion of acquisition of the bacterium in the POW camp under 

unsanitary conditions with poor nutrition. Essentially, the bacteria enter the normally sterile 

stomach and by using phospholipases, bury themselves under the protective mucus coat. 

There, they secrete urease, which degrades urea into ammonia and water. The ammonia 

combines with stomach acid and neutralizes it, thus allowing the bacterium to exist in an acid 

free environment within the stomach. Catalase is secreted, which protects the bacterium 

against oxygen metabolites produced from the granulocytes. The bacteria also secrete proteases, 

which dissolve the stomach’s own proteins and provoke an inflammatory response in the host. 

This causes the host to increase gastrin production, resulting in an increase of hydrochloric 

acid production in the stomach. In addition, the ammonia neutralizes much of the stomach’s 

acidity, diluting the normal acid feedback mechanism. As a result, a tremendous amount of 

acid is produced in the stomach. This acid falls into the usually neutral duodenum, producing 

duodenitis and finally, a duodenal ulcer. 

Almost 100% of all duodenal ulcers have been found to be infected with this bacteria and 

80% of patients with gastric ulcers have the bacteria. Only 25% of individuals infected with 

H. Pylori develop symptoms and even fewer develop a duodenal ulcer. Many other host 

variables therefore are involved. Infection with this organism also has been associated with 

gastric cancer and the mucosa associated lymphoid tissue (MALT) lymphoma. 
American Ex-Prisoners of War 67

Hepatitis 

Hepatitis infections were very common in all POW camps. Unsanitary conditions, poorly 

cooked food and contaminated water spread Hepatitis A. The hepatitis can be quite severe, not 

usually life-threatening in a properly nourished individual, but definitely life-threatening in a 

poorly nourished individual. No chronic carrier state has ever been demonstrated. 

Hepatitis B is seen primarily with parenteral and sexual modes of transmission, however, rare 

documented cases have been seen in individuals through the oral route. Chronic carrier states 

are seen in this particular infection. Non-A/Non-B Hepatitis, which includes Hepatitis C, also 

can have a severe acute phase and can eventuate in a chronic carrier state. 

Helminthiasis 

Helminthiasis is an intestinal infection caused by parasitic worms. The Morgan Board 

examination studies found that 60 to 70% of the returning POW’s from the Philippines 

harbored intestinal parasites, usually ascaris and hookworm. 

Strongyloides 

This intestinal nematode has a very complicated life cycle. Briefly, the larval forms penetrate 

the skin, primarily in the feet. In penetrating the skin, they cause a local inflammatory reaction. 

From the penetration site, they move into the lymphatic system and migrate to the lungs, 

where they begin to mature. This, in most cases, causes an eosinophilia. 

Once in the lungs, strongyloides migrate through the alveoli and mature further. They then 

migrate up the main-stem bronchi and are swallowed. They withstand degradation by stomach 

acid, mature in the duodenum and burrow into the wall. Here the female is inseminated by the 

male and produces her fertilized eggs. 

In studies of Far East-POW’s of the British, upon wet-prep examination of duodenal aspirates, 

viable parasites were found in up to 27% of studied individuals up to 40 years after repatriation. 

The parasite can auto-reinfect the host and possibly remain viable forever. In addition, an area 

of chronic inflammation is always present, with unknown long-term sequelae. 
American Ex-Prisoners of War 68

Ascaris Lumbricoides 

Ascaris lumbricoides, also is known as the giant round worm. The fertilized eggs are spread 

by fecal contamination of the soil. The eggs enter through the mouth, mature in the intestine, 

migrate through the intestinal wall, enter the lymphatic system and develop in the lungs. 

Similar to the life cycle of other worms, the mature forms migrate up the trachea, are swallowed again back into the esophagus, enter the small intestine and attach to the walls of the 

small and large intestines. When mature, these worms are usually 12 to 15 inches long. 

Heavy infestations of one’s colon by these parasites may cause a severe malabsorption syndrome, 

limiting use of available foodstuffs or even worse, an intestinal obstruction, a common way to 

die in POW camp. 

Ancyclostomiasis 

The buccal capsule of ancyclostomiasis, also known as hookworm, has an aggressive appearance 

and hence the name of this parasite. A heavy infestation of ones colon can be associated with 

blood loss of up to 100cc a day. These parasites derive both their oxygen and glucose supply 

from the host’s blood. Their life cycle is similar to that of strongyloides in that they penetrate 

unprotected feet and migrate in the lymphatics to the lungs, where they traverse through the 

alveolar sacs. Here, they mature and migrate up the trachea, are swallowed and become attached 

to the wall of the duodenum. Heavy infestations with this parasite decrease the absorptive 

surface area of the duodenum. These worms eventually succumb to host defenses that eliminate them, and they are not able to propagate a chronic carrier state like Strongyloides. 

Salmonella Typhi 

The bacteria Salmonella typhi was one of the most common of all intestinal infections. 

The bacteria Salmonella typhi produce the disease known as typhoid fever, which is spread by 

the fecal-oral route, primarily due to contaminated water. This disorder usually produces a 

self-limited illness, however, in individuals who are malnourished, any presentation is possible. 

The host’s defenses attempt to ingest these bacteria in the phagocytes. Unfortunately for the 

host, these bacteria are able to withstand bactericidal degradation, and intracellular multiplication 

takes place. It is the involvement of the Peyer’s patches in the intestinal wall that causes the 

general destructive nature of this disease. In addition to the intestinal involvement of the 

immune system, these bacteria also secrete an endotoxin, causing secretory diarrhea. Most 

patients experience a profuse watery diarrhea. In some extremely malnourished individuals, 

systemic dissemination of the typhoid bacilli may localize in any tissue of the body, with the 

production of a localized suppurative infection. 
American Ex-Prisoners of War 69

Approximately one-third of infected individuals are asymptomatic; in another third, the diarrhea 

is primarily watery, and in the final third, frequent watery, bloody feces are the initial presentation. 

Severe infection is accompanied by a malabsorption syndrome, primarily of the fat-soluble 

Vitamins A, E, D and K. The endoscopic view of infected colonic mucosa reveals superficial 

ulcerations over the entire bowel mucosa, a common presentation of advanced disease. 

Necrotic sloughing of the superficial layers and immense blood loss also are common in 

more advanced cases. 

Shigella 

The fecal-oral route, primarily contaminated water and food, also spreads shigella, known as 

bacillary dysentery. Symptoms consist of mild, watery diarrhea in the majority of individuals. 

In a malnourished state, however, virtually any colonic presentation is possible, and severe 

dysentery can occur. A very high fever, cramping abdominal pain and tenesmus accompany 

almost all cases. 

As viewed through the endoscope, shigella colitis can mimic ulcerative colitis with large 

ulcerative lesions, friable-looking intestinal colonic mucosa and extensive hemorrhagic areas. 

