Halifax Town (part 3 of 3)

( 'ERTAINLY the compassion of the community - its eager heartfelt sympathy - must go out to iRobert Simmons, a returned soldier of the S5th Battalion in the heavy load of sorrow fallen upon him thru the great catastrophe. Mr. Simmons' home was at 5 puffua street. Hie family consisted of his wife and two fine children - the picture of this group, Of a brave man's dearest is here I sliowii. The mother was killed by I the explosion. The smiling older I child with arm clasping his mother's neck lost the sight ofj both eyes; the baby, sitting in happy confidence on the mother's | knee, lest the sight of one - well ' may such sorrow as this stir us to Li very passion of ministry.

Mr. Fisher, an oil merchant, well f . known thruout the city. whose h I home was at 40:, '4 Gnttln.gen I. I street, had his house completely de- 1 jmollshed, his wife hc'iig badly 1 cut and having one arm broken, [ while he has lost the sight of one 1 eye.

It l8 t««nty-four days since the explosion. In thet short period twelve etaergenoy hospitals in Halifax, three in Truro, and one in Hew Glasgow and t'.v«lva or more emergency dressing stations have oeen organized and now, with few exceptions, disbanded or consolidated. More than twenty-five t.ye Specialists from various cities have cone and now very generally gone. These Specialists, with the help of other physicians and nurses - and in the first days of any helpers who mig^t be at hand are generally thought to have cared for at least ons thousand eye cases. Of these, five or six hundred oases were, without doubt, cases of cuts or bruises in which no question of enucleation or impaired vision existed. Of the remaining four or five hundred cases of serious injury to one or both eyes, we have record of three hundred and thirty. Less than a third of these appear to be one eye enucleations or injuries with normal vision in the remaining eye, out it is evident, from the way in which reports of ons eye enucleations continue to come in, that there is no complete record as yet of this class of injuries, ihirty-eight (issforo this was transoribsd the nuumber had Inoreased to Al and other reports are coming in) recorded oases are Imown to be totally olind - as many as three years of way have contributed to the whole of Canada. Of the remaining two hundred and five, sixty-one appear to be seiloue conditions but the outcome is not yet known, while one hundred and forty-four are eases in which the doubt, whether to place them among one eye or two eye permanent injuries, oomes from inadequate Information as to the condition of the remain- in coneidering thi# or any report under conditions of the dieaeter, it is to he remembered that it represents only the beet information that is available at this date and may be open to considerable change, tto complete record exists or ever can be made of the work done in the first days following the disaster. l<'or a large proportion of recorded cases still under treatment, the end results cannot be known for many weeks or months, and with a rapidly scattering population, only partly known then. Serious as the eye conditions are they are overshadowed

3. I'hat in spite of every effort, the blind population of Halifax has been at least doubled in a stroke, and perhaps trebled. Time only will tell which.

At the requaet of -^rs. Lothrop of the fjnerican Red Cross, Boston, two workers (Vise I.uoy Vright and Miss Amy M. Hamburger) came to Halifax to prepare a report on the Blind Situation, reaching here

The Immediate causes of the Inquiry were (l) requests from the American Ked Cross CoijLattes at Halifax for special adYice in this direction (2) a request from ifx. d, . Allen of the 1'erkins Institution of i^ostoni that the American Red Cross consider the needs of the Halifax School for the Blind and (3) newspaper reports to the effect that there were seven hundred totally blind and eichteen hundred partially blind in Halifax as the rasult of the explosion.

Miss .right with Mias kata Hcliahon director of the American Med Cross in Hallfajt, made their first errand a conference with Sir fc'rederlck kraser of the Halifax School for the Blind. At this conference it was a«;rsed that monsy and facts were the two things needed, and that kiss Wright and kiss Hamburger could best spend their time in Halifax by helping to pool all available information in regard to eye injuries.

A simple card was arranged as follows for indexing all reported serious eye injuries, but not including recovered oases of outs and bruises in which there had been no question of impaired vision.

Sir ?rederlclf Fraser oontrlbuted copies of all lists that had been reported to him and Colonel Bell of the Uedlcal Relief Committee made available all u»t. recorded there. As there had boon no Special roport on the eye oases at the emergency hospitals at New Glasgow and Truro, where four emergency hospitals had been opened at the time of the disaster. Uies Wrigjit and .iss Hamourger ware advised to Visit there promptly, and did so. They found a total of fifteen

(b) Doubtful, that is, all reports of "both eyes injured", "one eye enucleated, ot/:ar under treatment", and any condition that seemed to require follow-up and was not clearly to be classed, either as "totally or practically blind" or "one eye enucleated, other eye normal vision"

List one ( Alpha oetioal ) was taken to the registration department to check for addresses or other information. List two was tacen to each hospital for additions and up-to-date information. This work was handled by liiss H:.mburger with the help of j/edical-Boclal workers attaohed to the various hospitals, and fitiss .^ary and Miss Agnes Murphy of Halifax.

In the meantime, through the co-operation of workers of the re-habili tation ooiaraittee under ^iiss bird, the Medical-Social workers under Miss Lmeraon, and the iJursing Service under iss O'drj^an, cards were placed in the iiands of a large group of workers doing visiting in the homes. Cards were also placed in the hands of Hobt. M. Dexter wiio was sent by the rehabilitation committee to visit refugees in all out-lying oities and towns.

A plan for district canvass had been proposed, but with so many patients ctill in hospital and fifty or sixty nurses and visitors coming and going in the districts, it seemed best to try this plan first, and post-pone with questions of follow-up and after-care, the llllintt out oy epdcial vroricors for a fuller schedule relating to ollndneo® ( »ee end of report). Many patients it is to be reaaejibered eero etill too ill to be spoken with.

