110

OPHTHALMIA.

THIS distemper in the army ought properly to be designated as the ophthalmic conspiracy; for such a disease as our troops exhibited never yet was found in true nosology. It was long denominated and dreaded as the ophthalmic pestilence—a fearful contagion: now we know that there is nothing contagious or pestilential belonging to it, and that, as a contagion, it never had any existence. This requires some explanation. The terms of enlistment in our army for unlimited service; the then cruel punishment of all-prevailing flogging; the unvarying monotony of drills and parades; the unnecessary restriction of furloughs, and the tædium vitæ engendered in barrack life, where amusement was never cultivated, and pleasurable recreation, except in the barrack canteen, all but interdicted, had long rendered our service most odious to the British population. The soldier, in fact, was often weary of his life, and drunkenness and crime became his chief, his only resources. The recruit often tried escape from these miseries by inflicting upon himself spurious ulcers of the legs; but it was a trick most commonly of the recruit alone. The older soldiers knew better, and the troops generally became aware of, and laughed at it.

It was under these circumstances that the army proceeded upon the far-famed expedition to Egypt in the year 1800, where ophthalmia, whether proceeding from a fine impalpable sand ever floating in the atmosphere, or other causes, it matters not, was found to be an endemic disease of the country, and this, it would appear, led to new speculation amongst the bondsmen of military service, which was soon fostered into full activity by the high bounties then offered to induce men to enter the service, and by the system of retirement pensions afterwards promulgated.

Incurable blindness amongst the natives was everywhere to be

seen in Egypt, yet few of our troops, though many had suffered ophthalmia, returned from that land so blinded. It was not till several years after they had left it, that the Egyptian ophthalmia, as it was called, suddenly broke out, spreading terror and consternation in every military quarter where it appeared; and no wonder, - for men would mount guard in perfect health to be relieved very soon after, complaining that their eyes felt as if full of sand and gravel, which would next day go on to the utter destruction of the organ of sight: all this, too, spreading epidemically. The invasion was of so fearful a nature, and its effects so formidable, that men's minds were at first carried away by the terrible nature of the calamity, and it did not at first occur to any of us to inquire why this plague from Egypt had remained so long in abeyance, where it generally blinded the natives, only as a chronic disease of slow progress, and with their very defective means of cure, without ever having been suspected to possess any infectious or contagious quality—or why it was restricted to marching regiments alone-why it did not affect the English militia regiments inhabiting the same barracks, or the population of the neighbouring country—why, if so fearfully contagious, it did not attack the officers as well as the men—and why, above all, the medical staff of the infected regiments, continually engaged in the most intense examination of the eyes of their infected patients, should generally escape the disease, for, according to all the laws of contagion, there ought scarcely to have been an effective eye left amongst them.

When time had been given for men to reflect, these considerations at length had their due weight, and discoveries were soon made that the whole was a deep-laid conspiracy amongst the men for the purpose of procuring pensions, or at least discharges preparatory to enlisting again for fresh bounty, and to be saved from the dangers and severities of foreign service. It was the respectable calculating soldier or non-commissioned officer that speculated upon a pension; it was the reckless impostor who, whenever he durst, made desertion a trade, that looked forward to fresh bribes in the way of bounty-money. For these purposes, they had been taught carry the sublimate of mercury in the inner cuffs or skirt ornaments of their coats, for the purpose of inducing purulent oph

to

thalmia, or, where that article could not be had, to keep applying other noxious ingredients, such as the mortar of the walls where they lay, mixed with urine, and many others. The conspiracy was so well laid that the men possessed recipes for inducing temporary blindness, and others for being cured, as they believed, after they had obtained their discharges. Some of the most respectable noncommissioned officers were implicated in it. Children were occasionally blinded as proofs of the contagious influence, and women either offered themselves, or were made accomplices or victims of the deception. Some regiments had decreed amongst themselves that they would always be contagious, and never go upon foreign service, and relays of the diseased were always to be kept up in proof. Such was the conspiracy. I was, I believe, one of the first, after having been long completely deluded, to denounce it in a letter, dated 1810, to Sir D. Dundas, the then commander-inchief; and in the Peninsula and the West Indies, or wherever the ophthalmia appeared, I held myself ready, and, from my station, took effectual steps to unmask the imposture.

In the Peninsula, however, it never prevailed to any extent. In the first campaign some regiments fresh from Ireland tried it, but they speedily found it would not do. The early victories of Rolica and Vimeira had elevated the minds of the soldiers, and whatever possessed even the semblance of shyness to meet the enemy, was held amongst themselves to be infamous. This was

an effectual safe-guard, for whenever public opinion can be brought to bear upon crime, it will infallibly disappear, or at least vanish into the lowest haunts of infamy and degradation, and, amongst British soldiers, nothing so utterly degrades a man as deficiency of manliness and courage when near the enemy.