Amebiasis 

Consuming contaminated water spreads amebiasis, caused by the motile single-celled parasite 

Entamoeba Histolytica. This unicelled organism lives primarily on fecal debris and bacteria 

found in the colon. Some particular strains have an affinity for burrowing through the intestinal 

wall and do so in certain individuals for unknown reasons. They produce a small ulceration on 

the intestinal surface, with a much larger lesion underneath, creating an almost bottle-shaped 

deformity. The colonic mucosa between affected areas appears normal. As viewed from the 

endoscope, discrete ulcers are a hallmark of this disease. 

The prognosis in affected individuals may be severe scarring and an irritable colon. 

Uncomplicated infection readily responds to treatment; unfortunately, little immunity 

is conferred by this infection and recurrences are frequent. 

Giardiasis 

A multiflagellar protozoan that parasitizes the duodenum and the jejunum causes giardiasis. 

It attaches to the mucosa by means of a ventral suction disc. The parasite forms cysts and is 

transmitted by the fecal-oral route. It is a major cause of diarrhea in Third World Countries. 
American Ex-Prisoners of War 70

The symptoms of this disorder are an explosive, watery diarrhea and right-upper-quadrant 

pain. Occasionally, in heavy infestations, malabsorptive syndrome results due to a decrease in 

the absorptive capacity of the small intestine, particularly for fats and carbohydrates, further 

inhibiting the absorption of Vitamins A, E, D and K. 

Most patients produce a tremendous amount of intestinal gas, resulting in abdominal discomfort 

and flatulence. They stay nauseated, which leads to anorexia and a further depletion of energy 

reserves. Their stools are foul smelling and greasy. This infection is rarely chronic and recovery 

is usually complete. 

Cold Injury and Frostbite 

Frostbitten feet were very common in POW’s of Europe, POW’s of the Japanese who were 

transferred to northern Japan, Manchuria and Korea, and POW’s of the Korean conflict. 

Several factors predispose to frostbite. The most important is heat loss rather than heat gain. 

Eighty percent of total body heat loss can result from an uncovered head and neck. Wetness 

accelerates heat loss through convection. Fatigue and being in combat over 30 days also are 

major risk factors. Blacks are more susceptible to frostbite than Whites. Finally, poor nutrition 

is very important. 

Frostbite injuries are classified according to degree. Numbness, erythema and white or yellow 

plaques usually characterize first-degree frostbite injuries. Second-degree frostbite injuries are 

associated with epidermal injury and the formation of superficial skin vesicles with clear fluid. 

Dermal involvement and deeper blisters containing bloody fluid characterize third degree 

frostbite injuries. Fourth degree frostbite injuries produce transdermal destruction with 

mummification primarily involving muscles, tendons and joints. 

The course of the pathology is as follows: from zero to three hours following the injury, edema 

forms; vesicles, or blebs, appear within six to twenty-four hours. Over the next several days, 

the blebs rupture and eschars form. It is much better for the individual to have a deeper injury 

that occurs once and is adequately treated, than to have superficial injuries which thaw out, 

re-freeze and re-thaw, because it is the recurrent freezing and thawing that causes the severe 

damage. This freeze-thaw cycle was responsible for the deaths of so many of Napoleon’s 

troops when retreating from the Russians. 

The clinical appearance of frostbite is often deceptive when evaluating its severity. Color 

variations range from white, yellow-white to mottled blue. Examination of the extremity 

reveals it to be cold, hard or waxy to the touch. Most patients complain of numbness and 

some report decreased or absent sensation to the touch. Upon rapid rewarming, the extremity 
American Ex-Prisoners of War 71

usually responds with flushing. Approximately 75% of those individuals who complained of 

numbness describe a severe pain upon rewarming. Sensation usually returns soon after thawing 

and continues until the formation of blebs. Edema usually appears within three hours of 

rewarming, and vesicles form within six to 24 hours. These blisters usually rupture within 

three days and scab over. Associated symptoms then include various degrees of pain, tingling, 

burning and electrical shock-like sensations that last months and often longer. 

The injury in frostbite is due to the formation of ice, both intra-cellularly and extra-cellularly. 

In general, extra-cellular ice forms first. The formation of ice in the extra-cellular spaces will, 

in effect, pull fluids and electrolytes out of the cells resulting in cell dehydration and shrinkage. 

Furthermore, alterations in intracellular lipids and electrolytes occur, and massive protein 

damage results. As this proceeds, microvascular injury occurs, which is often irreparable. 

The prognosis is favorable if, after rewarming, the affected extremity regains sensation, warmth 

and normal color, and if large clear blebs form early on and extend to the tips of the affected 

digits. This indicates that no severe damage was done to blood vessels. A poor outcome is 

associated with small blisters that are bloody, appear blue, do not extend to the tips of the 

affected digits, and no swelling is involved in the extremity. This indicates that blood vessels 

have been irreparably damaged and gangrene is setting in. 

The long-term effects of frostbite range from non-existent to severe. In order of decreasing 

frequency, long-term symptoms include pain, cold sensitivity, numbness, excessive sweating, 

tingling and burning. Nerve conduction tests performed shortly after the frostbite have consistently revealed injury; however, no long-term studies have been performed to verify permanent damage. Physical findings often reveal persistent nail abnormalities, as well as scarring 

and skin discoloration. If the freezing was deep enough, joints may have been involved, along 

with the development of osteoarthritis. 

The skeletal changes may take months to become manifest and include osteoporosis, cysts and 

joint space narrowing. In all likelihood, temporary interruption in blood flow to the subchondral 

bone leads to degeneration of the articular cartilage and loss of joint space. If the patient 

presents with these changes, and they are confined to the extremities, he is likely to have 

osteoarthritis as a result of frostbite. 

Peripheral Neuropathy 

In Greek “peripheral neuropathy” literally means the suffering of nerves outside of the brain 

and spinal cord. Among former POW’s, there are several different causes of peripheral neuropathy, such as vitamin, essential fatty acid and selected mineral deficiencies. Infections, such 

as leprosy, are the most common cause of neuropathy in the world. Other causes to be considered 

are various toxins such as lead, copper and mercury, a hereditary predisposition to neuropathy, 
American Ex-Prisoners of War 72

deposition of amyloid and multiple other less common causes. 
American Ex-Prisoners of War 73

VII. The Psychiatric Presumptive Service-Connected Disabilities 


The Psychiatric Presumptive Service-Connected Disabilities are quite numerous and well 

beyond the scope of this presentation; nevertheless, a brief description is provided to the reader. 

From my personal experience, many of these men have been active and independent in their 

lives; however, with the loss of loved ones or a decline in their own health, many decompensate 

— especially when they are forced to rely on others to provide their care. This often produces 

flashbacks to the POW experience in otherwise psychologically healthy individuals. PTSD and 

dysthymia are very common, and should be recognized for what they are and compassionately 

treated. 

Psychosis 

The first presumptive is psychosis, narrowly defined as delusions or prominent hallucinations 

occurring in the absence of insight into their pathological nature. 