«l88 Tfright saw br. Fred '..Ptephens of Poston City Hospital at St. *ary's College Hospital; Dr. J. # , Patton of Truro who was at ;amp Hill Hospital irarjediately after the explosion ami later at the Truro emergency hospitals; Dr. R. '-vatt iiathere of 34i horris Street Halifax who worked at the Victoria General hospital and had a small emergency houpltal at hie own office; Capt. Swartz of the loea Scotia Honpitsl and later at the Y.:.l.G.A. eaiergency hospital; Dr. uaffee of Providence, ^nodc Island, who worked with the Bellevue Military Hospital ami later at the Y.ii.c.A. hospital and Colonel King Smith of the Cogswoll '.treet Military Hospital.

a general rough agreement as to numbers and uncertainties of outcome due to dsleyod care, refusal to have enucle?.tion, question of foreign bodies, and the general uncertainty an to the results iollowing these

To amplify ay rejiarks as to tha nm^bcrs it auet te ramemDered that not all the operationa done on eyes were anoleations. There was a wild or«y df taJclns out eye*. In «y own work I know there

Jkany of these to my knowledge did well, others when I loft ttalifax were still in doubt; some had been desperate attemps to save a fraction of vision in one eye where the otner had been totallylost. So that I fear some, perhaps quite a numoer of these loay

Please pardon this hurried letter, 1 auu afraid 1 oan give you little information of uervice, out i know you thoroughly appreciate the problem oy now, and have no doubt your organization will be able to afford a great deal of much ne<^ded assistance in this connection.

there la not definite information enough to Judge outcome, 6l appear to have unfavorable progreeo but the final outcome is not yet given, prooaoly not yet known.

The group -One eye Blind and one eye normal vision- numbers only 87, all oases m which there was not a clear statement of normal vision in the remaining eye have oeen left in "doubtful-. Of these 87 cases.

Tha needs su,ijieoted by these f inures are two, (l) jieed of adequate permanent provision for follow-up work and after care. (2) Need for added resources for education and care of both young blind children a«d blind adults, but especially of women.

In addition to the evidence of eye specialiet as to uncertainty of outcone in many cases, the practical problem can best be illustrated oy special instances as follows: -

(1) A child who received a blo« in the eye at the time of thd explosion had no trouble until two weeks later when she was suddenly unable to open the eye. Her Mother so far refuses treatment for her.

(3) One oi the e*aergency hospitals which luaij at any time be closed reports a child with a perforating wound in cornea and irie and a quesuion of tanss in the eyo-ball. The child le to return to tne out p.atlent department regularly, and all is well until tne ho jpitui is closed.

(4) A woina.i of 30 who has a jagged woufid in the eye, was advrsed to nave one e>e enucleated, she is pregnant and frightened, ner lecling can be understood, out the risks losing both eyes.

of 3^ had one ay® enucleated (iuring the early houae to house oanraea but hae had no rnedlcal care for a long time eince. The fatiie^ihJ has had no n.eiicil care at any lime hao what ap -oars to be a oerioue Injury to the Irnee-cap. the f amily appear- to be atill in a etate of shock and to need follow-uj In every eenss of the word.

of types of need, upon provision for which ho much of the future for eye oases depends. The importance of considering these needs is especially clear when we realize that iialifax is a City without a permanent ye Clinic and with only six or seven ye Specialists, of whom not an are active. For the moment, the situation is covered by the emergency hospitals and the large number of nuBses and social workers in the Jhstricts. an effoft has been :aade to acquaint all now. in the field both social workers and narses with the facts here outlined. but in view of the habit in all times of delay in going to tfte doctor, and the fact that eye conditions as only one of the oauses of suffering of refugees may easily be neglected, it is imperative to have a definite understanding how after-care is to be managed in Halifax from now on. :ye r-ipaciali sts make clear that the slightest pain or Inflaaatlon when the-e is nuestlon of a foreign body like gii4« in the eye, is to oe instantly heeded. Physicians assure us that »any eyes were lost in the district because of delayed treatment.

1. to be emohasized and re- emphasised. It 1. to oe remembered too. ihat eyes have never oefore been put to the terrible tests that cteriza this disaster. everal physicians have suggested the po.sioluty of Simple printed directions for wide dietribution. advising that heed be paid to symptons and advice sought of the nearest endnniiered by glase beforo in the world as in this explocion, and the i^reatest care is neceseap, that not a single one may be needlees. ly added to the Blind population, ihe greatest dangers are:-

Need for provinion of special care for the dllnd falls in t*o lines - (l) Ihe immediate need nt an experienced case vorlcer, recoenizod eapeclally at the iJospitale, and (2) heed of funds for special resources for tr-ininR and care, more particularly of *Tomen and otiildren.

ihe iin.i»ediate need of an experienced case worker, preferably attached to tiie School for the nlind, to whom canes ready for diecharge from the Hospitals or already discharged may be referred for special care is already felt. xhis is aa urgent as preTentire work. Not only because reassuring csre is needed for the newly blind through ^ome one who knows what life in the dark aeans and has confidence in the use of other sensee than that of eij^t, out because persons blinded in this disaster have endured other sufferings which increase immeasurably what has, in itself, heretofore been considered the most tragic nhysicial deorivatlon in human life. Patients in hospitals are beginning to be ready for the "curative oocupatione" that may kelp them face what is before them.

Home of the individuals now in hospital nearing the time of discharge who need a kind of care for which few communities have special provision are as follows:- hospital while her little daughter 9 years of age '>lind. is a patient in another. Iwo other children of this Mother were killed in the explosion little girls, were seen la one hospital, one about 2^ years old had had one eye enucleated, a hand nearly severed by outs and oad cuts on face; the other child, about 20 months old, had had to have both eyes enucleated; the visiting workers met the volunteer hefetofore inexperienced in nursing, who had. the night of the disaster, held these children during their operations.

A Uother 4;p years of age, now tot-^lly blind had five children of whom one is missing, one lost a leg, one is suffering from other serious injury, and one ie totally blind. The father was probably killed as he has been misning since the explosion. The child of their married dau^ter in also totally blind and badly mutilated.

A Mother of 39, totally blind, had a child of ten totally blinded in the explosion who has since died. A second Child aged twelve has lost one aye. The husband, a soldier, is in the trenches overseas.

tlo recommendation can be made for appropriation of money or offer of service for the blind of Halifax without an understanding of local provision for care of the blind. Uallfax is the one community in Uauada equipped with a School for tlie dlind of International reputation which cares for both children and adults. It Islhe School for the ' aritime Provincea. There is Government provision for payment to the School of an allowance for edouation for all blind persons from six to twenty-one years of age. There is al»o provielon for

-IJapvropriatlon for the epeclal tralnlnif of adulte recommended ae euitaole candidates. The School hae aleo eerred In training a email group of soldiers disabled oy blindness. .<inoe the war the finances of this School hare naturally been affected as hare those of other Institutions. It is a difficult problem for an Institution in a community doubly taxed oy war and disaster to suddenly face the needs of a blind population. - at least doubled, and an increase in the blind population in an entirely new direction. - notably of women between the ai^es of 21 and 4^.

