SPECIAL ARTICLE Blinking Sam The Ocular Afflictions of Dr Samuel Johnson Graham A. Wilson, MB, ChB, FRANZCO; James G. Ravin, MD, MS he poor health of Samuel Johnson (1709-1784) has fascinated the public for more than 200 years. The illnesses of few famous men, with the possible exception of Napoleon, have attracted more speculation. Johnson was an outstanding 18th-century literary figure, an essayist, novelist, and poet, and is particularly famous as the creator of the first important Tdictionary of the English language. His writings and those of his physicians and friends, particularly his biographer, James Boswell, provide an intimate account of a cultural icon. Arch Ophthalmol. 2004;122:1370-1374 Samuel Johnson had a multitude of physi- was born in the town of Lichfield in 1709, cal and psychological ailments. From the the son of a bookseller. He studied lan- beginning of his life as a hypoxic new- guages, literature, ethics, and theology at born, he was troubled by numerous ill- the University of Oxford, but, impover- nesses, including neonatal abscess of the ished and depressed, he left before obtain- buttocks, probable smallpox, and deaf- ing a degree. Nervousness, odd manners, ness in the left ear (and both ears later in and ill health made it difficult for Johnson life). As he put it, “My health has been, from to find work. Eventually, he became a my twentieth year, such as has seldom af- schoolmaster and later was employed by forded me a single day of ease.”1(pp147,148) a publisher. At the age of 26 years, he mar- The most important of his ailments were ried a widow 20 years older than he. Later scrofula (primary tuberculosis of the cer- he would write, “Marriage has many pains, vical lymph nodes, known during his life- but celibacy has no pleasures.”4(p99) After time as “the King’s evil”); depression (“I a boarding school he established failed, inherited a vile melancholy from my fa- Johnson moved to London in 1737 to be- ther”)2(p215); possibly Gilles de la To- gin his writing career. Once established, urette syndrome, since he experienced in- he wrote for Gentleman’s Magazine and voluntary contortions, gesticulations, and published a series of articles about impor- oral outbursts3; asthma; and dropsy tant physicians in history, including Boer- (edema). In adulthood, he also experi- haave and Sydenham. He collaborated with enced insomnia, a death phobia, intermit- Robert James, MD, in creating the Medici- tent excesses of alcohol and opiates, obe- nal Dictionary (1743-1745), a 1000-page sity, dyspepsia, flatulence, heart failure, compendium of pharmacology written for gout, and stroke. It is hardly surprising that a general audience. Johnson was led to comment, “Human life Public recognition of Johnson’s work is everywhere a state in which much is to came with the first edition of his Dictio- be endured, and little to be enjoyed.”4(p50) nary of the English Language (1755), which he compiled almost single-handedly and is BIOGRAPHY a landmark of literary achievement. It de- A brief summary of Johnson’s life is a fines more than 40000 words, was the first daunting task, because he was a man of important and precise English dictionary, many remarkable accomplishments. He and went through 5 editions during his life- time. In honor of this accomplishment, he From Nelson Hospital, Nelson, New Zealand (Dr Wilson); and Medical College of was granted a royal pension, even if he had Ohio, Toledo (Dr Ravin). defined the word pension sarcastically in his (REPRINTED) ARCH OPHTHALMOL / VOL 122, SEP 2004 WWW.ARCHOPHTHALMOL.COM 1370 ©2004 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 09/27/2021 dictionary as “pay given to a state hire- ling for treason to his country.”5 After Trinity College, Dublin, gave him an honorary doctoral de- gree in 1764 and the University of Oxford gave him another in 1775, he became known as Dr Johnson. He had risen from a humble back- ground to become the preeminent literary figure of his era. He knew most of England’s great thinkers, and his “supreme enjoyment was the ex- ercise of reason.”6(p66) Johnson was more famous for his brilliant con- versational remarks than for his writ- ings (see Box). Although he was eccentric in some ways and un- usual in appearance (Figure 1 and Figure 2), his peculiarities were overlooked as soon as he began to speak. He mixed serious comments with a good sense of humor.7(p269) Criticism did not faze him. He con- sidered it better to be criticized than overlooked and degrading to re- spond to insults. Dr Samuel Johnson had no medical degree, but because of his friendship with physicians, study of medical literature, and understand- ing of human behavior, people would