Panic Disorders 

According to DSM-IV, panic disorders are recurrent, unexpected panic attacks lasting at least 

one month or longer with several different diagnostic criteria. It can be either with or without 

agoraphobia, but not due to the direct effects of a chemical substance or medical condition. 

To meet the criteria for panic, a veteran’s symptoms should not be better explained by another 

disorder. 

Generalized Anxiety Disorders 

Generalized anxiety disorder is an excessive anxiety with worry occurring more days than not 

for at least six months, with several different characteristic symptoms. The anxiety causes 

significant distress or impairment in every day function but not due to the direct effects of a 

chemical substance or medical condition. To meet the criteria for generalized anxiety disorder, 

a veteran’s symptoms should not be better explained by another disorder. 

Obsessive-Compulsive Disorder 

Concerning the obsessive-compulsive disorder, obsessions are defined as recurrent and persistent 

thoughts, impulses, or images that are experienced as intrusive and inappropriate and not simply 

excessive worries about real life problems. The person attempts to ignore these thoughts and 

realizes they are a product of his or her own mind. Compulsions are repetitive behaviors or 

mental acts that the person feels driven to perform in response to an obsession or according to 
American Ex-Prisoners of War 74

rigidly applied rules. These behaviors have as their aim preventing or reducing stress or preventing some dreaded event. The person has recognized that the obsessions or compulsions 

are excessive, may cause marked distress and are time consuming. The obsession or compulsion 

is not due to the direct effects of a chemical substance or medical condition. To meet the criteria 

for obsessive-compulsive disorder, a veteran’s symptoms should not be better explained by 

another disorder. 

Post-Traumatic Stress Disorder 

In post-traumatic stress disorder, the affected individual experienced, witnessed, or was confronted with scenarios that involved actual or threatened death, or serious injury or a threat to 

the physical integrity of self or others. The person’s response involves intense fear, helplessness or horror. The traumatic event is presently re-experienced in multiple different ways, 

including recollections and dreams of the event. The affected individual persistently avoids 

stimuli associated with the traumatic event, as indicated by several different criteria. The 

affected individual also has persistent symptoms of increased arousal, which were not present 

before the trauma, as indicated by several different criteria. The duration of the disturbances is 

more than one month, and the disturbance causes clinically significant distress or impairment 

in social, occupational or other important areas of functioning. Acute symptoms are less 

than three months in duration. Chronic symptoms are greater than three months in duration. 

Symptoms with delayed onset occur at least six months after the stressor. 

Anxiety Disorder Not Otherwise Specified 

“Anxiety disorder not otherwise specified” is a mixed anxiety-depressive disorder with clinically 

significant symptoms of anxiety and depression not meeting criteria for a specific mood disorder 

or a specific anxiety disorder. 

Dysthymic Disorder 

Dysthymic disorder is characterized by a depressed mood for most of the day, for more days 

than not, as indicated either by subjective account or observation by others for at least two 

years and without the symptoms for more than two months at a time. The presence of specific 

diagnostic criteria are necessary, and the disturbance is not better accounted for by chronic 

major depressive disorder, active or in partial remission. The symptoms are not due to the 

direct physiological effects of a chemical substance or a general medical condition. The early 

onset of the disease occurs before the age of 21. Delayed onset of the disease occurs at the age 

of 21 or older, and the disease may have atypical features. 
American Ex-Prisoners of War 75

Summary
 

In conclusion, the American ex-POW has been exposed to an almost incomprehensible array 

of treatments. The torture, starvation diet, cold and filth exposure has left permanent scars in 

the survivors. The purpose of this program has been to enlighten all those so honored to be 

associated with the American ex-POW as to the most statistically common conditions which 

may affect any one ex-POW. However, one should bear in mind that many other conditions 

are possible on an individual basis. Although not intended to be an all inclusive, in-depth 

authority on all aspects of the POW experience, this program along with the DSM-IV and the 

following bibliography, completes the most concise reference yet assembled. 
 

 

American Ex-Prisoners of War 76

References
 

GENERAL HISTORICAL 

American National Red Cross. Report of Joint Red Cross Team Operation in Korea. 

Washington, DC: 1953.
 

Anderson C, Boysen A, et al. Medical Experience in Communist POW Camps in North
 

Korea. JAMA. 1954; 156:120-122.
 

Alvarez, E and Pitch, A. Chained Eagle. New York, NY: Donald Fine Inc; 1975.
 

Barker AJ. Behind Barbed Wire. London; BT Batsford Press; 1974.
 

Blakey S. Prisoner at War, The Survival of Commander Richard A. Stratton, New York, NY: 

Anchor Press; 1978.
 

Caplan L. The Wild Blue. New York, NY:G. P. Putman and Sons; 1961.
 

Coone HW. The Sequential Soldier. Baltimore, MD. Gateway Press; 1992.
 

Culbertson R. The Korean War: A Former POW’s Story. American Ex-POW Bulletin. 1993:
 

March; 29-33.
 

Davis G. Prisoners of the Japanese, POW’s of WW II in the Pacific. New York, NY: Williams
 

Morrow and Co;1989.
 

Donovan W. POW in the Pacific: Memoirs of an American Doctor in World War II.
 

Wilmington, DE: Scholarly Resources Inc; 1998.
 

Faulk S. Bataan, The March of Death, New York, NY: Jove Publications; 1987.
 

Grady F. Surviving the Day. Annapolis, MD: Naval Institute Press; 1997.
 

Hibbs R. Tell MacArthur To Wait, New York, NY: Carlton Press; 1988.
 

Lawton M. Some Survived: An Epic Account of Japanese Captivity During WW II, Chapel
 

Hill, NC: Algonquin Press; 1984.
 

History of the Defenders of the Philippines Guam and Wake Island. Paducah, KY: Turner
 
 

American Ex-Prisoners of War 77

Publishing; 1990. 


Ingle Don. No Less a Hero. Privately published; 1991.
 

Katz S. The Long and Costly Stay in the Hanoi Hilton’s Cells; Insight; The Washington Times.
 

June 8,1987; 8-15.
 

Kerr EB. Surrender and Survival. The Experience of American POW’s in the Pacific 1941­

1945. New York, NY: William Morrow and Company; 1985. 

Kim KH. The Last Phase of the East Asian World Order. Los Angles, CA: U. California 

Press; 1980.
 

Klozik P. POW Legacy of Paul Anthony Klozik. The Korean War Veterans Association.
 

1999;13: 50-52.
 

Knox D. Death March, The Survivors of Bataan. New York, NY: Harcourt Brace Jovanovich;
 

1981.
 

Morris E. Corregidor, The End of the Line. New York, NY: Stein and Day; 1981.
 

Waldron B, Burneson E. Corregidor, From Paradise to Hell, Pine Hill Press; 1990.
 

Norman EM. We Band of Angels: The Untold Story of American Nurses Trapped on Bataan
 

by the Japanese. New York, NY: Random House; 1999. 