;ork for the blind is in any case expensive, and in case of caring for women to whom few and ill-paid occupations are open and in this instance of vromen deprived of their natural means of support as well as their sight, the cost must be very great. '<i^atever action the Government takes, it is sure to be delayed by the complex questions involved in settlement and it is wholly conceivable that the form of relief decided upon may not touch the questions of shelter and curative occupation that are so immediate. The privilege of assuming a share in bearing this burden is open to the American Hed Cfoss.

31r Frederick and Lady Fraser have already opened their own apartments for the care of blinded infants when they are ready for discharge from the various hospitals and have passed the need' for medical and surgical care.

From the jL-oeurd and Corporation of the Hohool for the Mind a Committee was appointed on December IJth as follows for Halifax iilind Relief work.

Occupation

it is twenty- four dsys since the explosion. In tost snort period, twelve emergency hospitsls in helifex, three ii^ iruro, end one in i<eir Glasgow, and twelve or more emergeaey dressing ezetions have been organized, snd now, with few exceptions, disbanded or consolidated. itore than twenty-five eye specialists from various cities have come end nor, very generally, gone. These specialists, with the help of other physicians and nurses, - and in tne first days - of any helpers who might be st hend, are generally thought to have cared for at least one thousand eye cases. Gf these, five or six hundred were without doubt cases of cuts or bruises in which no question of enucleation or impaired vision existed. Cf the remeining four or five hundred cases of serious injury to the eight of one or both eyes, we have record of three hundred and thirty. less tnen a third of tnese appear to be permanent injuries to or enucleations of one eye, with normal vision in the remaining eye, but it is evident from the way in which reporte of one eye cases continue to come in, that there is no complete record as yet of this claas of Injuries, In even a short walk through the streets of halifax from December 21 to January 1, it has been common to meet a half dozen adults and children with one eye closely bandaged, Ihlrty-eight* recorded oases are known to be totally blind, as many as the total of blinded soldiers contributed by three years of war to the whole of Canada.

Of th« remeinlng two hundred and five, sixty-one appear to be serious conditions, but the outcome is not yet known, irhile one hundred and forty-four are cases in viiich doubt, whether to place them among one eye or two eye permanent injuries, comes from inadequate information as to the condition of the remaining eye. with few exceptions, all records represent permanent injury to at least one eye.

In considering this or any report under conditions of the disaster, it is to be remembered that it represents only the best information that is available at this date, and mey be open to considerable change. **0 complete record exists or ever can be made of the work done in the first days following the disaster, jor a large proportion of recorded oases still under treatment, the end results cannot be known for many weeks or months, and with a rapidly scattering population, only partly known tnen. uerious 88 the eye conditions ere, they are overshadowed for the present, even in cases of total blindness, by crushing family trsgedies. Several have died during the course of enquiry and others sre seriously ill from other oeusee than eye conditions.

2. I'hat from the neture of the injuries, much of the future depends upon tne amount of follow-up work end after-orre developed from now on.

At the request of Ars. Xothrop of the iimerican xied Oross, Boston, two workers (Aiss Lucy Wright and Liss Atny a., damburger) came to dalifax to prepare a report on the "Blind Bituetion", reaching here December twenty- first .

2. A request from jar. i. Jii . Allen of the rerkins institution of Boston, that the American Bed Cross consider the needs of the Balifex -school for the Blind, and

5. iilewapsper reports to the effect that there were seven hundred totally blind and eighteen hundred partially blind in nalifax as the result of the explosion.

Aiss Wright with -^ies Late AcAshon, Director of the American Bed Cross in nallfax, made the first errand here a conference with oir jsrederick i'raser of the halifax i-chool for the Blind. At this conference it was agreed that money and facts were the two things needed, and that Aiss Wright and i^iss iiamcurger could beat spend their time in Belifax by helping to pool all available information in regard to eye injuries.

AS there had been no special report on the eye cases at the emergency hospitals at aesr dipsgosr and I'ruro, where four emergency hospitals had been opened at the time of the disaster, ii-lea aright and Mss Hamburger were advised to visit there promptly, and did so. They found a total of fifteen eye injuries, with loss of one eye in fourteen cases, and both eyes in one case. Additional esrds for reporting were left with the eye specialists in both towns.

"one eye enucleated, other under treatment", and any condition that seemed to req^uire a follow-up and was not clearly to be classed, either as "totally or practically blind" or "one eye enucleated, other eye normal vision".

List 1 ( Alphpbetice 1 } was 'taksici to tiie registration department to check for addresses or otner iaformation. list 2 yas taken to each hospital for additions ana up-to-dste Information. This work was handled by -^iss iia.mburger with the help of iledioal-Sociel workers attached to the various hoapitals, end l^iss liery and "*iEB Agnes iiui^hy of nalifex.

in the meentime, through the co-operation of y/orkers of the hehabilite tion Committee under -liss .oird, the Aedicalijocial workers under kiss imierson, and the hursing oervice under kiss C'hrien, cards were placed in the hands of e large group of workers doing visiting in the homes. Cards were also placed in the hands of Jtr. i^eiter, who was sent oy the Aehabilitation Committee to visit refugees in all out-lying cities and towns.

-A. plan for district canvass had been proposed, but with so many patients still in hospital, and fifty or sixty nurses and visitors coming and going in the districts, it seemed best to try this plan first, and postpone, with questions of follow-up and after-care, the filling out by special workers of a fuller schedule relating to blindness. Uee end of report).

