Ophthalmic and Aural Work
When one of us joined the hospital as oculist and aurist and registrar (Lieut.-Col. Barrett) he was informed that specialists were not required, but apparently those responsible had formed no conception of the excessive demands which would be made on the ophthalmic and aural departments. The first patient admitted to No. 1 General Hospital was an eye case, and an enormous clinic rapidly made its appearance. It was conducted somewhat differently from an ordinary ophthalmic and aural clinic, in that (by reason of the remoteness of their camps) some patients were admitted for ailments which would have been treated in the out-patient department of a civil hospital. There were usually from 60 to 100 in-patients and there was an out-patient clinic which rose sometimes to nearly 100 a day. It should be remembered that these included few, if any, serious chronic cases, which were at once referred back to Australia. The amount of ophthalmic and aural disease was very great. The figures subjoined show the extent of the work done.
From the opening of the Hospital to September 30, 1915, the patients treated in the Ophthalmic and Aural Department numbered as follows:
| Ophthalmic cases | 1,142 |
| Aural, nasal, and throat cases | 1,474 |
| There were 246 operations. |
The ophthalmic cases may be roughly classified as follows:
| Ophthalmia (chiefly Koch-Weeks and a percentage | |
| of Diplo-Bacillary) | 546 |
| Affection of lids | 15 |
| Pterygium | 8 |
| Corneal opacities | 6 |
| Trachoma | 17 |
| Iritis | 12 |
| Cataract | 8 |
| Foreign bodies in the eye | 14 |
| Old injuries | 9 |
| Detachment of retina | 2 |
| Strabismus | 16 |
| Concussion blindness | 4 |
| Refraction cases: | |
| (a) Hypertropia | 210 |
| (b) Myopia | 30 |
| (c) Hypertropic astigmatism | 230 |
| (d) Myopic astigmatism | 15—485 |
| —— | |
| 1,142 | |
| ==== |
Aural, Nasal, and Throat Cases
Operations Performed | |
| Ophthalmic | |
| Excision | 36 |
| Iridectomy and extraction | 11 |
| Removal F.B. | 7 |
| Pterygium | 4 |
| Minor operations | 6 |
| — | |
| 64 | |
| == | |
| Aural | |
| Mastoid operations | 17 |
| Removal F.B. | 3 |
| — | |
| 20 | |
| == | |
| Nasal | |
| Adenoids | 73 |
| Spurs | 34 |
| Polypi | 14 |
| Tonsils | 41 |
| — | |
| 162 | |
| == | |
| Total performed, 246 | |
The distribution of disease is unusual. In the course of a long and extensive practice one of us (Lieut.-Col. Barrett) had not seen as many cases of adenoids in adults as he examined in Egypt in three months. It seemed that the irritation of the sand containing organic matter caused inflammation and irritation of the naso-pharynx. Of ophthalmia there was a great deal. It was usually of the Koch-Weeks variety, and gave way readily to treatment. There were a few cases of gonorrhœal ophthalmia, two of which arrived from abroad, and all of which did well. After the arrival of the wounded, however, a new set of problems made their appearance. A limited number of men were totally blind, mostly from bomb explosions, and a large number of others had received wounds in one eye or in the orbit. It soon became evident that an eye punctured by a fragment of a projectile is almost invariably lost. The metal is non-magnetic. It is usually situated deep in the vitreous; it is practically impossible to remove it even if the eye were not infected and degenerate. A still more remarkable phenomenon, however, made its appearance. If a projectile enters the head in the vicinity of the eye, and does not actually touch it, in most cases the eye is destroyed. Whether from the velocity or the rotation of the projectile, the bruising disorganises the coats of the eye and renders it sightless. In all such cases, if the projectile was lodged in the orbit, the eye was removed together with the projectile. The total number of excisions was thirty-six. In no case did a sympathetic ophthalmitis make its appearance. The eyes were not removed unless the projection of light was manifestly defective. A fuller account of the precise ophthalmic conditions will be published elsewhere.
If the general physical examination of recruits was defective, it is difficult to find suitable terms to describe the examination of their vision. Instances were not infrequent where men with glass eyes made their appearance, and there were several recruits who practically possessed only one eye. Spectacle-fitting was the chief work, as many of the recruits required glasses, mostly for near work, but sometimes for the distance. Ultimately the War Office decided to provide the spectacles. In such a war, it is impossible to exclude recruits for fine visual defects, still, men with only one eye can hardly be sent to the front.
One remarkable instance occurred. A man suffering from detachment of the retina had but one effective eye. I gave directions that he should not be sent to the front, but he eluded authority, and reached Gallipoli, where he was hit in the blind eye with a projectile. I subsequently removed the eye.
The work was excessive, but only one life was lost, though on occasion the condition of some of the sufferers was grave to a degree. One of the most remarkable cases of injury was that of a man who was struck below the left eye by a bullet which emerged through the back of his neck, to the side of the median line. The bullet in emerging tore away a large quantity of the substance of the neck, leaving a hole in which a fair-sized wine glass could have been placed. He was a cheerful man, and sat up in bed propped with pillows, because of the weakness of his neck, and observed to a visitor "Ain't I had luck!" He made an excellent recovery.
It is remarkable that there should have been so much refraction work, and there is no doubt that a working optician, i.e. spectacle maker, should accompany every army. Men are often just as dependent for their efficiency on glasses as on artificial teeth, and in a war of this character cannot be rejected.
The acute inflammations of the middle ear were of the most severe type, caused temperatures rising to 103° F. and sometimes left men on convalescence as weak as after a serious general illness. The attacks were so vicious that the pathologist, Captain Watson, sought for special organisms, but found only staphylococcus. Probably the same group of organisms which caused vicious pulmonary attacks also caused these severe aural inflammations.
Before our arrival in Egypt malingerers in the force who, having enjoyed a holiday trip to Egypt, wanted to go home again, suddenly discovered that they were blind or deaf. For a time the department was fairly busy detecting the wiles of these men. When they discovered, however, that they would be subjected to expert examination, sight and hearing soon returned. A number of devices were resorted to in order to detect the fraud—i.e. the use of faradisation, blind-folding, and the like—and it was rarely that the impostor escaped.