Pow-key S. The History of Korea. Seoul, Korea: Korean National Commission or UNESCO;
 

1970.
 

Rochester S, Kiley F. Honor Bound: The History of American Prisoners of War in Southeast
 

Asia, 1961-1973. Washington, DC: Historical Office, Office of the Secretary of Defense;
 

1998.
 

Rupp A. Beyond the Threshold. Long Beach, CA: Almar Press; 1983.
 

Sides, Hampton. Ghost Soldiers. New York, NY. Doubleday; 1999. ((need to check date))
 

Skelton WP, Skelton NK. American Women as Prisoners of the Japanese. Federal
 

Practitioner. 1996; 13:41-45.
 

Skelton WP, Skelton NK. The American Woman Ex-POW. Ex-POW Bulletin. March,
 
American Ex-Prisoners of War 78

1994:17-19.
 

Skelton WP. Repatriated Prisoners of War: Tallying the Tolls from each Theater. VA
 

Practitioner. 1992; 9: 669-675. 


Smith S. Prisoner of the Emperor. University Press of Colorado; 1991.
 

Snyder DJ. A Soldier’s Disgrace. NH: Yankee Books; 1987.
 

Sommers S. The European Story. American Ex-POW Inc. National Medical Research
 

Committee. No. 8; 1980.
 

Sommers S. The Korea Story. American Ex-POW Inc. National Medical Research
 

Committee. No. 9; 1981.
 

Stratton R. The Boat School Boys. Tales from Southeast Asia. 


Stratton R. The Man Who Would Be King. Tales from Southeast Asia.
 

Rowe J. Five Years to Freedom. New York, NY: Ballentine Books; 1971.
 

The Japanese Story, American Ex-POW National Medical Research Committee, 1980.
 

Toland J. The Rising Sun. The Decline and Fall of the Japanese Empire. New York, NY:
 

Bantam Books; 1971.
 

Turbak G. Death March Across Germany. VFW Magazine. April, 1999; 30-34.
 

Whiting C. Death of a Division. Stein and Day; 1981.
 

Zellers L. In Enemy Hands: A Prisoner in North Korea. The University Press of Kentucky;
 

1991.
 
 

American Ex-Prisoners of War 79

GENERAL MEDICAL 

Beebe G. Follow-Up Studies of World War II and Korean War Prisoners, II: Morbidity, 

Disability, and Maladjustments. American Journal of Epidemiology, 1975; 101: 400-422. 

Berg W, Richlin M. Injuries and Illnesses of Vietnam War POW’s. Military Medicine. 

1977;142: 514-518. 

Cohen B, Cooper M. A Follow-Up Study of World War II Prisoners of War. VA Medical 

Monograph. September; 1954: 1-81. 

Diem C, Richlin M. Dental Problems in Navy and Marine Corps Repatriated Prisoners of 

War Before and After Captivity. Report # 76-23. San Diego, CA: Navy Health Research 

Center; 1976. 

Freed G, Stringer P. Comparative Mortality Experience 1946-1963 Among Former Australian 

POW’s of the Japanese. Medical Research Bulletin. 1968;2:4-28. 

Guest CS, Venn AJ. Mortality of Former Prisoners of War and Other Australian Veterans. 

The Med. Journal of Australia. 1992; 157: 132-135. 

Keehn R. Follow-Up Studies of World War II and Korean War Prisoners, III: Mortality to 

1 January, 1976. American Journal of Epidemiology, 1980;194-211. 

Kelnhofer GJ. Life After Liberation. Understanding the Former Prisoner of War. St. Paul, 

MN: Banfil Street Press; 1992. 

Morgan H, Wright A, et al. Health of Repatriated POW’s from the Far East. JAMA. 

1946;130:13. 

Nezfger D. Follow-Up Studies of World War II and Korean War Prisoners, I. Study Plan 

and Mortality Findings. American Journal of Epidemiology. 1979; 91:123-138. 

Page WF. The Health of Former Prisoners of War. Results from the Medical Examination 

Survey of Former POW’s of World War II and the Korean Conflict. Medical Follow-Up 

Agency Institute of Medicine. National Academy Press: 1992; 1-123. 

POW, Study of Prisoners of War, Veteran’s Administration Monograph;1980. 
 

American Ex-Prisoners of War 80

Skelton WP. Prisoners of War: The American Experience. American Ex-Prisoners of War, 

Inc; 1989. 

Skelton WP, Skelton, NK. Environmental Trauma in Former Prisoners of War. Federal 

Practitioner. May, 1995;12: 42-47. 

Skelton WP, Skelton NK. Disabilities in Women Prisoners of War of the Japanese. American 

Ex-POW Bulletin. July, 1995;23-24. 

Venn AJ, Guest CS. Chronic Morbidity of Former Prisoners of War and Other Australian 

Veterans. The Med Journal of Australia. 1991:155:705-712. 

PERIPHERAL NEUROPATHY 

Adams R, Victor M. Nutritional Polyneuropathy. Principles of Neurology. 2nd ed. New York, 

NY: 1996; McGraw Hill; 711-713. 


Cruickshank EK. Painful feet in Prisoners of War in the Far East, Review of 500 cases.
 

Lancet. 1946; 111:369-372. 


Gill GV, Bell DR. Persisting Nutritional Neuropathy amongst Former War Prisoners. Journal
 

of Neurology, Neurosurgery and Psychiatry. 1982; 45:861-865. 


Hong CZ. Electrodiagnostic Findings of Persistent Polyneuropathies due to Previous
 

Nutritional Deficiency in Former Prisoners of War. VA Practitioner 1987; 63-68. 


Hong CZ. Peripheral Neuropathy in Former Prisoners of War. VA Practitioner. 1987:63-68. 


Katz CJ. Neuropathologic Manifestations Found in a Japanese Prison Camp. Journal of
 

Nervous and Mental Diseases. 1946: 103:5:456-463. 


LeQuesne PM. Persisting Nutritional Neuropathy in Former War Prisoners. Br. Med. J. 1983;
 

286: 917-918. 

Lewis RB. Painful Feet in American Prisoners of War. U.S. Armed Forces Medical Journal. 

1950; 1:2:146-157. 

Takahashi K, Nakamura H. Axonal Degeneration in Beriberi Neuropathy. Arch. Neurol. 1976; 

33:836-841. 
American Ex-Prisoners of War 81

APPENDIX A 

AVITAMINOSIS/RELATED SYNDROMES 

Alleman R, Stollerman G. The Course of Beriberi Heart Disease in American Prisoners of War 

in Japan. Annals of Internal Medicine.1948; 28:949-962. 


Artas M, Hanley D. Fulminant Beriberi Heart Disease with Lactic Acidosis: Presentation of a
 

Case. Circulation. 1978;58:566-572. 


Brown C. The Japanese POW Syndrome. Diseases of the Nervous System. 1949; 10:1.
 

