“The galloping Ghost of the Java Coast




Peter Winstanley

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STENING,SAMUEL EDWARD LEES  Surgeon Lieutenant Commander (Medical Officer) HMAS Perth


Sam Stening was born in Sydney 14 May 1910.  He is understood to have been educated at Sydney Boys High School.  He attended the Medical School at Sydney University and graduated in 1933.  He enlisted in the Royal Australian Navy on 14 May 1940.   Prior to the entry of the Japanese into the war in December 1941, Sam had been on the HMAS “Waterhen” when it was sunk in the Mediterranean Sea.  He then joined the HMAS Perth as the ship’s doctor (Medical Officer).


By late February 1942, the Japanese had captured Malaya, Singapore, Borneo, the Celebes, Timor and other Islands in South East Asia. The following is a short account of the events which culminated in the sinking of the HMAS Perth -.


HMAS PERTH was light cruiser of 6830 tons.  She boasted a speed of 32.5 knots, was armed with 24 guns of varied calibre and 8 torpedo tubes, and to those with a fond regard for ships, sported fine lines.   PERTH entered into the service of the RAN on 10 July 1939.  She saw extensive service in the Atlantic, Mediterranean, Indian Ocean, and Australian waters before commencing refit at Sydney in July 1941.

On 14 February 1942, PERTH sailed for the Java Theatre after a period of exercises and patrols that followed her refit, during which Captain Hector Waller, DSO and bar, had assumed command.  On 26 February, the ship departed Surabaya in company USS HOUSTON and other Dutch and British cruisers, as well as Dutch and British destroyers. During the night of 27-28 February the combined American, British, Dutch and Australian (ABDA) force engaged Japanese forces in the disastrous Battle of the Java Sea, from which only PERTH and HOUSTON survived in a fit operational state.

PERTH and HOUSTON arrived at Tandjung Priok on 28 February after the day and night actions that had just taken place off Surabaya. Unfortunately, stocks of fuel were low and PERTH could only receive 50% of her total capacity.  The same evening, both ships sailed under orders to proceed through Sunda Strait to Tjilatjap.

Just before midnight, a vessel was sighted.  When challenged she proved to be a Japanese destroyer and was immediately engaged. Shortly afterwards, other destroyers were sighted to the north and the armament of PERTH was split so as to engage more than one target.  PERTH and HOUSTON had actually come across the Japanese naval ships protecting the West Java invasion force of approximately 50 vessels, which effected a landing in Banten Bay, Java. During the action, a large number of enemy destroyers attacked from all directions.  Under overwhelming odds, it proved impossible to engage all targets at once.  Eventually, some of the Japanese destroyers were able to close to very short range.

By this stage, PERTH’s men had been in combat over a period of three continuous days.  At about midnight, it was reported that very little 6" ammunition for the ship’s main guns was left, so Captain Waller decided to attempt to force a passage through Sunda Strait. He ordered full speed and altered course for Toppers Island. PERTH had barely steadied on course when she was struck on the starboard side by a torpedo. Captain Waller gave the order to prepare to abandon ship. A few moments later another torpedo struck just ahead of the first hit, and the Captain gave the order to abandon ship. After five or ten minutes a third torpedo struck well aft on the starboard side. This was followed shortly afterwards by a fourth torpedo, which hit on the port side; the ship then righted herself, heeled over to port and sank at around 1230 on the morning of 1 March 1942.  USS HOUSTON was still fighting bravely although badly on fire. She was hit by torpedoes and sank shortly afterwards closer inshore.

Most of PERTH’s crew abandoned ship between the second and third torpedoes, but it is doubtful if any of the boats were successfully launched. During the abandon ship operation, PERTH was under fire from several destroyers at close range, many of which made direct hits causing additional casualties.  Tragically, many of the ship’s company were killed or wounded in the water by the explosion of the last two torpedoes and by shells exploding nearby. At the time of her loss, PERTH’s ship’s company totalled 681 personnel. 353 (including Captain Waller) did not survive the sinking. Those who did numbered 328.  Sadly, almost all were taken into captivity as prisoners of war, and, by the end of hostilities, only 214 men were repatriated to Australia.