Sn the meantime, impressions of numbers and extent of injuries were to be gathered by conference with eye physicians and other. kiss Aright saw x»r. i'red h. Stephens of boston City nospital at St. kary's College x^spital; i)r. .. xatton of Xruro, who was at Camp uHi hospital immediately after the ex- plosion and Istsr at the iruro emergency lioapitals; hr. h. nvatt i^athera of ^4 \l2 ::orri8 street, i^lifax, who worked at the Victoria General nospital and at a small emergency hospital at his own office; Gapt. Jwertz of the i).ov8 ocotia -capital and later at the 1. C. A, emergency hospital; hr. i^uffee of Irovidenoe, nhode island, who worked with the Bellevue iiHitary nospltel and later at tne hospital, and Colonel king Gmith of the Cogswell street hilitaxy -aospitel.

following is a letter from i^r. George Cox of hew Glasgow, which gives an idea of impreesione gained in tnis way. There seems to be a general rough agreement as to numbers end uncertainties of outcome due to delsyed cere, refusel to have enucleation, questions of foreign bodies, and the general uncertainty as to results following these unprecedented causes of eye injury.

Two instances were reported in which individuals who had lost an eye earlier in life, lost tlie remaining aye in the explosion. One instance occurred in which e glass eye was shattered and the remaining eye happily untouched, one physician showed a helf-lnch triangle of glass which he had removed from an eye where it hsd penetrated to the optic nerve. Another showed a half-inch square of glass which he had removed under similar conditions. ^ few eyes were reported ruined by blows, but the "blizzard of glass" was the one great cause of eye damage.

"Of course 1 take it your enquiry applies solely to ceses connected with the explosion. As to the cases with which I dealt £t Halifax, I have no records, i was there from six p.m. that Ihursday until the following i'uesdey. The first twenty-four hours it was a question of dealing as rapidly ss possible with a huge mass of people at Oamp ^111 where 1 was.

one or both eyes passed under my care the first two days, 1 can therefore form no idea. Beginning oaturday efterno.on, however, I was able to have a record kept and to begin a census of the eye cases on the lower floor of the nospitel which had been my privete preserve, and these records were left at the hospitel. -.esntime of course the cases were rapidly being dispersed so that ss you now realize, it will be a matter of time and search and advertising to reach them.

and so on. I don't know, but 1 judge one hundred will cover the final total. ihat will include the number who in the next few weeks, or montns, or a year may lose the sight of the remslning eye from sympathetic ophthalmia, either from

"I heve had, since i came hosie, to remove three 'single* eyes from victims end enclose their ca.rds; in each cese there is no danger of impeirment of the other eye.

To amplify my remarks as to the numbers, it must be remembered that not all the operations done on eyes irere enucleations. Ihere iras no -aild orgy of taking out eyes. In ay o'Tn work i. know there was a large number of 'repair Jobs', iridectomies, trimming up prolapsed irises, suturing wounds of cornea and sclerotic, end so on.

"-^ny of these to my knowledge did well; others when ^ halifax were still in doubt; some had been desperate attempts to save a fraction of vision in one eye where the other had been tota.lly lost. i>o that I fear some, perhaps Quite a nuMber, of these may prove failures and finally fall under the dread classification of 'blind'.

"I lease pardon this hurried letter. 1 am afraid i can give you little information of service, but I know you thoroughly appreciete the problem by now, ana have no doubt your organization will be able to afford a greet deal of much needed essistmce in this connection.

j'ollorlng ie the list of iye specie lists tio far secured. Later official reports from Uolonel Bell's office trill, irithout doubt, complete this end other records

Halifax, Cesember 15 - "One of tne saddest effects of this awful disaster," said I;r. a. a. ^rvey last night "will be the great number of blind it will leave in nalifax. Irobebly two hundred children will be sightless and a deplorable nxunber of adults " aed uross unit and is assisted by yr. *xerry ^xessenger. ne is warm in his praise of the work that was done by the Halifax civil and military doctors in those first awful hours of agony and it was with a splendid spirit of willingness that he came to their assistance for hr. Hervey is a xialigonian by birtri, having left this city in ^ d fl^h ® cousin of C. n. Harvey, of tne marine lasp night, is the fact that there were meny children whose eyes were injured who were not sent at once to the hospitals for proper care. flew cases are being discovered every day where if the patients had been taken at once to the hospitals, something mlgnt

^0 understand; howoaes would prefer to stay at home, thinking that they were making room for more serious cases, v^ur unit is concareful and systematic search for cases in homes tnat should be attended to at the earliest possible moment, ihe headquarters of the unit ere at the xialifax J^nfirmery."

rwL distressed. He, with hr j or xiough, arnight, and in the storm Hundey they made a houseiiff to inwii e large number of places in the &orth x.nd attendbe^ffi people. a simple Instance of their good work may be given. They met a little girl in the street with her eye bandaged hid* got a enquiries of the little girl and she said she

The group of 205 marked "doubtful" represents the group from which by follow-up we should in time be able to place each one in one of the three divisions;- Totally blind in both eyes; blind in one eye, normal vision in other eye; or recovered sight la both eyes There is little reason to expect that many who have been registered in this list will belong in this lest group.

Of these 2O5 cases, 144 appear to have had serious injury, but there is not definite information enough to judge outcome; 6l appear to have unfavorable prognosis, but the final outcome is not yet given, probsbly not yet known.

Ihe group "One eye blind and one eye normal vision" numbers only 87; all cases in which there was not a clear statement of normal vision in the remaining eye have been left in "doubtful".

(1) Weed of adequate permanent provision for follow-up work and after-care eepeclally for the 205 "doubtful" cases. (2) ineed for added resources for education and care of both young blind children and blind adults, but especially of women who constitute seventy-five per cent, of the group from 21 to 4^ years of age.

In addition to the evidence of eye speoialist as to uncertainty of outcome in many cases, the practical problem can best be lllustrsted by special instances as follows:-

(1) A child who received a blow in the eye at the time of the explosion had no trouble until two weeks later, when she was suddenly unable to open the eye, uer mother so far refuses treatment for her.

closed, reports a child of 4- 1/2 years with a perforating wound in cornea and iris, and a question of glass in the eye-bell. The child is to return to the out patient department regularly, end all is well until the hospital is closed.

(4-) A woman of JO who has a jagged wound in the eye, was advised to have one eye enucleated; she is pregnant and frightened, her feeling can be understood, but she risks losing both eyes.