Coke LR. Late Effects of Starvation. Canadian Services Medical Journal. 1961;17:313-324. 


Burgess RC. Deficiency Diseases in Prisoners of War at Changi, Singapore. Lancet.
 

1946;411-418. 


Bloom S, Mertz E. Nutritional Amblyopia in American POW’s Liberated from the Japanese.
 

Am J of Opthalmology. 1946;29: 1248-1257. 


Cruikshank EK. Painful Feet in Prisoners of War in the Far East. Lancet. 1946; 369-372. 


Fischback W. Cardiac and EKG Observations on American POW’s Repatriated from Japan.
 

1948; 48:1:69-74. 


Gill GV, Bell DR. The Health of Former Prisoners of War of the Japanese. VA Practitioner.
 

1981; 225:531-538. 


Gottlieb ML. Impressions of POW Medical Officer in Japanese Concentration Camps, Naval
 

Medical Bulletin. 1946; 46:5:663-673. 


Harris BR, Stephens, MA. Experiences at Nagasaki, Japan. Connecticut Medical Journal.
 

1945; 9:913-917. 


Hibbs RE. Beriberi in Japanese Prison Camp. Ann of Intern Med. 1946; 25:2:270-282. 


Jacobs EC. Effects of Starvation on Sex Hormones in the Male. Journal of Clinical
 

Endocrinology. 1948: 8: 227-232. 


Jacobs EC. Gynecomastia Following Severe Starvation. Ann Inten Med. 1948; 28:792-796. 

American Ex-Prisoners of War 82

Jacobs EC. Oculo-Oro-Genital-Syndrome. A Deficiency Disease. Ann Intern Med. 1951: 35:
 

1049-1054. 


Monthly Progress Report, Section 7: Health of Army Service Forces, U.S. War Department,
 

Washington, DC: January 31, 1946;14-16.
 

Morgan HJ, Wright IS et al. Health of Repatriated Prisoners of War from the Far East. JAMA. 

1946; 995-999. 

Musselman MM. Nutritional Diseases in Cabanatuan. War Medicine. 1945;8:325-332. 


Nardini JE. Vitamin Deficiency Diseases in Allied Prisoners of War of the Japanese. Naval
 

Medical Bulletin. 1947;2:273-278. 


Sable H. Thiamine: Twenty Years of Progress. Annals of the New York Academy of Sciences,
 

Vol 378. 1982.
 

Skelton WP. Avitaminosis in Former Prisoners of War. VA Practitioner. 1990:7:3: 103-109. 


POST-TRAUMATIC OSTEOARTHRITIS 

Pinals RS. Disruptive Articular Trauma: Post-Traumatic Osteoarthritis. In Arthritis and Allied 

Conditions, McCardy, AJ, Ed. Eleventh Edition. Philadelphia. PA: Lea & Febiger; 1989:1574. 

Skelton WP, Skelton NK. Post-Traumatic Osteoarthritis. American Ex-POW Bulletin. 1993; 

50: 10: 21-23. 


Skelton WP, Skelton NK. Post-Traumatic Osteoarthritis. Consultant. 1994;34: 11: 1619. 


Soren A, Klein W. The Synovial Changes in Post-Traumatic Synovitis and Osteoarthritis.
 

Rheumatology and Rehabilitation. 1978; 17:1:38-45. 

ISCHEMIC HEART DISEASE 

Adena MA. The Health of Australian Veterans. Med J Australia. 1989;150: 356-357. 

Eberly RE, Engdahl BE. Prevalence of Somatic and Psychiatric Disorders Among Former 

Prisoners of War. Hosp Community Psychiatry. 1991; 42: 807-813. 
American Ex-Prisoners of War 83

Fishbach, WM. Cardiac and Electrodiographic Observations on American Prisoners of War 

Repatriated from the Japanese. U.S. Naval Medical Bulletin. 1948;48: 69-74. 

Fred G, Stringer PB. Comparative Mortality Experience, 1946-1963, Among Former 

Australian Prisoners of War of the Japanese. Aust. Repat. Dept. Med. Bull. 1968;2: 28. 

Gill G. Study of Mortality and Autopsy Findings Amongst Former Prisoners of the Japanese.J 

Army Medical Corps. 1983; 129: 11-13. 

Gill GV, Bell DR. The Health of Former Prisoners of War of the Japanese. Practitioner. 1981; 

225:531-538. 

Gill, GV, Henry L. Chronic Cardiac Beriberi in a Former Prisoner of the Japanese. Br J of 

Nutrition. 1980; 44: 273-274. 

Jeffry FE, Ableman WH. Recovery of Proven Shosin Beriberi. American Journal of 

Medicine. 1971;50:123. 

Oboler S. American Prisoner of War - an Overview. Williams T (ed), Post Traumatic Stress 

Disorder: A Handbook for Clinicians. Cincinnati, Ohio: Disabled American Veterans. 1987; 

131-143. 

Page WF, Ostfeld AM. Malnutrition and Subsequent Ischemic Heart Disease in Former 

Prisoners of War of World War II and the Korean Conflict. J Clin Epidemiol. 1994; 47:12: 

1437-1439. 

Richardson HJ. Report of a Study of Disabilities and Problems of Hong Kong Veterans 

1964-1965. Canadian Pension Commissions Commission, Ottawa. 1965. 

Salmond GC, Geddes MK, et al. The Health of Former Servicemen. Wellington, New 

Zealand: War Pensions Medical Research Trust Board; 1977. 

Skelton WP, Skelton NK. Ischemic Heart Disease. American Ex-POW Bulletin 1994; 51: 8: 

30-32. 
American Ex-Prisoners of War 84

FROSTBITE 

Altman MI, Hutton SJ. Late Neuropathic Sequelae of Cold Injury. J Foot Surg. 1987; 

26:213-216. 

Barber FA. Cold Injury in the Military. Med Bull of the U.S. Army, Europe. 1980; 37: 22-27. 

Blari JL, et al. Sequelae to Cold Injury in One Hundred Patients. JAMA. 

1957;163:14:1203-1208. 

Frey CS. Frostbitten Feet. The Physician and Sports Medicine. 1992;20:1:67-70. 


Glick R, et al. Frostbite Arthritis. J Rheumatology. 1979;6:456-460. 


Lewis TL. Observations on Some Normal and Injurious Effects on Underlying Tissues:
 

Frostbite. British Medical Journal. 1941;2:869-872. 


PSYCHIATRIC 

APA Diagnostic and Statistical Manual III. American Psychiatric Association. 1990.
 

APA Diagnostic and Statistical Manual IV. American Psychiatric Association. 1994.
 

Brill NQ. Neuropsychiatric Examinations of Military Personnel Recovered From Japanese
 

Prison Camps. U.S. Medical Dept. 5:429-438. 1946. 