An account of part of Sam Stening’s time from the sinking of the Perth to his time in Serang on the island of Java is covered (as well as the written word can do) in the book Proud Echo by Ronald McKie.  In Proud Echo it is said that Sam Stening suffered a fractured skull at the time of the sinking.  The following is an extract from the respected text Medical Middle East and Far East by A.S. Walker:-


Many of the more severely wounded did not survive the ordeal of the hours in the water, which was covered densely with fuel oil. Surgeon Lieutenant S.E.L.Stening R.A.N. who was wounded, was amongst those saved: they were picked up by a Japanese destroyer and transferred to the Somedong Maru, on which they were imprisoned for a week. After some days a Japanese Army surgeon came with two assistants and good equipment, and with the help of Stening and a petty officer dressed the wounds, though insufficient dressings were left for after care.  Some 300 men were then taken to Serang in trucks, where they were kept in the gaol and cinema. Only after ten days were the medical officers released from the gaol cells.  Stening had only a dressings forceps and scissors and very few dressings with which to work, and quite inadequate drugs to treat the dysentry and malaria which soon beset the 600 men in the prison compounds.  After a month ,during which two deaths occurred, Stening and twelve other officers were taken to Batavia and shipped to Japan…..


In 2006 I (the compiler of this article) had email contact with a survivor from the USS Houston David Flynn from Florida USA.  He remembered Sam Stening and provided me with the following comments.-


On March 1st., 1942, I was picked up by a Japanese Whale Boat and taken to a Japanese repair ship.  There were five or so other American prisoners on board. I was taken to their "sick bay", had some shrapnel removed and joined the other prisoners.  We were questioned by their captain.   We were fed and treated well.  We knew nothing.  Time elapsed (don't know how much but somewhere around a couple of hours) and the ship was torpedoed.  I put my trousers on (inside out) and went over the side.  At this point I was again picked up and joined Dr. Stening on the Jap destroyer.  I did not meet or talk to him. Topsides of the Jap destroyer was covered with prisoners - English, Australian and as far as I know one American (me).  My experiences were similar to the first page of the reference letter.


I was imprisoned in the cinema in Serang, Java. We were required to sit cross legged and my immediate associates were English.  I distinctly remember asking one of the English gentlemen what he did in civilian life.  He told me he was a "clark".  I had difficulty in understanding him.  It later developed that he was a "clerk" in civilian life.  The cockney accent had me floored.


My English friends took me to see Dr. Stening. Dr. Stening had offices (outside) and in back of the cinema not far from an open latrine.  Dr. Stening removed more shrapnel using a razor blade as a scalpel.  Again I remember requesting something to smoke during surgery.  Dr. Stening told them to give to me only after he was finished with the work at hand.  I spent the remainder of the war in bicycle camp in Batavia (now Djkarta).


In 2007 Sam Stening’s brother Malcolm Stening provided me with the following account (next paragraph) of his brother’s time in Java and Japan.  Uniquely, Sam is one of the few Australia’s who were in Japan for over three years.  He moved from Batavia on the Maru Ichi around 1 April 1942 with a small number of POWs (including 4 other Perth officers).  Sailing was via Takao, Formosa and the vessel arrived at Moji, Japan after about 14 days.  It is said the POWs looked like a lot of hobos, being bearded and wearing ill fitting, cast-off civilian clothing perhaps looted from the Dutch on Java. (Reference- Death on the Hellships- Prisoners at sea in the Pacific War by Gregory F Mitchno).


“They left Batavia on the night of the 28th February after refuelling, and soon sighted a large enemy force north of Sunda Strait, Houston was hit and took fire; Perth was also hit and, all ammunition being expended, the order “abandon ship” was given.  Severe damage continued to be inflicted on Perth after the order to abandon ship.  The forward medical station was still receiving patients at the time, but the sick bay had been wrecked by a shell.  Further torpedo hits caused damage and casualties on the other part of the ship.


