S. stercoralis infection is common amongst ex-FEPOWs, particularly those from the Thai-Burma Railway project. It is usually characterized by a 'larva currens' rash and marked eosinophilia. The condition is eminently treatable, and continued diagnostic surveillance is needed, if cases of potentially fatal hyperinfection are to be avoided.

Though medical consequences of war attract attention, the health consequences of the prisoner-of-war (POW) experience are poorly researched and appreciated. The imprisonment of Allied military personnel by the Japanese during the World War II provides an especially dramatic POW scenario in terms of deprivation, malnutrition and exposure to tropical diseases. Though predominantly British, these POWs also included troops from Australia, Holland and North America. Imprisonment took place in various locations in Southeast Asia and the Far East for a 3.5-year period between 1942 and 1945. Nutritional deficiency syndromes, dysentery, malaria, tropical ulcers and cholera were major health problems; and supplies of drugs and medical equipment were scarce. There have been limited mortality studies on ex-Far East prisoners (FEPOWs) since repatriation, but these suggest an early (up to 10 years post-release) excess mortality due to tuberculosis, suicides and cirrhosis (probably related to hepatitis B exposure during imprisonment). In terms of morbidity, the commonest has been a psychiatric syndrome which would now be recognized as post-traumatic stress disorder--present in at least one-third of FEPOWs and frequently presenting decades later. Peptic ulceration, osteoarthritis and hearing impairment also appear to occur more frequently. In addition, certain tropical diseases have persisted in these survivors--notably infections with the nematode worm Strongyloides stercoralis. Studies 30 years or more after release have shown overall infection rates of 15%. Chronic strongyloidiasis of this type frequently causes a linear urticarial 'larva currens' rash, but can potentially lead to fatal hyperinfection if immunity is suppressed. Finally, about 5% of FEPOW survivors have chronic nutritional neuropathic syndromes--usually optic atrophy or sensory peripheral neuropathy (often painful). The World War II FEPOW experience was a unique, though often tragic, accidental experiment into the longer term effects of under nutrition and untreated exotic disease. Investigation of the survivors has provided unique insights into the medical outcome of deprivation in tropical environments.

Background: Burning feet syndrome (BFS) has been described anecdotally in the literature for over 200 years. Described subjectively by patients as burning, prickling and unremitting with nocturnal exacerbations, the condition draws parallels with the burning dysaesthesia found in diabetic peripheral neuropathy, and appears to display a similar chronicity. Despite being a common symptom, especially among the elderly, its etiology in non-specific and often marked by a lack of objective clinical signs. Historically, burning feet syndrome has been recorded in situations of poor nutrition, including malnourished African populations in the early 20th century, South American plantation workers in the 1920s and during food shortages in the Spanish Civil War. Perhaps the best described and largest outbreak of burning feet occurred amongst prisoners of war (POWs) of the Japanese during the 2nd World War in South East Asia and the Far East. In this review we summarise reports of the condition, in particular amongst Far East POWs (FEPOWs), using both the available literature as well as a unique and previously unknown contemporary study carried out in a POW camp. Materials and Methods: During his stay in the Tandjung Priok POW camp, Nowell Peach recorded 54 cases of burning feet seen over a 4 month period during captivity. This data was concealed from his captors and survived to return home with him. Results: 54 prisoners presented over a 4 month period with a mean age of 28 years and mean duration of symptoms of 12 weeks. Neurological signs were meticulously documented. All were on an inadequate diet, 20 (38%) were on less than a full ration. Accompanying tropical infections were common including malaria (73%), dengue (45%) and dysentery (41%). Discussions: The Peach survey confirmed the frequency of burning feet amongst FEPOWs and was unusual in that the neurological examination and conditions endured were documented in captivity. A paucity of physical signs was noted, and a suggestion that burning feet could be precipitated by intercurrent infection. Conclusions: Burning feet syndrome can be regarding as an antique medical condition as chronic malnutrition becomes less common. This hidden study carried out during captivity provides remarkable new insight into the disease which is now essentially unknown to modern practitioners.

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