American Ex-Prisoners of War 85

Federal Benefits for Ex-Prisoners of War and Their Dependents
 

Most American ex-POW’s are unaware of the benefits to which they are entitled from the 

Department of Veterans Affairs. The following information is provided to help inform the 

former prisoners of war and VA providers of these benefits and how to access them. 

Disability Benefits 

The VA administers two disability programs. Both pay monthly benefits to disabled veterans. 

Disability Compensation 

Studies have shown that the physical hardships and psychological stress endured by POWs 

have life-long effects on health, social and vocational adjustment. These studies also indicate 

increased vulnerability to psychological stress. 

The laws on former POW benefits recognize that military medical records do not cover periods of captivity. Former POW’s who were incarcerated for at least 30 days are presumed to be 

eligible for disability compensation if they become at least 10 percent disabled from diseases or 

disorders associated with POW’s. Compensation is paid based upon the degree of disability. 

The presumptive service-connected disabilities associated with POW’s can be found in 

Appendix B. 

Current Monthly Compensation According to Degree of Disability 

Percentage Disability Amount of Compensation 

10 $ 101 

20 194 

30 298 

40 427 

50 609 

60 769 

70 969 

80 1,125 

90 1,266 

100 2,107 
American Ex-Prisoners of War 86

APPENDIX B 

Education and Training 

The VA pays benefits to eligible veterans, dependents, reservists and service members while 

they are in an approved training program. Generally, veterans have 10 years from the date 

they were last released from active duty to use their education benefits. 

Vocational Rehabilitation 

The VA can help certain service-disabled veterans get and keep suitable employment. 

Home Loans 

VA loan guaranties are made to service members, veterans, reservists and un-remarried surviving 

spouses for the purchase of homes, condominiums and manufactured homes, and for refinancing 

loans. VA guarantees part of the total loan, permitting the purchaser to obtain a mortgage with 

a competitive interest rate, even without a down payment, if the lender agrees. VA home loans 

may be obtained more than once. 

Burial Benefits 

The VA offers certain benefits and services to honor our Nation’s deceased veterans. 

Headstones and Markers: Headstones and markers are provided for the unmarked graves of 

veterans anywhere in the world and of eligible dependents of veterans buried on military posts 

or in state veteran or national cemeteries. 

Burial Flags: VA provides an American flag to drape the casket of a deceased veteran. 

Veteran must have been separated from the service under conditions other than dishonorable. 

After the funeral service, the flag may be given to the next of kin, close friend or associate of 

the deceased veteran. Burial flags may be obtained at VA regional offices, national cemeteries 

and most local post offices. 

Reimbursement of Burial Expenses: VA will provide a burial allowance of up to $1,500 

if the veteran’s death is service-connected. VA will pay $300 burial and funeral expense 

allowance for veterans who, at the time of death, were entitled to receive pension or compensation or would have been entitled to compensation but for receipt of military retirement pay. 

Burial in a VA national Cemetery: Veterans and service members are eligible for burial in a 

VA national cemetery. Burial benefits in a VA national cemetery include the gravestone, a 
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headstone or marker, opening and closing of the grave and perpetual care. Many national 

cemeteries have columbary or gravesites for cremated remains. Spouses and minor children 

of eligible veterans and of service members also may be buried in a national cemetery. 

Gravesites in national cemeteries cannot be reserved. Funeral directors or others making burial 

arrangements must apply at the time of death. 

DIC Payments to Surviving Spouse 

Dependency and Indemnity Compensation (DIC) payments may be available for surviving 

spouses who have not remarried, unmarried children under 18, helpless children, those 

between the ages of 18 and 23 if attending a VA-approved school , and low income parents of 

deceased service members or veterans. To be eligible, the deceased must have died from: (1) 

a disease of injury incurred or aggravated while on active duty or active duty for training; (2) 

an injury incurred or aggravated in line of duty while on inactive duty training; or (3) a disability 

compensatable by VA. DIC payments also may be authorized for survivors of veterans who 

were former prisoners of war who died after September 30, 1999, and who were continuously 

rated totally disabled for a period of a least one-year immediately preceding death. Surviving 

spouses of veterans who died after January 1, 1993, receive $881.00 per month. Plus, $191.00 

if the veteran received 100% service-connected compensation for at least eight continuous 

years prior to death and the surviving spouse had been married to the veteran for those eight 

years. This is paid without regard to your income from other sources. Additional amounts also 

are payable depending upon your specific circumstances. Ischemic heart disease, or coronary 

artery disease, is one of the POW presumptive disabilities and often is a contributory cause of 

death, which may entitle you to DIC. 

Health Care Benefits 

Former POWs are not subject to VA’s health care eligibility assessment and are entitled to VA 

hospital care. VA may provide outpatient care without limitation to former POWs. POWs held 

for more than 90 days are eligible for dental treatment. Those held for less than 90 days are 

eligible for dental treatment for service-connected, noncompensatable dental conditions. Their 

primary care provider may refer POWs to other specialists. Health care services may include 

outpatient, inpatient, intermediate care, nursing home care, pharmacy and prosthetic services. 

VA provides medically prescribed prosthetic and sensory aids to eligible veterans. These aids 

include artificial limbs, hearing aids, communication aids, eyeglasses, orthopedic braces and 

shoes, clothing, wheelchairs, crutches and canes. For additional information, contact the prosthetic representative at the nearest VA medical center or outpatient clinic. 
American Ex-Prisoners of War 88

The Home Improvements and Structural Alterations program provides funding for eligible 

veterans to make home improvements necessary for the continuation of treatment or for disability access to the home and essential lavatory and sanitary facilities. Disabled veterans may 

be entitled to a grant from VA for a home specially adapted to their needs or for adaptations to 

a house. In addition, a veteran can get automobile assistance in the form of a payment toward 

the purchase of an automobile and adaptive equipment that may be needed on that automobile. 

Nursing Home Care: The Veteran’s Millennium Health Care and Benefits Act requires that 

the VHA (Veterans Health Administration) provide nursing home care, either directly or 

through contracts, when clinically indicated to a veteran who needs nursing home care for a 

service-connected disability, and to any veteran needing such care who has a service-connected 

disability rated at 70 percent or more, or to any veteran in need of such care for a serviceconnected disability. VHA may provide nursing home care based upon available resources, 

either direct or through contracts, when clinically indicated to all other eligible veterans who 

need nursing home care. 

VHA ensures that a veteran described above, who continues to need nursing home care, is 

not, after placement in a Departmental nursing home, transferred from the facility without the 

consent of the veteran or, if the veteran cannot give consent, the veteran’s designated representative. Patients should be placed in Home and Community-Based Care when clinically appropriate, and patients receiving VA Nursing Home Care or Community Nursing Home care will 

be transferred to appropriate assisted living or home and community-based care settings when 

nursing home care, at any level, is no longer clinically indicated. 

Aid and Attendance or Housebound Benefits 

A veteran in a nursing home, who is otherwise determined by VA to be in need of the regular 

aid and attendance of another person or who is permanently housebound, may be entitled to 

higher income limitations or additional benefits, depending upon the type of pension received. 

