The Australian Army Medical Corps in Egypt Part 9

AURAL, NASAL, AND THROAT CASES

Acute catarrh (middle ear) 95 Chronic " " " 315 Cerumen 190 Dry catarrh (Eustachian) 120 Oto-sclerosis 138 Ot.i.tis externa 143 Concussion deafness 139 Nasal catarrh 114 Septal deflection 96 Adenoids 74 Polypi 4 Enlarged tonsils 12 Antra and sinuses 14 Pharyngeal catarrh 11 Aphonia 8 Laryngeal growth 1 ----- 1,474 =====

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 gonorrhoeal 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 gla.s.s 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 gla.s.ses, 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. .h.i.t 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 quant.i.ty of the substance of the neck, leaving a hole in which a fair-sized wine gla.s.s 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.

[Ill.u.s.tration: HELIOPOLIS PALACE HOTEL: ROTUNDA AND PIAZZAS.

_To face page 97_]]

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 gla.s.ses 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.

OTHER DISEASES: MEASLES AND ITS COMPLICATIONS; FOOD INFECTIONS

The danger run by an army from measles is very great indeed, and at an early stage the position was surveyed, and an attempt made to limit the trouble. A cable message was sent to Australia, asking that precautions should be taken against s.h.i.+pping measles cases or contacts. At Suez arrangements were made with the Government Infectious Diseases Hospital to admit any patients suffering from measles or infectious diseases who might land with the recruits. In such cases the clothing of the remaining recruits was disinfected before they were allowed to proceed to Cairo. In this way disease was kept out of Egypt as much as possible.

In the case of measles it is not simply temporary disablement, but also the complications and sequelae which are to be feared. The experience gained has made us converts to the open-air method of treating such cases, at all events in a rainless country like Egypt. Treated on piazzas and in open s.p.a.ces the cases seem to do better than in hospital wards, and, as far as one can judge without a critical examination, with a lower mortality.

The extent to which the troops suffered from measles and other diseases was the cause of the appointment of a committee to inquire into causation. The committee made some inquiries, but owing to a set of complications never completed its work. There seemed, however, to be a consensus of opinion that the use of the bell tent was objectionable, as it did not ventilate readily, and that the habits of the men contributed to these diseases.

The men were apt to visit Cairo, spend the evenings in the cafes or theatres, ride home in the cold nights in a motor car or tram, get to bed at the last moment possible, and then turn out again for a hard day's work. The opinion of the physicians was that the drilling of men suffering from even a moderate cold was a source of considerable danger.

If to these causes be added the neglect of the teeth on the part of many of the men, some explanation may be found for the presence of these diseases. Every effort was made to instruct the men through the regimental officers, and there is no doubt that as time went on the quant.i.ty of this type of disease somewhat diminished.

Sunstroke was practically unknown. A number of cases occurred during a severe khamsin, but the use of a looser and lighter uniform, and the adoption of sensible hours of work, prevented any recurrence. Of two deaths known to have taken place the cause was only partly due to heat.

The men were warned against the risk of bilharzia, and as they were provided with shower baths there was no inducement to bathe in the muddy pools and ca.n.a.ls where bilharzia lurks.

With the provision of dentists another risk was removed, at all events in parts. In hospitals, tooth brushes were supplied in thousands, and every effort was made to get the men to use them.

As the summer wore on, however, another type of disease made its appearance--the intestinal infections which, at first unknown, became so frequent in Gallipoli as to be more serious than fighting. In Gallipoli itself it is difficult to see how they could be prevented. In a limited s.p.a.ce there were many dead bodies scantily buried, and consequently myriads of flies. The plentiful use of disinfectant, had it been obtainable, might have been useful, but the difficulties were great.

Once the dysenteric organisms were introduced, it was practically impossible to stop the spread of disease.

THE FLY PEST

At the Island of Lemnos, however, which was not under fire, and where there was room, the conditions appear to have been nearly as bad, and it is somewhat difficult to know why the fly pest could not have been got under at Mudros. At Heliopolis at an early stage the fly problem was seriously tackled. A sanitary officer was appointed, and charged with the duty of dealing with this important matter. The following precautions were adopted. All refuse and soiled dressings were placed in covered bins, which were provided in quant.i.ty. These were removed once daily. Any moist ground in the vicinity of these bins was watered with sulphate of iron solution, and sprinkled with chloride of lime. Fly papers in great numbers were distributed throughout the wards. The food in the kitchens, whether cooked or uncooked, was kept under gauze covers or in gauze cupboards. By these means the fly pest was reduced to small proportions. But with the least slackness in administration the flies were again in evidence. It was most instructive to see a floor covered with flies if fluid containing food material had been spilled, and to see dirty clothing covered with ma.s.ses of flies. A piece of soiled clothing half buried in the desert appears to act as an excellent breeding-place.

It was impracticable in Egypt to cover all the windows and doors with fly-proof netting. The exclusion of the air in the hot weather would have been troublesome, and the best type of netting was not obtainable.

Furthermore the precautions already enumerated kept the pest under in Heliopolis.

The fly problem was one of the most serious the army had to face. The pa.s.sage of a dysenteric stool by a man who is really ill was often followed by the entry into his a.n.u.s of flies before an attendant had time to intervene. Each of these flies might then become a source of infection and had only to light on a piece of food, cooked or uncooked, to cause further damage.

CIRCULAR ISSUED BY THE OFFICER COMMANDING THE HOSPITAL _Destruction and Prevention of Flies_

_Outside._

1. No rubbish heaps will be allowed.

2. All manure heaps shall be sprayed twice a week with sulphate of iron--2 lb. to 1 gallon of water.

3. All food in the Arab quarters shall be kept in a closed cupboard.

4. All rubbish boxes and open receptacles shall be removed from the premises and neighbourhood.

5. No receptacles other than iron tins with lids kept closed will be allowed to be used for refuse.

6. Every place on which garbage has been exposed shall be freely sprinkled with chloriated lime.

_Wards._

1. All food and receptacles for food shall be kept constantly covered.

2. All spit-cups shall be kept covered.

3. All remains of food shall be removed at once to receptacles which are to be kept covered completely and constantly except when uncovered necessarily to receive waste materials.

4. Sisters-in-Charge shall use a liberal quant.i.ty of fly papers. Surgical soiled dressings shall be placed in special bins which shall be kept covered.

_Kitchen and Mess Rooms._

1. All food shall be kept locked up or completely covered.

2. All remains of food shall be treated as in the wards. The responsible officer shall use a liberal supply of flat or hanging fly papers.

It need hardly be said that the enforcement of even these simple precautions is more difficult than giving the order.

A good sanitary officer, however, acting on these directions, can and did reduce the fly danger to small proportions. The flies were never exterminated, but were kept well under. The least slackness, however, ended in their rapid reappearance. As they are in all probability the princ.i.p.al cause of the gastro-intestinal infections, the matter is one of the first importance.

Typhoid fever made its appearance, and a proper statistical investigation should be made later on to show the extent of the damage done. The general impression respecting the result of the inoculation to which all the troops were subjected was that the disease was not so frequent and certainly not nearly so fatal as it otherwise would have been. Deaths were few.

The men had not been inoculated against paratyphoid, so that exact conclusions will be difficult to draw even when figures become available.