(5) Another type of case is represented by a fpjnily in which a child of 5 1/2 years had one eye enucleated during the early house- to- house canvass, but has had no medical care for a long time since. ihe father, who has had no medicel cere at any time, had what appears to be a serious injury to the knee-cap; the family appears to be still in a state of shook and to need follow-up in every sense of the word.

The particular oaaes cited here will get attention beceuse they are now known. They are given here only by way of illustration of types of need, upon provision for which so much of the future for eye cases depends. The importance of considering these needs is especially olear when we reslize that helifsjc is a '^ity without a permanent iye Clinic, and with only six or seven eye specialists, of wnom not all are active. Jor the moment, the situation is covered by the emergency hospitals end the large number of nurses and social workers in the districts. Through group meetings an effort has been made to acquaint all now in the field, both social workers and nurses, with the facts here outlined, but in view of the habit, in all times, of delay in going to the doctor, and the fact that eye conditions, as only one of the causes of suffering of refugees, may easily be neglected, it is Imperative to have a definite understanding how after-care is to be managed in Halifax from now on. It is to be remembered that the "follow-up" idea from a preventive or public health point of view, hss not been developed in Halifax up to the present time.

The need is, however, so olear, and the response to the suggestion has been so prompt, that it seems practicable to carry out, if an acceptable plan can be made. In making a plan, the character of the refugee families of Halifax should be kept clearly in mind. They represent a group of self-directing citizens, economically Independent before disaster. They have been accustomed to making their own plans and not to being planned for. ahstever arrangements are made should be wholly acceptable from tncir point of view. nothing has been more impressive in Halifax than the unfslling recognition of tMs feet, as shown in the attitude of more fortunate citizens of halifax towards their suffering neighbore. Inevitably this is not as keenly sensed by strangers who have developed efficient plane of work often adapted to the needs of an utterly different population.

iiye specialists make clear that the slightest pain or inflammation when there is question of a foreign body like glass in the eye, is to be instantly heeded. ihey assure us that laany eyes were lost in the district because of the delayed treatment. Ihis is to be emphasized and re-^mphasized. It is to be remembered, too, that eyes have never before been put to the terribly tests that characterize this dlsaeter, oeverel physicians have suggested the possibility of simple printed directions for wide distribution, advising that heed be paid to symptoms, end the advice of the nearest oculist sought. If approved by medical authorities, some such notice as the following might be tried;-

If you or any of your family or neighbours who sufferef \ by the explosion of i^ecember 6, notice the least pain or inf laaa^- \ tion of the eye, be sure to seek the advice of the nearest eye I specialist at once'. Many eyes are lost through delay, iyes j have never before in the world been so endangered by glass as in; this explosion, and the greatest care is necessary that not a i single one may be needlessly added to the blind population. - ih, immediate need of an exferlenoed after-oare worker preferably attaohed to the oohool for the Mind, to whom oases ready for discharge from the hospitals or already dlsoharged nay be referred for speoial care, is already felt. Ihls is' as urgent a, preventive work. hot only because reassuring oar. is needed for the newly blind through some one who knows alat Ilf. in the dark maens, and has confidence In the use of than that of sight, but beoause persons blinded In this disaster have endured oth-r sufferings which Increase Imneaaurebly what has itself, heretofore, been considered the -at tragic physical deprivation In human life, latlent. In hoe- Plui. are beginning to be reedy for the-ouratlve occupations" that may help them to face what Is before them.

(1) A woman of Jl now totally blind ie a patient in one hospital, while her little daughter, 9 years of age, totally blind, is a patient in another, iwo other children of tiiis mother were killed in the explosion and two were baaly cut, but will recover. xne husband and father was killed at his work, 'inis mother wanted to be told about -what blind women may do, and felt that there would be real chances in life for her little blind daughter, but few for herself.

(2) In another family, the mother, 55 years old, is totally blind, the father has lost one eye, end a child, aged 5, le totally blind. ihere were seven children in all in this family, of whom the remaining six are being cared for by aged grandparents. One of these children is tubercular.

a discharged disabled soldier, who has lost one leg, was not injured in the explosion, -hen their two children, little girls, were seen in one hospital, one, about 2 1/2 years old, iied had one eye enucleated, a hand nearly severed by cuts, and had bad cuts on face; the other child, about 2u months old, had had to have both eyes enucleated. i'he visiting workers met the volunteer, heretofore Inexperienced in nursing, who had, the night of the disaster, held these children during the operations .

(5) A mother, 4-5 years of age, now totally blind, had five children, of whom one is missing, one lost a leg, one is suffering from other serious injury, end one is totally blind, fhe father was probably killed, as he has been missing since the explosion, i'he child of their married daughter is slso totally blind end badly mutilated .

A mother of 59, totally blind, had a child of lu totally blinded in the explosion, who has since died. A second child, aged 12, has lost one eye. 'ihe husbena, a soldier, is in the trenches, oversees.

iio reoommendptlon can be made for epproprlstion of money, or offer of service for the blind of iisllfex, without an understanding of local provision for cere of the blind. Halifax is the one community in CEneda equipped with e Hohool for the Blind of internstionel reputetion, which cares for both children and adults. It is the Hchool for the iiaritlme Provinces. (see accompanying Annual Heport) . fhere is tiovernment provision mt for payment to the ochool of an allowance for education for all blind persons from six to twenty-one years of age. Ihere is also provision for appropriation for the special training of adults recommended as suitable candidates, ihe school has also taken part in the training of a small group of soldiers disabled by blindness. Hlnce the war, the finances of this School have naturally been affected as have those of other institutions. It is g difficult problem for any institution in a community doubly taxed by war and disaster to face suddenly the needs of a blind population, - at least doubled, end an increase in the blind population in an entirely new direction, - notably of women between the ages of 21 end 4-5. Aork for the blind is in any case expensive, and in oase of provision for women to whom few and ill-paid occupations are open, and in this instance of women deprived of their natural means of support as well as their sight, the cost will inevitably be greet. mhatever action the Government takes, it is sure to be delayed by complex questions l.nvolved in settlement, and it is wholly conceivable that the fora of relief decided upon may not touch the questions of shelter and curative occupation that ere so immedlcte. ihe privilege of

Glr irederick and ^dy -eraser have already opened their oira apartments for the care of blinded infants when they are ready for discharge from the various hospitals, end have passed the need for medical and surgical care.