Captain ‘Hec’ Waller, a sick man with jaundice from gallbladder disease, went down with his ship on the bridge.  In Perth out of a complement of 682 men only 229 survived the sinking to become prisoners-of-war.  My brother, Sam, who was sent to Japan as a prisoner-of-war was awarded the Distinguished Service Cross (DSC) and received unstinted praise for his courage, care and protection of his fellows in the years of internment.


Sam reports:  “About 240 men, including myself, were picked up from the sea by destroyers and other ships and transferred later to the Somedono(sic) Maru.  A Japanese army surgeon and two assistants arrived next day and I helped them to tend the wounded, removing shrapnel, dressing wounds, treating eyes damaged by fuel oil and resplinting a compound fracture of a leg.  S.B.P.O. Cunningham, S.B.A. Mitchell and P.O. Telegraphist Fowler also helped.  The instruments and dressings provided were good and two days after additional small supplies of dressings were obtained, but thereafter nothing more was forthcoming.  After a week the men in the Somedono Maru were transferred either to the civilian gaol or to the cinema at Serang in Java.”


We had to sleep on bare concrete.  Hygiene, when it existed at all, was of the primitive form, and although orders were obtained for a minimum of sanitary precautions, it was almost impossible to ensure they would be carried out.  The average diet consisted of cold rice and a green vegetable and occasionally small pieces of fish or meat, with certain additions for the sick, which were obtained from Dutch internees.  Cooking conditions were filthy.  The galley was never cleaned and was traversed by a water channel used as a sewer.  Permission was later given to construct an oven for baking bread and for two open ranges.  Medical care was at first completely lacking.  Then one day a Japanese army surgeon came and did some dressings – the first attention some of the prisoners had had.  After an interval dressings were done for several days by a Chinese and a Javanese doctor.  These local doctors also made a sincere effort to obtain any drugs or dressings which were requested.  Lieutenant Burroughs, an American naval medical officer, was released from his cell to help, and for several days I too was allowed to help.  Finally, Lieutenant Burroughs was ordered by the Japanese to attend to all men in the gaol, and I the men in the cinema.


In the cinema were 600 prisoners, servicemen of different nationalities.  They slept on bare floors, and used the seats as fuel for cooking.  They had no water for washing, and no proper sanitary arrangements.  Later a pit latrine was dug alongside the sleeping quarters, the only available space, near which the cooking and boiling of water was also done.  Efforts to improve conditions failed at first because of lack of materials, but after a time field kitchens were erected.  I saw at least 100 to 120 men at the daily muster.  A Chinese doctor attended too, and C.P.O. Bland, a cook, gave invaluable assistance.  I tried to arrange for all the sick to be sent to the local hospital.  After some weeks I succeeded in having two transferred, but as they received no attention other than what could be given by two American cooks sent to prepare their food, their condition may have been worse than before.


Some of the men both at the gaol and in the cinema were suffering from severe injuries.  One rating had a wound involving the posterior tibial artery:  he was operated on successfully by an American medical officer with a Japanese army surgeon giving the anaesthetic.  Other men had to submit to surgery without an anaesthetic and carried out with the only instruments available:  a pair of scissors and a pair of forceps, both rusty.  Under these conditions shrapnel was removed and a sequestrectomy performed.  Men who were in the water when the already sinking Perth was struck by further torpedoes showed evidence of thoracic or abdominal blast.  All but one recovered, but very few facilities existed for treating them or others who became ill while at Serang.  Malaria was prevalent.  As the only clothing many men possessed was a loin-cloth it was impossible for them to take precautions against the bites of mosquitoes, and while there was a small amount of quinine for treatment, none could be spared for prophylaxis.  Dysentery and diarrhoea were also rife and, with only charcoal to treat them, soon reached epidemic proportions.  There were two deaths.  During my months stay there were no further deaths, despite the conditions.