The A & A form is completed by the primary care provider and is sent to the Regional Office 

for disposition. 

Assistance with Insurance 

Policyholders with National Service Life Insurance can contact 1-800-669-8477 for additional 

information. 
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Military Recreation Centers 

Four Star hotels are available at reduced cost to veterans throughout the world. 


Call 1-800-527-2345 or 703-527-0203 or go online at www.military living@aol.com
 

National Service Officer 

Legislation in the last few years has made significant changes to benefits and health care available through the Veterans Health Administration. Veterans who have not sought services from 

the VA since these changes went into effect should contact a National Service Officer to learn 

which resources are available to them. A Service Officer is an advocate for the veteran, and 

is not an adversary of the VA. He helps a claimant in preparing a well-grounded claim. The 

Service Officer is thoroughly familiar with the process and will assist from the development 

of a claim to the final adjudication. 

Many former POWs do not consider all of the things that happened to them while they were 

in an enemy’s hands, including the physical abuse, such as beatings and forced marches; the 

mental abuse of being questioned over and over about military matters, spending time in solitary 

confinement or other forms of torture. Were you well fed? Did you have adequate clothing 

and housing? Did you have leisure time in the company of your buddies? Unfortunately not. 

Maybe you have managed to get along fairly well right after you returned home, but how are 

you feeling now, 50 or 55 years later? 

For further information, contact the Ex-Prisoner of War Coordinator at the VA Medical 

Center. 
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Presumptive Service-Connected Disabilities Associated with Ex-Prisoners of War
 

ARTHRITIS, TRAUMATIC 

This disorder looks and is treated just like a degenerative arthritis (arthritis associated with 

age), except it is caused by severe damage to a single or few joints producing early onset 

arthritis. This is an extremely difficult diagnosis to make, but in general, one has to prove that 

a specific trauma occurred to a single or very few joints, and other changes consistent with 

degenerative arthritis are not present throughout the rest of the body at the same time. In short, 

these changes need to be localized. 

AVITAMINOSIS 

The total lack of vitamins in the diet. This disorder is a fatal condition unless it is supplemented 

with vitamins within a few weeks. Therefore, most individuals suffer from hypovitaminosis, 

which is a relative deficiency of vitamins in the diet. The specific type, intensity and duration 

of deprivation determine the long-term effects. 

BERIBERI 

Caused by a severe lack of Vitamin B-1 (thiamine) in the diet. This produces changes in the 

nerves (both in the brain and extremities) and the heart. Brain changes could produce dementia 

or psychosis. Nervous changes usually are associated with numbness and /or painful feet. 

Beriberi heart disease is an acute condition, similar to congestive heart failure, except that the 

heart pumps more blood than in normal congestive heart failure and it is associated with the 

presence of an excessive amount of lactic acid in the body. 

DYSENTERY, CHRONIC 

A disease characterized by frequent and watery stools, usually with blood and mucus, and 

accompanied by rectal and abdominal pain, fever and dehydration. This is an infection in the 

colon and it can be caused by a multitude of different organisms, the most common of which 

is amoebae, which can produce a mild or severe dysentery, possibly is associated with a chronic irritable colon. 
American Ex-Prisoners of War 91

FROSTBITE 

The actual freezing of tissue. This is graded on a continuum with one representing mild to four 

representing mummification of the tissue. The extremities farthest from the heart are usually 

affected, with primarily the nose, ears, fingertips and toes being involved. This usually produces 

long-term side effects, such as numbness, discoloration, excessive swelling and pain in the 

affected area. 

HELMINTHIASIS 

Infection with any type of worms that parasitize the human. Most infections usually resolve 

spontaneously either with proper treatment or as the natural course of the disease. 

MALNUTRITION 

Merely means bad nutrition. The nutritional depletion may be either caloric, vitamin, fatty acid 

or mineral deficiency, or more likely a combination. Depending upon the type, intensity and 

duration, it may yield permanent side effects, or no lasting side effects at all. 

PELLAGRA 

Literally meaning rough skin in Italian, also known as black tongue in dogs. It is caused by 

a virtual lack of Vitamin B-3 (niacin) in the diet, producing the classical triad of diarrhea, 

dermatitis and dementia. All easily are treated early on with no side effects. The dementia, 

if left untreated, may produce permanent mental deficits. 

OTHER NUTRITIONAL DEFICIENCY 

The lack of protein and calories in the diet generally produces no lasting side effects. 

However, vitamin deficiencies other than the aforementioned B-1 (beriberi) and B-3 (pellagra) 

can have very disastrous effects on one’s body. Also, deficiencies of certain fatty acids and 

essential minerals in the diet can have lasting and long-term consequences. 

PSYCHOSIS 

A generic term for any of the insanities. Generally, it is thought of as a mental disorder causing 

gross disorganization of a person’s mental capacity and his ability to recognize reality and 

communicate with others regarding the demands of everyday life. 
American Ex-Prisoners of War 92

PANIC DISORDER 

Characterized by discrete periods of apprehension or fear, with at least four of the following 

during an attack: shortness of breath, feelings of heart skipping, chest pain, dizziness, sweating, 

fainting, trembling, fear of dying or doing something uncontrollable during an attack. These 

attacks need to occur at least three times within a three week period, and not be associated 

with physical exertion or life threatening situations. Also, there needs to be an absence of 

severe physical or other mental illness, which could cause these symptoms. 

GENERALIZED ANXIETY DISORDER 

Characterized by generalized persistent anxiety and with symptoms of at least three of the 

following four categories: (1) motor tension as characterized by shaking, jumpiness, trembling 

and restlessness; (2) autonomic hyperactivity, such as sweating, cold or clammy hands, high 

or irregular heart rate, dry mouth, etc.; (3) apprehensive expectations, anxiety, worry, fear or 

anticipation of misfortune to himself or others; (4) tendency to insomnia, hyper-attentiveness 

and irritability. All of these symptoms had to have lasted at least one month. Also, there 

needs to be an absence of all other mental disorders and physical disorders, which could 

explain 

the symptoms. 

OBSESSIVE COMPULSIVE DISORDER 

This may be either obsessions or compulsions. Obsessions are recurrent, persistent ideas or 

impulses. Attempts are made to ignore or suppress them. Compulsions are repetitive and 

seemingly purposeful behaviors that are performed in certain similar manners. The behavior is 

felt by the individual to produce or prevent some future event. Generally, the individuals 

recognize the senselessness of the behavior and do not derive pleasure from carrying it out, 

although it often relieves tension. Also, obsessive or compulsive individuals are associated 

with a significant sense of distress because it interferes with social or role functioning. 

POST TRAUMATIC STRESS DISORDER (PTSD) 

The re-experiencing of a trauma of a past recognized stressor that can produce symptoms 

of distress. 