Sir -arederick end lady -srescr have offered their little son's nursery to ell the children who as the result of the greet eetastrophe have lost their sight - most piteous fate', -.aster -e^red is very keen indeed to have the smell sufferers come in and very eager to do his bit to make them happy. oir .arederick, ever on the alert to secure for the blind the fullest possible advantage both in the matter of skilled medical attention and the educetion which takes away the chief terror of blindness (dependence), has been profoundly stirred, as has lady -eraser, by the wide spread injury to eyes, and both in conversation with ihe -aereld expressed the hope that suffering little children would be be brought to the nursery, where they will be given the tenderest ca re .

Arrangements have been made to open a -tJiursery in tne ^superintendent' s apartments, School for the Blind, for babies blinded by the explosion, where the little ones will be tenderly eared for. Applications for the reception of all children under six years of age should be made to Lady -Eraser, bchool for the Blind.

ifrom iioerd end ^orporstioa of the ^.chool for the Blind, a Committee was appointed on ^^ecember 15th, ae follows, for Halifax Blind relief work.

Ottawa, December Jl - Announcement was made here today that three thousand dollars has been subscribed by members of the Canadian xleheries association for the relief of tnose blinded in the nelifax disaster. ihe sum represents contributions from fishermen, skippers and dealers from all parts of Canada.

In discussing this question of eye injuries et xielifax, three questions ueuelly come up; do you account for the eerly reports of numbers? how do you account for the large proportion of women? ehet is your estimate of the final results? answers to these questions can be based partly on fact, partly on impressions .

ihe early figures were very nsturally exaggerated. In hospitals end on streets, the obviously large numbers of bandaged eyes still leave you with the feeling that figures of any size might be true. If you did not know that patients were often transferred from one hospital to another and counted three times, that two physicians who worked on the same case each reported it, and that a very large number of injuries were outside the eye rather than injury to the eye itself, you might still believe some of the higher estimates.

-Knowledge of individual histories lesds to the belief that the large number of women is accounted for by the fact thet the men of these families were in many cases killed st their work; the children in many cases killed at their school; while the mothers in a large number of homes, survived with injuries from blows end from glass.

As to fin®l results - tii®t is a metter pertly of facts, partly of Impressions. i'he facts so fer recorded, and the estimates of several physicians who have been close to the situation from tne start, point to one hundred as the probable list of "totally or practically blind in both eyes", ihe conditions that make this a minimum estimate and make 150 - 2iJU quite conceivable, ere that uncertainty of outcome is greatly increesed by the neglect incidental to an ill-protected population, suffering from many other than eye injuries, and often dispersed far from the cere of the eye specialist.

oir Jirederlck eraser believes the estimate of 21u persons being blinded is below the mark, ihe proportion of blinded in the army at the front is one in lO.Oti^. In xtp.llfax the proportion has been 55 lO.OCt.

ior some months halifax has been struggling with the problem of training the returned blind soldier for taking up life afresh. Tne explosion has added materially to the number of those people who will need such training, ihe majority of operations being performed throughout the City are. upon the eyes, and it is estimated tliat not fewer than 2wti or 250 of those who were injured will be totally blind. in one day the Victoria Ceneral -ucepital alone performed sixty operations for the removal of hopelessly injured eyes.

Two points of isaportence in an economio sense should not he overloolced. Cne it, that the eignificence of one eye losses cennot he minimized, especislly in the esse of men. It is Tell known thst the renks of the sdult blind are often recruited under ordinary conditions from men who have lost sn eye early, ssy through smell pox or injury, end thought nothing more about it until e dengerous trade, ssy the steel industry, deprived them of the other. It is to be remembered, too, that unless specisl provisions sre msde for employment of the hendiospped in industries coming under the iorkmen's Compensetion end the iwnployers' iiebility Acts, men or women losing the sight of one eye are liable to difficulty in finding employment in these occupstions under existing laws. It is true that many people have lived out their lives comfortPbly with the sid of only one eye, but the greatly increased risks both to eyesight and occupation cannot be overlooked.

serious economic condition of single blinded individuals, ee cannot assume, as some of the illustrations have already shown, the usual family background, isometimes there ere several blinded in one or both eyes in one family, in other Instances there may be only one blinded individual, but very little, or no, family has survived. iemllies where one out of forty-two connections, two out of ten, and so on, are all who remain, were commonly reported in Halifax. &ven with a surviving older generation, it is inconoelveble that grandparents In average olreumstanoes can afford the burden of care of e widowed blind daughter with a blind child and perziaps other uninjured children.

It is easily forgotten that txie handicap of blindness is a lifelong economic and physical handicap, - not a temporary one. iven if the numbers of blind are subetantielly less than eerly reports gave us, it is to be realized that tne economic situations and the extremity of immediate needs resulting from eye injuries cannot be exeggereted.

1. i'hat, without delay, the expenses of a small staff to be attached to the ochool for the £lind, consisting of a nurse, an after-care worker or workers, and a clerk, be authorized. The nurse, whether attached to the oohool or to a permanent local district nursing service, will devote herself to follow-up for preventive work; the after-care worker, or workers, will take up oases discharged from hospitels, and provide curative occupatione wherever needed; the clerk will keep up the register which is now in the hands of wir jirederick .araser. (^r. Carstens has wired this plan to 4.r. l-ersons for approvsl.)

2. i'hat 8 joint committee of three Oanediene and three itftterioans be asked to serve as advisers to the xielifax uchool for the Blind and the iunericen ixed Cross, in formulating farther plans for cere of the blind in nslifax. (ihe three persons named for the nelifex School for the Blind, are A.r. ->u6tice Barrie, C. j. I'ernan, end isir Frederick eraser. ii*.r. Carstens has wired Mr. xersons about this.)

J. That all tentative plans so far discussed for taking cere of the increased number of blind children in excess of school aocommode tions , and for the care of adults, especially of women, be held subject to the development of further follow-up work and to the co\mBel8 of the committee provided for above.