On 5th April 1942 I was taken with four other Australian officers from Perth and eight American officers From Serang to Batavia, where we embarked in a Japanese transport for Japan.  Conditions on board were far better than those at Serang and during the voyage the health of the prisoners improved considerably.  We arrived at Moji 5th May and went by train to Ofuna near Yokohama, an interrogation camp under naval control.  From Ofuna I was taken with four officers from Perth to Zentsuji, the main prisoner-of-war camp in Japan from 1942 to 1943.  It was designed as model camp for officers.  On arrival the prisoners were required, under duress, to sign an undertaking not to attempt escape, but apart from this there was no mental strain.  It was permitted to send a radio message and to write letters, and some of the earlier inmates had already received mail.  There was a canteen, classes in a variety of subjects, deck tennis, a weekly walk through the countryside and an area set aside for the rearing of rabbits.  The diet, prepared by the prisoner’s own cooks, was adequate for a sedentary life.  The men who were working, mostly American sailors and marines from Guam, were given extra rations.  At first captured clothing was issued periodically; later it was sold to officers.  Red Cross comforts and foodstuffs were received at the camp, and a scanty distribution by the Japanese began.  It was noticed that a number of men developed subcutaneous oedema soon after their arrival from Ofuna.  However, this soon disappeared, presumably with a heightening of their metabolism due to improved diet.  Some medical treatment was entrusted to officers of the U.S. Army Medical Corps, but I was not so engaged.


In November 1942 an emergency medical party was sent from Zentsuji to Moji to attend to the passengers of a Japanese transport, the Singapore Maru, which had just arrived from Java and Singapore.  The unfortunate men on board, originally about 1,000, had been confined in unsanitary holds for a month, without sufficient food; they had suffered a terrible outbreak of dysentery and over 90 had died.  The medical party, consisting of eight medical officers, one dental officer and about 30 medical orderlies, was divided into three groups.  I was included in one under Lieutenant Commander Moe, United States Navy.  When our group arrived at the ship all the fit prisoners and the majority of the sick had been removed.  The remainder were very sick.  We were faced with the major task of separating living from dead.  Down into this forward hold we gazed upon a filthy, odorous mass of rubbish, excreta, food, clothing and equipment amongst which we could see here and there a body which may or may not have been still living.  One man there was not suffering from any illness but from complete exhaustion.  He was Gunner C.W. Peacock, of the Royal Artillery.  Single-handed, he had cared for, fed, comforted and nursed the sick men in the hold.


Despite the bitterly cold weather, none of the sick had winter clothing, and our party quickly covered them in our own warm overcoats.  The patients were then transferred by junk to the Shimonoseki quarantine station, where Moe’s group looked after them for two months with the somewhat unwilling help of a few Japanese nurses attached to the station.  The accommodation at Shimonoseki was adequate, the sanitation good, and the heating moderately so.  Medical equipment and supplies, however, were scanty, and it was only by daily supplication of the Japanese.


From October 1943 to June 1944 I was senior officer and the only allied medical officer in Oeyama camp.  This camp was on Honshu Island near a nickel mine, in which the inmates, clad in thread bare garments, carried out heavy work in rain and slush; when they returned to camp at night, wet to the skin, they had no change of clothing.  One gang worked for more than a week up to the knees in icy water.  Work bosses pushed the men to the limit of their endurance, and often the sick were forced to work, thus contributing to the death of many of them.  Food though good at first soon fell off in quantity and quality.  The lot of the workers was improved by the medical officer’s decision to give them 360 grams of grain ration daily, although this meant cutting down the ration of resting men to 250 grams, plus what additions could be spared.  These difficult conditions were lightened by the arrival of the Red Cross food in December, almost a parcel to each man.  However, the unaccustomed food, added to the extra for Christmas supplied by the Japanese, upset many of the men.  In March more Red Cross supplies arrived but most of those set aside for the sick were retained by the Japanese, who also kept some of the general supply for the camp until a successful appeal was made to the camp commander.


In June 1944 the Japanese doctor produced a ration scale of 3,700 calories for the workers and 3,400 for resting men.  However, as most of the items on the scale were never received regularly, the actual figures were well below this.  As hunger increased the men in the camp became more difficult to handle.  They would steal from each other and from the Japanese and these later thefts, if detected, led to severe punishments.  In May 1944 I was empowered by the camp commandant to take control of the discipline of the camp and all the punishments.  On the whole, this system worked well.