Let us now examine whether there be such a disease as contagious ophthalmia proceeding from one eye to that of another person, through the medium and contact of the atmosphere: that of an inoculable ophthalmia, from the actual imposition of the matter of the disease, is not now the question. Every one, I suppose, has witnessed an epidemic ophthalmia, proceeding from atmospherical blights and vicissitudes of temperature, under high piercing winds, to which troops or the labouring population may

be exposed.* All, too, must have seen the dreadful purulent ophthalmia, going on to disorganize the eyes of new-born infants, or even grown people, under particular circumstances and seasons; but in both the one and the other it is uniformly a sporadic disease; and even he who finds contagion in every thing, must be puzzled to find it in the one above mentioned. There is one truly inoculable ophthalmia-the gonorrhoeal; but the purulent ophthalmia of the army could not be so classed, for medical officers (vide Edinburgh Medical and Surgical Journal) inserted it into their own eyes with impunity, or bound it upon them for the whole night, when they went to sleep, with the same results. The ophthalmia of the soldiers' children at the Royal Military Asylum, so well described by the late Sir P. M'Gregor, in the Medico-Chirurgical Transactions, was, I think, as likely to be a gonorrhoeal ophthalmia as any thing else; and when we consider that the children were then in the hands of the women of the army, who were at the very time accomplices in the conspiracy of their husbands, the idea gathers strength. That the ophthalmia of the men was not the gonorrhoeal I soon had full proof, from the following circumstance, which, in itself, first served to open my own eyes to the true character of the disease, and inspired doubts in regard to its contagion. A blinded soldier at one of our hospital stations in the Kent district, where I had the superintendence, was holding his baby on his knee, and I saw the matter from his eyes drop fully and repeatedly upon the infant's face, which had always been, and continued to be in perfect health. His wife, too, who had all the while been lying in the same bed, and using the same pillow, was perfectly untouched by the ophthalmia.

However the disease may have been generated, or whether contagious or not, a discovery was ultimately made in the treatment, which at all future times must ever be precious in ophthalmic surgery. On the first alarm of the new ophthalmic

* I witnessed a remarkable instance of this when I was surgeon of the 5th Regiment, at Norman Cross Barracks, in the cold spring of 1799, when the men, mostly recruits, on being severely drilled during some high easterly winds, were very generally affected with what I believe is now called rheumatic ophthalmia.

I

pestilence, it was attacked with all the appliances of antiphlogistic medicine, under their most active forms; and, in as far as our knowledge then went, they appeared to be most necessary, for sight was sometimes irretrievably lost, and the coats of the eye ruptured from suppuration, in the space of a very few hours from the first invasion. The practice of venesection-the first and most obvious resource-although carried to a length far exceeding any thing ever attempted before, was far from being successful, and the number of incurably blind proclaimed its inefficacy. The stimulating plan, as described by Dr. O'Halloran in his work upon Purulent Ophthalmia, was made to supersede the antiphlogistic, and the effect was successful in at least a fourfold degree.* The experiment is most valuable, in proving that whether in constitutional or surgical diseases a new principle of cure has been

* The Brunonian doctrines of superseding all diseases by appropriate stimuli are true in themselves. The difficulty lies in discovering what are appropriate, for a scurvy constitution is a constitution per se, and has laws of its own. The patient may be lost or killed in the experiment before we can ascertain how he ought to be treated, and the via tuta of allopathic medicine becomes the only justifiable course until experience can point out a better road. Hahnemann's similia similibus is but a weak burlesque of the Brunonian principle. Brown went boldly to work with his wine and brandy, and committed havoc like a man of business. Hahnemann, I cannot but think, must have been long hung in his sleeve, for to treat of his minimo-infinitesimal doses without laughter exceeds all power of face; verily he must have been a wag, but his waggery is too severe, for it goes to proclaim physic a farce in toto, and homoeopathy the last act of the performance. Brown, it must be owned, stands on stronger and better ground, for who has not seen turpentine supersede the best-established inflammations, and arrest the most acute hæmorrhages, or black pepper (Ward's paste) do the same in the most violent attacks of hæmorrhoids? Mercury, too, the most general and undoubted of all stimulants, goes to supplant, by its own peculiar action, almost all constitutional inflammations; and the lunar caustic, as in the case before us, will act like a charm in curing ophthalmia, gonorrhoea, and almost every topical inflammation to which it can be applied. It is, in fact, the sedative par excellence in all inflammatory irritations. It may, however, be carried too far, and could Hahnemann ever have heard of the heroic practice described in another part of this work as being so common within the Tropics,—and indeed we may add sometimes amongst ourselves,—we might give him credit for having written in ridicule of the calomelanists, did not the exquisite absurdity of his billionth, trillionth, and decillionth infinitesimals so far transcend all ordinary concoction. Granting, however, that he was serious, he certainly has succeeded in carrying the joke further than any satirist of modern times.