Beeore Explosion Befobl Explosion

* In case of "partial" blindness learn, if possible, physician's estimate of remaining fraction of sight after ell possible medical care and with the best glasses obteineble. Btete whether petient reiysrtmouth, ^^eceiaber 12 -- Jsmes Cooper, iiawthorne street vss the only resident In the south end of ^ertmouth irho tes killed -hen the first rumble of the explosion came, sne frentteallv grabbed her bebe and c second later vas blown tnrough the iiSiw fevering an artery in her throat and bleeding to death. ntv husband was away to work, and before the neighbors coulo get medical Bid ^re. Cooper was deed. ine baby has since died as a ^ult ff inluries suffered when it was blown through the window huddled in its mother's arms, a husband and one cnild survives.

jeverel well knotm ^/ertmouth women have lost tne sight of both eyes, while a number of others have sufferea the loss of one eye. Lts William ^umaresq, who resided at luft's Cove, had ootn eyes gouged out by coming in contact witn oroken glass, her nusband was killed at the plant of the xialifex breweries. nie bouy was founa on the railroad track soon after the explosion. he ..as a county consUble and had frequently worked at painting. uis wife and two out i'hey were in the house at the time of the explosion and because of the way in which it wrecked all means of escspe except by jumping from the bedroom window a distance of twenty-five feet, was ifith her two children huddled in one arm, i-rs. i/umaresq clung frantically to the broken window sash, crying wildly for help. Che clung there for nearly ten minutes, before assistance cam® "ied" Craham rushed into the house end heroically rescued her and her two children. After seeing that she wee well oared for he searched the neighborhood for over two hours for his wife and family rn®v were more or less severely cut by flying glass. ... .

It is believed that ibrs . C. a. Orathorne has lost tne sicnt of both eyes. ohe was in the house at the time of the explosion and was shelled by broken glass, aer house is .

The house wae badly wrecked, whe was removed to the home of hr father, br. -Morris of -middle J.usquodoboit . about the face, but not seriously, anc is able to

Ara. «-. 0. Bishop will likely lose one. eye. she is progreasing as well as can be expected, i^r . bishop's house on ileasen btreet, north, wae badly damaged, but is not beyond repsii.

George berguson, ir., motor-truck driver for the Ooasumers' Cordage Company, has lost one eye and may lose the signt of the ovier. .le was at the works when tne explosion occurred ana was looking at the fire from the business office window, i-eo Graham, manager of the works, had to have one eye removed end he :aay yet lose the sight of the other.

Are. Archie eraser, niindmlll noad, is recovering from her wounds. Her two children suffered severely. One child has lost the sight of both eyes while t .e other hes lost one eye.

iirs. uwen isawlor, relzsnt street, has lost the sight of hoth eyes. i**r - wpwlor is safe and the sou is recovering from outs, i'heir nome was destroyed, fire finishing whet the explosion left.

lir. fisher, en oil merchant, well known throughout the city, whose home wes at 4-U5 1/2 Cottingen street, had his house completely demolished, his wife being bsdly cut and having one arm broken, while he has lost the sight of one eye.

Certainly the compassion of the community - its heartfelt sympatliy - must go out to hobert oimmons, a returned soldier of the 85th battalion, in the heavy load of sorrow fallen upon him through the greet catastrophe. i.r. Cimiaons' home was at 5 Miffus street. his family consisted of his wife and two fine children - tlie picture of this group of a brave man's dearest is here shown. The mother was killed by the explosion. Ihe smiling older child with arm clasping his mother's neck, lost the sight of both eyes; the baby, sitting in happy confidence on the mother's knee, lost the sight of one. wiell may such sorrow as this stir us to a veiy passion of ^linistry.

Among those who lost one of their eyes in the explosion were hussel fard, the well-known athlete and an employee «t Gland's Brewery; iilss bvelyn iiacvoaeld, i»isynard btreet;

One eye blind, other defective, 3« One eye partially blind, otner defective, I5 One eye blind, other O.K., 242 One eye partially blind, other O.K., 22 One eye defective, other O.K., 24 One eye blind, other result unknown

One Eye Doubtful

Tne group "One eye blind and one eye normal vision" numbers 241;- all cases in which there was not a clear statement of vision in the remaining eye have been left in "doubtful". Of these 241 cases, g2 are males, 157 females, sex not Known 2. The age groups are as follows

8. When do you expect to finish such vocational study as can be properly made at this stage of recovery? in other words, when are you hoping to finish up?

11. Has the opposition of the local eye men, or anything else, encouraged private or publio (press) insinuations against the Committee receiving special contributions for blind relief? (I told Sir Frederick I had heard

I began my duties Jan. 17th, at that date the register contained 500 names of people suffering from eye injuries cqpsod by the Dec. 6th explosion. From the date of the disaster the school nurse Miss. Lockward had been constantly at work and beginning the afternoon of January 17th, her work was supplemented by the Victorian Order hurses. Five f^ull time Victoria Order nurses and one half time nurse wore kept busy visiting nev/ and revising critical eye cases to see that the sufferers were having every possible thing done to save sight. Our first policy was to give an order on an oculist where no oculist v/as already treating the case.

V/hen a sufferer v;as too ill to walk or go in the oar the nurse v/as authorized to take her in a carriage. Later stopped issuing order as the i.Ledlcal Relief had the matter in charge.

The good result of the faithful work done by the nurses cannot be counted in mere figures. Their v.'ork can only bo estimated on '^ho "stitch in time" basis. If the stitch is not taken all the world runs the extend of the damage but if the stitch is taken the dtuiiage is corrected or made so 8li( ht that it passes unnoticed. So with some of the eye cases whore the individual was too stunned, careless, ignorant or indifferent to realize the urgent need of iiimedlate and constant care, the nurses visits proved of untold value. Mo count will ever show how many people owe present sight to the follow up care of these nurses.

There v/ere many unavoidable delays in starting the eye clinic. The local oculists unfortunately looked upon the clinic as a criticism of their work. However after many disappointments a clinic was opened at the School fcr the Blind Jan. 31st. The original idea was to have a regulto: clinic opened at the School for the Blind every day and all day where eye disaster victims could come as tlieir right without in any sense being considered chai'ity patients and have eyes treated, receive glass eyes and be refracted if necessary.

It v/as found impossible to establish such a clinic, the best that could be done vfas to have a place where people could come for consultation.