Hygiene was rigidly enforced by the prisoner’s own administration.  Notwithstanding, diarrhoea was rife:  it frequently became a chronic and was often a terminal event.  As was to be expected, malnutrition was prevalent, particularly beri beri with or without oedema.  Thoracic and abdominal effusions occurred, and often followed the administration of sulphonamides, even in a low dosage such as 1 gram daily for two days.  “Painful feet” resisted treatment, and skin affection, due to local conditions, were very common.


Taisho camp was also in the Osaka area.  I was sent there in June 1944.  Previously the medical care of the prisoners at Taisho had depended on a medical orderly who had worked and fought well for his patients.  Some of the prisoners were doing labouring work and others more specialised tasks at the Osaka ironworks.  Food was good at first but deteriorated when a new Japanese quartermaster was appointed.  Red Cross food came in November and helped the men through the winter, while their diet was further supplemented by the products from their own garden.  Another improvement was the provision by the Japanese camp staff of a midday meal for men who were working.  Still malnutrition was rife in the camp, a predisposing cause being the prevalent diarrhoea.  Beri Beri of all kinds was common.


At the time of my arrival a Sergeant Nakate was the camp commandant, and the prisoners were treated well.  When he was replaced by Sergeant Kakuia harsh and capricious treatment became the rule.  All Japanese, including civilians, were given licence to indulge their sadism, men were punished, often severely, for minor offences or for no offence at all.  One man was stripped and made to stand in the open with the temperature below freezing point.  A Japanese sergeant then threw buckets of water over him after first breaking the ice from the tops of the buckets.  The sick were often ordered to work and appeals on their behalf by the medical officer were mostly disregarded.  Conditions improved from November 1944, the improvement being coincident with the beginning of air raids over Honshu Island and especially over Osaka itself.  A never to be forgotten sight was the flight of American heavy bombers over Osaka in broad daylight, and later the big fire in Osaka, when incendiaries also rained on the camp.  As the confidence of the Japanese was sapped, so the prisoners gained heart.  The food supply both legal and illicit increased, work decreased and the Japanese officers began to live at the camp.


On 17th May the entire camp with the exception of a few men who were sick or otherwise useless to the Japanese moved to Takefu about 70 miles to the north-east of Osaka.  From 17th May until the end of the war there were 167 Australians from Taisho and 33 Americans from Umida in Takefu.  I was the only medical officer there, and in fact the only officer.  As was perhaps unavoidable in a camp of mixed nationalities, there was occasional friction.  Work in the nearby carbide factory was heavy:  there were many accidents and increasing numbers of men failed in health through being driven incessantly on inadequate rations.  Though Red Cross food was in the store, it was not forthcoming when requested, and, in May, June and July 1945, the food ration was reduced; it was further depleted by the thefts of the Japanese camp staff.  As at other camps, sick men were often forced to work.  Intervention on their behalf was sometimes successful but more often than not led to a worsening of their plight.


Punishments were frequent and I too suffered many indignities.  One barbarous form of punishment was popular with the Japanese.  A man would be forced to kneel on bamboo with crossed legs; another bamboo would be placed behind his knees, and a 4 gallon can of water on his thighs, which he would have to hold still without spilling.  This would continue for as long as an hour and a half.  One man after suffering this punishment had to be carried back to camp, and was unable to walk for four hours.  In one respect, however, Takefu was an improvement on other camps:  once the prisoners had returned from work and had entered their sleeping quarters they were usually left alone.  They did not suffer the mental strain of incessant intrusion by the Japanese looking for trouble and distributing punishments.  There were few serious illnesses in this camp but skin diseases caused by the chemicals with which the men worked were prevalent.  Some medical supplies were available having been brought surreptitiously from Taisho, and though the Japanese took Red Cross supplies to their quarters, they allowed modest requisitions to be filled, usually after furious argument:”


The following is copy of an article from the Medical Journal of Australia of 1 June 1946 page 773. Permission to reproduce the article has been given.  The article is titled EXPERIENCES AS A PRISONER OF WAR IN JAPAN By S.E.L. Stening   Sydney


“My ship was sunk shortly after midnight of February 28, 1942.  The survivors were in the oil-covered water for anything from seven to fifteen hours, and for this reason most of the severely wounded failed to live through the night.  A Japanese destroyer rescued many, who, on reaching the destroyer’s deck, were stripped and searched.  The oil-soaked clothing was immediately jettisoned.  Thus we began our prisoner-of-war life, quite naked, but well covered with oil, some wounded, but with no dressings or instruments at all.