•	 Intrusive recollections: remembering painful experiences when you do not want to. Can 

occur with or without reminders. The recollections must be recurrent, intrusive and 

distressing. They seem to have “a life of their own.” 
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APPENDIX C 

• Recurrent and distressing dreams: may be straightforward dreams of war events, but 

more frequently, with the passage of so many years, they contain intermingling of war and 

post-war themes and elements. 

•	 Flashbacks: were experienced by a minority in the years right after the war. The person 

has a sense of reliving the trauma in the here-and-now, and briefly loses the ability to 

distinguish between the past and present. 

•	 Distress when reminded: fear, anxiety, sadness or sense of impending doom in the face of 

a symbolic representation of the traumatic event. A variety of common and idiosyncratic 

stimuli may elicit memories of trauma. They may be visual, auditory, olfactory or tactile. 

Less obviously, interpersonal interactions that typically elicit modest levels of emotional 

reactivity in most people may produce intense, painful reactions in POWs. Feelings of love 

and caring may elicit associations with the loss of fellow soldiers. Interpersonal conflicts 

may produce memories of hostile combat or prison camp situations. 

•	 Physiologic reactivity to reminders: may be expressed in a variety of ways: heavy or 

irregular breathing, rapid or irregular heartbeat, knot in the stomach, sweating or feelings 

of numbness or tingling in the extremities. 

• Avoidance of trauma-related thoughts, feelings, or conversations-Avoidance of trauma-related situations: intentional efforts to avoid must have been made, but need not have 

been successful. Avoidance efforts may be obvious or subtle, relatively adaptive or clearly 

maladaptive. Examples include avoiding not only “war movies,” but any portrayal of violence. Less obvious forms might include substance abuse to suppress trauma-related 

thoughts or emotions, or working long hours to distract one’s thoughts. 

•	 Psychogenic amnesia: one or more parts of a traumatic experience cannot be remembered; 

complete amnesia for an event is less common, and should be distinguished from failures of 

memory formation due to head injury, delirium, etc. 

• Trauma-related diminishment in interest: This loss is most often noticed upon return 

to civilian life following service discharge. Try to distinguish it from changes in interest 

associated with maturation and aging, loss of physical capability to engage in the activity 

and anhedonia, a core depressive symptom. 

•	 Detachment/estrangement from others: again, the essential feature is change after the 

trauma — the person felt markedly more distant/cut off from others after the war than 

before. POWs often report that they have few or no one outside of their immediate family 
American Ex-Prisoners of War 94

American Ex-Prisoners of War
 

Independent Study Test Questions for CME Credit 

Instructions: Using the Independent Study Participant Registration/Answer Sheet, please 

completely fill in the lettered box corresponding to your answer next to the appropriate 

number. 

1.	 As a group, which Theater of Operations has produced the most American ex-POW’s? 

a) Germany 

b) Japan 

c) Korea
 

d) Vietnam
 

2.	 As a group, which Theater of Operations had the highest mortality? 

a) Germany 

b) Japan 

c) Korea
 

d) Vietnam
 

3.	 As a group, which Theater of Operations has the highest morbidity? 

a) Germany 

b) Japan 

c) Korea
 

d) Vietnam
 

4.	 Which Stammlager (Stalag) in Germany during WW II held the most American POW’s? 

a) Stalag VII-A 

b) Stalag Luft IV 

c) Stalag XIII
 

d) Stalag XX
 
American Ex-Prisoners of War 95

5.	 During the early portion of WW II, most Americans captured by the Germans were from 

which branch of the service? 

a) Infantry 

b) Army Air Corps 

c) Navy
 

d) Marines
 

6.	 During the death march in the Philippines, approximately how many American 

soldiers died? 

a) 650 

b) 1,650 

c) 2,650
 

d) 3,650
 

7.	 The primary causes of death in American prisoners of the Japanese in the Philippines 

during the first six months of internment included all except: 

a) Malaria 

b) Dysentery 

c) Worm infections
 

d) Starvation
 

8.	 After the fall of Corregidor, where were the American survivors sent? 

a) Bilibid Prison 

b) Camp O’Donnell 

c) Cabanatuan Camp I
 

d) Cabanatuan Camp III
 

9.	 Which Maru had the most Americans killed while on board? 

a) Arisan Maru 

b) Oryoku Maru 

c) Brazil Maru
 

d) Enura Maru
 
American Ex-Prisoners of War 96

10.	 Because of the basic diet, the most common vitamin deficiency among Americans held 

prisoner by the Japanese was: 

a) Scurvy 

b) Beriberi 

c) Pellagra
 

d) Aribinoflavinosis
 

11.	 Regarding American women captured by the Japanese, which statement is true? 

a) The same percentage died in captivity as their male counterparts. 

b) Most were captured on Bataan. 

c) They were initially kept with the men in Camp Cabanatuan.
 

d) Less than 100 were captured.
 

12.	 During the Korean War, most prisoners captured by the Chinese were from which branch 

of service? 

a) Army 

b) Air Force 

c) Marines
 

d) Navy
 

13.	 Because of the basic diet, the most common vitamin deficiency among Americans held 

prisoner by the Koreans/Chinese was: 

a) Scurvy 

b) Beriberi 

c) Pellagra
 

d) Aribinoflavinosis
 

14.	 Which of the following statements is false regarding the Chinese brainwashing 

techniques used against the American prisoners of the North Koreans? 

a) The program was used to convert susceptible prisoners. 

b) Exposure to cold, torture and hunger were common. 

c) Forced reading of Communist literature was common.
 

d) The program was successful.
 
American Ex-Prisoners of War 97

15.	 Most soldiers captured by the Viet Cong in South Vietnam were 

a) Army 

b) Navy 

c) Air Force
 

d) Marines
 

16.	 Which North Vietnamese show camp was used for propaganda? 

a) The Zoo 

b) Skid Row 

c) The Plantation
 

d) Hanoi Hilton
 

17.	 Characteristic findings useful in the diagnosis of Post-Traumatic Osteoarthritis (PTOA) 

include all the following, except: 

a) Similar disease is not present in other non-traumatized joints. 

b) An effusion or structural damage had to occur after the injury. 

c) The joint in question had to be normal prior to injury.
 

d) The amphiarthrotic joints are the most commonly involved. 


18.	 The most common type of nutritional depletion among American prisoners of the 

Germans during WW II was: 

a) Vitamin deficiencies 

b) Mineral deficiencies 

c) Caloric deficiencies
 

d) Essential fatty acid deficiencies
 

19.	 The most detrimental type of nutritional depletion among American prisoners of the 

Japanese during WWII was: 

a) Vitamin deficiencies 

b) Mineral deficiencies 

c) Caloric deficiencies
 

d) Essential fatty acid deficiencies
 
American Ex-Prisoners of War 98

20.	 Vitamin B-1 (thiamine) deficiency affects all of the following systems, except: 

a) Cardiovascular 

b) Nervous 

c) Skin
 

d) Pulmonary