The second clinic was hold from Fob. 15th-22 Inclusive with Dr. Hai'vey of Providence R.I. as consultant engaged oy the Halifax Relief Commission. Sixty-six cases attendea the clinic. The local oculists were on service and Dr. Harvey visited outside patients. Eye sufferers came for the comfort and peace of mind of knowing that they had done or >yMX. still doing, all that was possible to save- or regain vision.

to Dr. McDonald, Neurologist from Providence, R.I. who was in Halifax for a time. It was felt unfortunate that the Halifax Relief Commission v/ould not allov/ greater publicity, it is foiu-ed many did not know about this second clinic until too late. That the first reports of blindness following the disaster were so Itur-go, may be duo to the fact that dust, smoke and powder so inflamed eyes that many whose eyes are now all right have said that for aays the eyes were so swollen they could see nothing. Guts on lids or nei-or eyes, glass in eye but not affecting vision and other causes necessitating bandages, and the rromber of one eye enucleations all

The tea.cher from the School for the Blind is visiting and giving instruction in reading by touch, knitting, the use of writing board etc. Owing to crowded conditions under v/hich sc many are living it is difficult h both pupil and

Out of the seventy-one cases for whom "study" cards were made thirty-seven v/cre v/omen, of this' number four are already in the school for the Blind trhe Blind and seventeen have babies or little children to care for. Und_er ordinciry circumstances their time v/ould be considered t'lully occupied vrith the housekeeping and care of the children. As yet several have been semi invalids (many have other injuries besides the eyes) and the housing, living, relief Jind pension problems have been the questions they wanted settled first.

Prom nov; on seems the moment to awaken interest in in - distrlal training, to have teachers frequently visit and instruct in their homes those v/ho are not able or fit to go out. For those v/hc can leave home for at least a part of

Sir Frederick expects to stt-rt at the School for the Blind. Besides the opportunity for training under right conditions the fact of ^;ottlng cut, the change of scons and thought and the value of having definite v/ork to do at a definite time must tend for benificial results. Guides should be provided to take them to and from the School and their homes.

locked or disregarded, the explosion victims need to have their minds tiirned to cheerful things in oroer not to dv'ell on the horrors of the explosion.

The problem of the care, re-education and industrial training of these explosion victims is not one to be settled in weeks or it will need attention, study and v/ork indiflnitcly . The seeing and blind alike in Halifax wall need to be taught resources and possibilities ano. educatt.<^ to know what can bo done without sight through the cultivation of all other senses. If wisely led and thoroughly instructed the blind can accomplish much, but tiio sighted must also be educated to accompany them step by stop so that the

In response to a telegraa Jan,] 14tri, froir ttie Joint ixecutive Coanittee aSKini; le to tatie the aanatjement of a sight saving clinic to open io.a,eaiately viith a gcvernoeiU appoinleJ oculiat; I was sent up by the Aii-erican Rea Cross to .ord under Mr,' Allen (their representative) ana Sir freaerici (raser I tnsan u.y duties Jan,- 17ta, at tnat aate the register containea f^OO naita cl people sutlerins Iron eye injuries causea cy the Dec,- ^th explosion - Frott the aate or the disaster Miss Locs^ara haa been constantly at dors ana * beginning the afternoon of January l^tb. her .ori .as suppletentea cy t^e Victorian Order Nurses,: Five lull tiu.e Victoria Order nurses ana one hilt tiaae nurse .ere Kept busy visiting ne». ana revising critical eye cases to see that the sufferers were having every possible tning done to save sight,' Our first colicy was to give an order on an oculist where no oculist was already treating the case,] When a sufferer was too ill to waU or go in Me car the nurse was authorized to taze her in a carriage. Later etoppei Msuing order as the Medical Relief had the matter in charge,'

.e good result of the faithful word done by the nurses cannot re ante in cere figures,' Their word oan only be ectiaated on the "stitch in tUe basis,- If the stitch is not tawen ali the world runs the exten o ^

It was founa itr.possiele to estatlish each a clinic; the test that cojla ce aone was to have a place where people coula cone for consultation,'

One of the local oculists was on service e^ch afternoon with Dr,' Sterling cf Montreal as consulting pnysician,' Seventy-nine eye cases attenaea tne clinic,' Tne local acn tooK Dr.; Sterling arouna to patients in hospitals ana hones in the aornings,; ^

The secona clinic was held frotij Feb,- ihth-£2 inclusive with Dr,' Harvey Of Proviaence R.I. as cor.eultant engaged ty the Halifai Relief Coitiii saion,' Eiity-six cases atlendea the clinic.' The local oculists were on aervice ana Dr.' Harvey visitea outsiae patients.' lye sufferers caB.e for the coD.fort cina peace of Djina of mowing that they haa aone or were still aoing, all that was possible to save or legaiu vision,'

Many were retraction cases, many will neea later to have clastic operations,' Some were nerve cases and ware referred to Dr,' McDonala, Neurologist froir Proviaence, R. I. who was in Halifax for a tiae,' It was felt unfortunate that the Halifax Relief Coattission wouia net allow greater publicity, it la learea aeny aia not Know at, out this secona clinic until too late,' That tfe first reports of tiinaness following the atsaster were so large, may be aue 0 the fact that aust, smoKr ana powaer so inflaaea eyes that many whose eyes are now ail right have saia that for days the eyes were so swollen they coula

Out or the seventy-one oases for who., "study" oards were c.a3e thirtyseven were woaen, of this nuoiter four are already in the School for the Elina ana seventeen have hatles or littlo chlldroa to care for.' Unaer ordinary circutstanoes their tii.e v.ooij be consiaerea tuiiy occupiea with the housekeeping ana care of the children.' Ae yet the reea for occupational work has not teen felt to any extent, several have teen sedi invalias (aany nave other injuries tesiaes the eyes) ana the housing, living, relief ana pensior proclecf-B have teen the cuestions they wantea settlea first.'

FrotD now on seea.s the coaent to awaken interest in iraustriai train' nd to have teachers frecuently visit una in.struct in their hod.es tnone wno'are not atie or fit to go cut., For those who can leave ho.e ror at least a pirt Of the aay it wcuia te well for then to attena the suerrer school Sir Freaer ck 0,3 ,, 3,^^, opporturi.y