FEPOW and LSTM

On his return from the Far East in November 1945, Lieutenant Colonel Phillip Toosey resumed his business life in Liverpool. In 1947 he re-joined the Territorial Army (TA) in Liverpool, taking the rank of Honorary Brigadier. To this day, as testament to his service to the TA, their base in south Liverpool till bears his name, the Brigadier Phillip Toosey Barracks.

During his captivity Toosey had been senior British officer at Tamarkan Camp in Thailand. It was the prisoners of war in this camp who built the infamous "Bridge over the River Kwai". He had been a charismatic leader, and was much respected by his men (listen to audio description here). After the war he helped to organise regular meetings for former prisoners, many of whom were having difficulty returning to civilian life. He noticed that a number were having health problems – in particular attacks of recurrent diarrhoea or fever.

Smithdown road hospital

Through his professional links in Liverpool, Toosey had met Professor Brian Maegraith – the recently-appointed Dean of the Liverpool School of Tropical Medicine (LSTM). When Toosey told him of these health problems Professor Maegraith agreed to see the men. They were admitted to Smithdown Road Hospital where LSTM had a tropical diseases ward and it was discovered that a number were suffering relapses of amoebic dysentery or malaria. So began a link between FEPOWs and the LSTM which was to last over 60 years.

The front elevation of the military hospital, Queen Mary’s, Roehampton (courtesy of the QMH archives)

Professor Maegraith and his colleagues continued to see FEPOWs and during the 1950’s the School’s reputation in FEPOW care grew and referrals from outside Liverpool increased. At the same time, nationally, most FEPOWs were seen at the “FEPOW Unit” of Queen Mary’s Hospital, Roehampton – a specialist military hospital in south London. In 1968 Queen Mary’s became an NHS hospital and as a result the FEPOW Unit closed.

The Liverpool School was asked by the Department of Health to take on the national lead role in FEPOW care and screening. Maegraith and Professor Herbert Gilles (Professor of Tropical Medicine) fully supported the invitation and during the 1970’s and 1980’s large numbers of FEPOWs were seen at the School’s Tropical Unit at Sefton General Hospital, the majority of whom were under the care of Dr Dion Bell.

Dr Bell was Senior Lecturer (later Reader) and Honorary Consultant Physician at the Tropical School. He saw literally hundreds of FEPOWs and his sympathetic and expert clinical care led to him achieving legendary and iconic status amongst the FEPOW community.

Dr Dion Bell

Born in 1931 in Yorkshire, Dion Bell was a graduate of Leeds University Medical School. In the early 1950s he spent two years national service with the Royal Army Medical Corps (RAMC) in Ghana where he developed his lifelong interest in tropical medicine. His clinical interests were primarily in gastrointestinal disease and he developed a particular interest in parasitology and epidemiology related to tropical disease of the gut.

Dr Bell was tireless in his clinical care of FEPOW. Following their repatriation in late 1945, many FEPOW had suffered from the effects of myriad tropical illnesses which often went undiagnosed and untreated for decades post-war. His interest in their health, both physical and mental, and their general welfare (for he also recognised the silent burden of these problems on the individual’s family life), brought him the undying respect, admiration and grateful thanks of thousands of FEPOW and their relatives over the years.

Far East veterans could be referred to LSTM by their GPs, some even referred themselves. But the majority was sent to Liverpool by the Ministry of Pensions as a result of applications for war pensions.

Brigadier Toosey (left) in conversation with Steve Cairns, 1970sSteve Cairns, a FEPOW and veteran of the Thailand-Burma railway camps, was the National Federation of FEPOW Clubs and Association’s (NFFCA) national welfare adviser. Steve had been encouraged to take on this role as early as 1947 by Brigadier Philip Toosey, when he had been a long-stay patient at Smithdown Road Hospital.

One of his key roles was liaising with FEPOW clubs across the UK, assisting the men with applications for war pensions. Over many years he worked closely with both the Ministry of Pensions and also staff at LSTM; he and Dr Bell became close associates in their work with, and for, FEPOW.

Dion Bell relished a challenge. Many of the FEPOW that he and his colleagues were seeing in Liverpool were found to be suffering from illnesses associated with previous tropical disease infection – malaria, dysentery (amoebic), persistent strongyloidiasis (an intestinal worm infection) – as well as resulting from a range of nutritional deficiency diseases, such as beriberi and pellagra, with associated and persisting neurological disorders.

As a result of the growing number of pension claims received from this group of war veterans, the Ministry of Pensions asked LSTM to lead the Tropical Disease Investigations screening programme (known as TDIs). As well as providing clinical care and treatment, rigorous scientific research by doctors and scientists at LSTM investigated these longstanding health problems and many detailed studies were published in medical journals during the subsequent four decades. These included reports in prestigious journals on subjects such as persistent strongyloidiasis, long term neuropathic syndromes, the general long term health effects of Far East captivity, as well as new methods of diagnosing conditions such as Strongyloides stercoralis.

Initially, FEPOW who came to Liverpool for TDIs had to be in-patients at Sefton General for five days to allow sufficient time for the wide range tests for tropical and general medical conditions to be carried out. Later on, due to the advances made in laboratory testing, men attended as outpatients with those coming from outside the area staying overnight at local hotels. During the 1980s the numbers of men coming forward as a result of these medical reports was such that LSTM could not cope and other centres around the country took on some of this work; military hospitals such as the RAF hospital at Ely, army hospitals at Catterick, Millbank and Woolwich and the Royal Naval hospital at Haslar.

A youthful-looking Dr Gill (rear left) observes as Dr Bell takes blood from FEPOW Bernard Sayles during a FEPOW meeting in Scarborough in 1979
Apart from their observational clinical research on FEPOWs and the laboratory diagnostic advances, in 1986 Dion Bell and Geoff Gill undertook a particularly unusual line of enquiry when they attended the NFFCA annual reunion taking place at the Grand Hotel in Scarborough. There they collected blood samples and completed health questionnaires in relation to persisting Hepatitis B infection and coronary artery risk factors among FEPOW (see news cutting). This work became known as the Scarborough Survey. Later on that summer, both doctors visited the annual reunion of Burma Star Association veterans further down the coast at Bridlington, where they repeated the research using these men as a control group. Results of this unique work showed that FEPOW had had very high levels of Hepatitis B infection during captivity and also, interestingly, that FEPOW had better than normal serum cholesterol levels. This work explained previous observations from the USA and Australia, showing increased FEPOW prevalence of liver cirrhosis but reduced occurrence of coronary heart disease.

Thanks to the incomparable efforts of Steve Cairns, this extraordinary, and in the history of LSTM, quite unique collaboration between patients and doctors, continues to this day.

As well as his clinical support and persuasive medical reports, Dion also inspired younger colleagues to undertake groundbreaking research and take forward the FEPOW programme. For more information about the work of Dr Geoff Gill, Dr Nick Beeching, Dr Wendi Bailey and Dr Kamaluddin Khan click here.

A charismatic and immensely likeable man, Dion Bell became a personal friend of many FEPOW and rightly enjoyed legendary status among the wider FEPOW community, not only for his pioneering work, but also his dogged determination.