After a day in the destroyer we were transferred to a prison ship.  Over 300 men were crammed into one hold, and here we lived, ate, washed on two occasions, slept and tried to care for the wounded and sick.  Some materials were acquired from the Japanese, but my entire stock of drugs, dressings and instruments fitted into a cardboard shoe box.  However, owing mainly to the sterilizing effect of the fuel oil and salt water, most wounds remained clean during our week on board.  There was only one death; this was from ruptured viscera caused by a torpedo explosion near the man in the water.


From this ship we were taken to a town in western Java, jeered at by the native populace en route.  Here about half were lodged in the local native gaol and half were housed in the cinema.  The gaol was of concrete, and we found it very difficult to rest on these concrete slabs, without clothing or pillow.  The medical officers were locked behind the bars and could do no medical work for ten days, during which time of the hitherto clean wounds became septic.  After ten days my daily duty took me, barefoot, on a hot tarred road, to the cinema about a third of a mile away, where I did a daily “sick call” for well over 100 men.  Dressings and medicines were extremely scarce.  I had one pair of dressing forceps and one pair of scissors, and with these I had to remove shrapnel and do other minor surgery.  For treating dysentery and diarrhoea there was a half-kerosene tin of magnesium sulphate and a small supply of charcoal.  Malaria soon appeared, and for this there was a bottle of some 200 tablets of quinine – this for some 600 men.  Food was in microscopic amounts twice a day, but was supplemented by those few who had negotiable currency.


There were only two deaths in that so-called camp in the four weeks during which I was there, and then twelve other officers and myself were taken to Batavia, thence to a ship and sent post haste to Japan. Once arrived in Japan, this small party was taken straight to an interrogation camp near Yokohama.  In his camp communication with the other prisoners was absolutely forbidden, the diet was about 1,200 calories a day, and here our party languished for five months.  I attempted to assume the position of camp medical officer, until a difference of opinion with the Japanese navel medical orderly led to both the patient and myself being severely beaten with sticks as the “star turn” of a special parade.


Soon after this, in May or June – that is, three or four months after capture – deficiency diseases began to appear.  Some men developed oedema and some developed signs of pellagra.  The latter complaint was most intolerably itchy, weeping eczema of the scrotum.  I can assure that a summer can be most uncomfortable when one is suffering from that complaint.


It was while we were in this camp that we were told that we were not prisoners of war, but still the enemy, the only difference being that we were not unarmed, and that we would not be prisoners until we entered a recognized prisoner-of-war camp.  We were treated accordingly.


We became prisoners officially when we had the great good luck to be sent to the next camp.  There were many medical officers in this camp, both American and Australian; but only two Americans were allowed to practice.  After some two months’ rest and recuperation here, a special party of doctors and orderlies was hurriedly organized and sent to the west to the relief of prisoners brought to Japan in a “hell ship”.  This ship had left Singapore with over 1,000 prisoners aboard; 80 had died between Formosa and Japan from starvation and dysentery.  A further 200 or more died after Japan had been reached.  With scanty materials we had to try to nurse back to health men suffering from most severe dysentery and malnutrition. Our party stayed three months on that job, and less than 60% of our patients walked out with us.  The remainder are buried somewhere in Japan.


For the next few months our small party of eleven travelled in several other camps for like emergencies.  Train travel was quite interesting.  The Japanese civilians never interfered with us, and our guards always made sure we had a comfortable seat by forcibly ejecting the appropriate number of civilians.  Touring Japan came to a close in October, 1943, when I was sent to a new camp on the north coast of Honshiu Island, and it is about some of the medical problems I encountered there that I should like to talk.