Figure 1. Sir Joshua Reynolds, English. Samuel Johnson, circa 1790. Oil painting. Reprinted by kind occasionally ask if he were a physi- permission of Loren and Frances Rothschild. cian or even an oculist.2(p96) James Boswell considered him a “great dab- bler” in medicine.9(p152) He noted that a young Scottish lawyer, who made infected cow’s milk, and this Johnson took “a peculiar pleasure in his own fame with his Life of Samuel caused many problems during his the company of physicians,” some Johnson (1791). Undoubtedly, this childhood. His eyes were severely of whom were the leading practi- is the best known and most widely affected. Treatment included mak- tioners of his day.1(p293) If one of his read biography ever written. Johnson ing an “issue” in his left arm, an friends would complain about phy- died a national celebrity and is bur- incision that was kept open with a sician’s fees, he would challenge ied in Westminster Abbey. small foreign body such as a pea. them to produce a single example of This obsolete form of therapy was a large estate founded on a medical JOHNSON’S EYES intended to drain away evil hu- practice.7(p223) In contrast to his mors. He was taken the then–long friendly attitude toward physi- “My mother had a very difficult and distance of 20 miles to consult an cians, “Johnson never had a good dangerous labour...Iwasborn al- oculist, Dr Thomas Attwood, but word for an attorney.”7(p151) Johnson most dead, and could not cry for no records of his diagnosis or treat- 11(p3) even associated attorneys with street some time.” He was placed with ment have survived. At age 21⁄2 robbers and wrote this couplet: a wet nurse and 10 weeks later “taken years, his mother took him to Lon- “There ambush here relentless ruf- home a poor, diseased infant, al- don to be 1 of 200 individuals fians lay, And here the fell attorney most blind.”11(p5) Many commenta- given the “royal touch,” an ancient prowls for prey.”10(p126) tors have felt the wet nurse gave magical ceremony designed to treat Johnson defined the word Johnson scrofula, which affected his scrofula. He was examined by the patron humorously in his dictio- eyes, but this hypothesis is unlikely court physician, blessed by the nary as “a wretch who supports with to be correct, because scrofula is not court chaplains, and presented insolence, and is paid with flat- transmitted through breastfeeding, with a golden amulet by Queen tery.”5 A decade after the dictionary and tuberculosis in infancy is nearly Anne.11(p8) He wore this charm came out, he came under the pa- always fatal.12 Johnson’s first ocular around his neck ever after. Not tronage of Henry Thrale, a wealthy problem may have been ophthal- surprisingly, Johnson’s scrofulous brewer, and his literary wife, Hes- mia neonatorum.13 sores were not cured, and the scars ter, who wrote a biography of Johnson developed scrofula at on his face and neck were visible Johnson. But it was James Boswell, approximately age 2 years from for the rest of his life. (REPRINTED) ARCH OPHTHALMOL / VOL 122, SEP 2004 WWW.ARCHOPHTHALMOL.COM 1371 ©2004 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 09/27/2021 corded, “My eye is almost recov- ered, but is yet a little dim, and does not like a small print by candle- light.”15(p45) The attack was dis- cussed with a physician, John Mudges, who said, “unless Mr Johnson took the greatest care to have the inflammation removed the danger of losing his sight was very great.”10(p506) The recovery was not complete, but Johnson felt well enough to embark on a tour of Scot- land with Boswell a few weeks later. Johnson’s left eye was the weaker of the two, and he once said, “the dog was never good for much.”6(p41) Boswell concurred, writing that scrofula “hurt his visual nerves so much, that he did not see at all with one of his eyes, though its appear- ance was little different from that of the other.”6(p41) Boswell acknowl- edged that many of Johnson’s friends knew he had an ocular defect, “though I never perceived it; I sup- posed him to be only near-sighted; and indeed I must observe, that in no other respect could I discern any defect in his vision; on the contrary, the force of his attention and perceptive quickness made him see and distinguish all manner of Figure 2. After Joshua Reynolds, English. Samuel Johnson, late 18th or early 19th century. Pastel. objects.6(p41) Reprinted by kind permission of the trustees of Dr Johnson’s Birthplace. Johnson once used his myopia as a convenient excuse to not go on an 14(pp132,133) Because of his poor eyesight, little.” He was relieved when expedition, saying Johnson did not go to school until improvement followed and thanked he was 8 years old.