This camp was originally one of 200 men, but another 100 arrived in January of the next year.  The men began their sojourn in Japan in fair condition, but soon they were being laid low by the severe climatic conditions and hard work.  It was soon the camp with the worst health record in Osaka area, owing to diarrhoea and deficiency diseases.



Diarrhoea soon became almost universal.  It is certain that a considerable proportion of the prisoners suffered from chronic bacillary and amoebic dysentery – about 30% of those in the camp, I should judge.  But it should be noted that I was never able to do more than inspect the stools and the patient, so my figures may be quite wrong.


As I have said, diarrhoea became universal, and this was the commonest type:  it was a diarrhoea directly related to diet, especially a diet containing an excess of indigestible matter – for example, soya beans, wheat, or a species of partly hulled rice known as “rubber rice”.  The men were starving hungry and used to eat leaves and grass, berries and acorns, with dire results.  Such a meal lay heavily in the gut of the consumer, and after four or more hours he would begin to feel “bloated” and to eructate huge quantities of foul gas.  Diarrhoea soon followed, and before long the sufferer was dehydrated, weak and suffering agonies from colic.  The stools consisted of about a litre of brown fluid containing much undigested food, sour-smelling and bubbling merrily from fermentation.  One could usually tell the exciting factor of the attack by inspecting the stools, for much matter was excreted unchanged.


In treatment, a preliminary dose of castor oil if available gave excellent results, while magnesium sulphate prolonged the attack into the second week.  The drug of choice was “Carbarsone”, one capsule being given once or twice a day for two or three days.  The sulphonamide drugs – sulphaguanidine, sulphadiazine and sulphathiazole – were also efficient even in as small doses as 0.5 grams twice a day.


The diet was reduced to a minimum; but meat and fish were never withheld even in the most severe case.  It seemed so important that each man should have his last milligramme of protein that I encouraged the patients to eat their meat or fish in the hope that some at least might be retained.


The attacks of diarrhoea aggravated any existing vitamin B deficiency and often precipated an exacerbation of clinical beriberi.


The Deficiency Diseases

In this camp of 300 men, I had under treatment at one time (May 17, 1944) 209 suffering from beriberi, 156 suffering from pellagra, 120 suffering from defective eyesight, and eight suffering from nerve deafness.



All the 209 men suffering from beriberi had oedema of mild or severe grade.  In some of these cases the condition could not be distinguished from starvation oedema, but since this condition appeared to pass slowly into the final stage of wet beriberi, I did not try to dissociate them.  A tremendous quantity of vitamin preparations was needed to treat these men, so, since there was only a limited supply, the drugs were rationed according to the severity of the disease.


In my experience the presence or absence of reflexes meant little in the diagnosis of beriberi.  Some of the most severely affected patients I saw, who died by drowning in their own fluids, had a positive reflex until a few days before death.


Bradycardia was the rule, pulse rates below 40 per minute being common.  Any sudden rise in pulse rate was of bad prognostic significance; but men sometimes died with pulse rates of less than 30 per minute.


Blood pressures were always low, the lowest being 88 millimetres of mercury, systolic, and 64 millimetres, diastolic.


The severest cases of beriberi appeared after an attack of diarrhoea or pneumonia which had been treated with sulphonamide drugs.  The effect of all the sulphonamide drugs, even in as small dosage as one gram per day for two days, was to cause an exacerbation of the oedema, usually after a latent period of a week.  Sometimes this exacerbation was pronounced, with oliguria, anasarca, ascites and hydrothorax.  I considered then that the cause was combined liver and kidney failure from the toxicity of the drugs used; but I now know that the cause is the destruction of the intestinal bacteria and subsequent failure of certain vitamins.


In treatment huge doses of thiamine hydrochloride up to 120 milligrammes per day (50 milligrammes by intramuscular injection) had only slight effect.  Other means tried to promote diuresis were the use of sodium caffeine benzoate, “Salyrgan”, urea, “Scillaren” (a preparation of squill), digitalis and hot kidney packs. All these had little effect.  Restriction of the intake of fluids, even to total prohibition, until the tongue was dry, brown and cracked, gave good results.  Salt restriction was unnecessary, since we rarely had any salt.  A diet rich in protein was tried; eight to twelve ounces of canned meat product with 130 grammes of bread and a little fluid gave the best result of all in the only case in which it was tried.  Unfortunately supplies were not enough for another case.


Paracentesis abdominis and paracentesis thoracis were performed frequently.  The loss of protein in this form of therapy was serious but unavoidable.


In this camp of which I am speaking over a period of eight months, there were 41 patients with ascites, nine of whom died; of these 41 patients there were 21 who were subjected to paracentesis abdominis, of whom nine died.  There were nine subjects with pleural effusion, of whom one died; while of the four men who underwent paracentesis thoracis, none died.


My most severe non-fatal case was that of Canadian, who was in hospital for over six months with anasarca, hydrothorax and ascites.  This man ran the gamut of all treatment, including huge doses of thiamine, riboflavin and nicotinic acid.  He suffered paracentesis abdominis  more than 40 times, over 161 litres of fluid being removed; 300 millilitres of fluid were also removed from his thorax.  This was the case in which the high protein diet was so successful.  The patient was oedema-free when last examined.



The most prominent symptoms of pellagra that I saw were as follows:  glazed tongue and angular stomatitis; dark, fish-scale skin; eczema of the scrotum; defective vision; painful feet; diabetes insipidus and polyuria; mental deterioration.


Now the syndrome of “painful feet” may be present without other signs of pellagra.  This syndrome presents with burning, tingling, shooting pains and numbness in the toes, feet and legs, and occasionally the hands.  This condition led to much misery, sleeplessness and even death from pure exhaustion.  Relief was found from exposure to cold, and so these men used to sleep, in winter, with their feet poking out from under their blankets; they walked barefooted on frozen ground and soaked their feet in icy water.  The result was gangrene, analogous to the “trench foot” of the last war.  The skin of toes, whole toes and even feet would become gangrenous and separate after a period of months.  Of the 200 men in camp, no less than 85 were affected in some degree in the months of December, January and February.


The loss of sleep from the “painful foot” syndrome was much diminished during the winter months, since most of the men had partly frozen feet with complete anaesthesia almost to the knee.  There was no way of avoiding the frozen feet, since the men had to go to work; many had no socks, their boots had worn out, and they were wearing Japanese canvas and rubber boots which remained wet until the snow and slush of winter had passed.  These men had to work in snow and water, exposed to icy winds, with little clothing and poor food for all that dreadful winter.  Finally, when rubber knee boots were provided late in February, it was found that many men were too weak to lift one foot after the other in them, and so they had to revert to their smaller, wet, canvas boots.


In that camp, out of 200 original workers, 36 or 18% lost their lives from exposure, diarrhoea and malnutrition, including one man who froze to death under eight blankets.


Another symptom of pellagra that I should like to mention is the frequency of micturition and enuresis which occurred.  Diabetes insipidus is stated to be a symptom of pellagra, and these men certainly had it.  A diet of soup, boiled grain and tea supplied a sufficiency of fluid, which was eliminated gleefully by efficient kidneys.  The men’s bladders became increasingly sensitive, and it was no uncommon thing for a man to get up and pass urine fifteen times in a night.  Some men found it impossible to hold their urine until they reached the latrine, and they eventually reached a stage when they passed their urine in bed through sheer exhaustion.  As these men slept in every stitch of clothing they possessed, all their clothing, blankets and mats became wet, smelly and sodden with urine.  Punishment was their lot when this state of affairs was discovered on inspections.  You can imagine the feelings of the Japanese when a urine-soaked sleeping mat produced a fine crop of mushrooms early in the summer.



I have mentioned only a few of my experiences; other camps were similar, and so I close, hoping that I have given you an idea of my last visit to Japan.


*Read at a meeting of the New South Wales Branch of the British Medical Association on March 15, 1946”.


Post War Dr Sam Stening resumed his life as ………………………………………….?



This account was compiled by Lt Col Peter Winstanley OAM RFD JP and has been assembled from a number of sources, hence sometimes there is repetition of the information.   The compiler makes no apology, he just wanted the story to be told.


Did Sam Stening marry etc?                              When did he die?