The Ocular Afflictions of Dr Samuel Johnson

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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 dictionaryT 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

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©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 degree 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 writings (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 considered 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.

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©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 discussed 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 appearance 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. Although the “Almighty God, who hast restored “I see but at a small distance. So it school was fewer than 150 yards light to my eye, and enabled me to was not worth my while to go to see birds from his home, a servant would es- pursue again the studies which thou fly, which I should not have seen fly; and cort him there and back or even hast set before me.”11(p60) Unfortu- fishes swim, which I should not have seen swim.10(p148) carry him. Boswell describes how nately, the problem recurred later once, when the servant was late, that year, and he attributed it to the Traditional teaching is that Johnson started off alone and was scrofula he had acquired in child- Johnson’s left eye was either blind obliged to kneel down to see the gut- hood. Boswell first met Johnson in or amblyopic from scrofula and the ter before he ventured to step over 1763, when the latter was 54 years right eye had a lesser degree of dam- it.6(p39) His mother was afraid he old, and found his appearance dread- age. His myopia is well docu- would fall into the drain in the street ful due to inflamed eyes, ungainli- mented. On the other hand, some of or even the sewer at the market. He ness, strange movements, and scars his contemporaries’ accounts give often used his limited eyesight as a from scrofula. contradictory evidence and indicate convenient excuse to avoid attend- Eye pain occurred during the his vision was reasonably good. Fanny ing church and would wander off next few years, and in letters writ- Burney, who described his nearsight- into the countryside instead, tak- ten in 1773 Johnson wrote, edness, also said, “he sees wonder- 1(p160) ing along something to read. Poor “My fever has departed but has left fully at times.” He was able to vision did not prevent him from do- me a very severe inflammation in the see- tell the time on the Lichfield town ing well academically at school, but ing [right] eye....Myeyeisyetsodark clock and could make out details in- it kept him from playing the usual that I could not read....Iread for a very side a French cathedral. Surpris- childhood sports. short time, in a book of a minute print, ingly, there is no mention of his eyes There is little new mentioned and at night felt a pain in my eye, which during the 9 years he labored on his was next day inflamed to a very great about his eyes until 1756, when 47- 15(pp35,37,40) dictionary. Sir Joshua Reynolds noted year-old Johnson wrote, “The in- degree. his intermediate vision was subnor- flammation is come again into my He was treated by bleeding and purg- mal, saying “pictures he could not [right] eye, so that I can write very ing. A few months later he re- well see.”16 Johnson appeared to en-

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©2004 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 09/27/2021 joy art for he left behind a collection A Johnson Sampler of 146 portraits when he died.7(p214) It is difficult to believe that at the age On physicians: of 66 years, Johnson would have gone “I believe every man has found in physicians great liberality and dignity of sen- on a 100-day frolic around Scotland timent, very prompt effusion of beneficence, and willingness to exert a lucra- with Boswell if his visual impair- tive art where there is no hope of lucre.”7(p223) ment were severe. “That the greatest physician of the age [Sydenham] arrived at so high a de- Johnson read with the mate- gree of skill without any assistance from his predecessors, and that a man emi- rial held very close to his face (Fig- nent for integrity practiced medicine by chance and grew wise only by murder, is not to be considered without astonishment.”8 ure 1). His friend Thrale noted that Johnson’s wigs were scorched from On cataract: reading too close to a candle and was “A suffusion of the eye, when little clouds, motes, and flies, seem to float about seriously afraid that Johnson might in the air; when confirmed, the pupil of the eye is either wholly, or in part, cov- burn himself up while reading in ered, and shut up with a little thin skin, so that the light has no admittance.”5 bed.7(p307) According to the sister of (quoting Quincy) the artist Sir Joshua Reynolds, To couch: Johnson’s sight was so poor that he “To depress the film that overspreads the pupil of the eye. Some artist, whose could not distinguish faces half a yard nice hand couches the cataracts, and clears his eyes, and all at once a flood of away.10(p92) Hester Thrale believed his glorious light comes rushing on his eyes.”5 (quoting Dennis) crude eating habits owed some- On glaucoma: thing to his poor eyesight. Johnson “A fault in the eye, which changes the crystalline humor into a greyish colour, confirmed as much to Boswell, say- without detriment of sight, and therein differs from what is commonly under- ing “I am short-sighted, and afraid stood by suffusion.”5 (quoting Quincy) of bones, for which reason I am not fond of eating many kinds of fish, be- On sight: cause I must use my fingers.”1(p206) “Perception by the eye, the sense of seeing. O loss of sight, of thee I most com- Although willing to acknowl- plain! Blind among enemies, O worse than chains, Dungeon or beggary, de- crepit age!”5 (quoting Milton) edge that he was myopic, Johnson was defensive about the appearance of his eyes. After seeing a por- trait of himself painted by Sir Joshua cave lenses for the correction of myo- adequate functional vision for the Reynolds that depicted him hold- pia were available in Johnson’s day, rest of his life. His visual impair- ing a book very close to his face (Fig- but cylinders were not, and we as- ment, which seems to have been se- ure 1), he protested that he “would sume he experimented with glasses vere in childhood, appeared to be not be known by posterity for his de- but did not find them helpful. less of a problem when he was an fects only...Iwill not be blinking There are many paintings, etch- adult, possibly as a result of slow Sam.”9(p273) Johnson defines blinkard ings, pastels, and sculptures of clearing of phlyctenular disease and in the fourth edition of his dictio- Johnson, but it is difficult to use adaptation to his refractive error. He nary as “one that has bad eyes” and these to diagnose his ocular prob- could read and write to the end of to him to blink meant “to see ob- lems. Evidence from portraiture is his life, and his penmanship was leg- scurely.” (Modern dictionaries de- apt to be unreliable, because artists ible a week before he died. A post- fine blinkard as an archaic word often flatter their sitters to please mortem examination was made 2 meaning one who blinks with, or as them. Johnson may have had a con- days after his death, which found if with, weak eyes.) genital left superior oblique palsy, emphysema, aortic sclerosis, gall- There has long been uncer- because a head tilt to the right shoul- stone, small kidney, hydrocele, and tainty concerning the relative con- der is observable in several por- varicocele, but the head and eyes tribution of eye disease and re- traits of him (Figure 2). were not evaluated. fractive error to Johnson’s visual The ocular inflammation Although there is much we can impairment. According to an ac- Johnson experienced as a child, be sure of, a definitive ocular diagno- count published in 1784, Johnson which may have been phlyctenular sis is elusive. Much remains specu- did not wear glasses “because he was keratoconjunctivitis, could have relative, including the impact of his eye assured they would be of no service sulted in fine scarring of the cornea disease on his life and its severity. It to him.”7( p343) He was well aware of and astigmatism and reduced his vi- is likely that his poor distance vision the benefits of glasses. His friend Rey- sual acuity. No scarring of the ocu- led him to concentrate on near work nolds wore them, and Johnson was lar surface or strabismus is evident and influenced his career choices to- constantly mingling with physi- in his portraits. The defects were not ward books and literature. cians who would have advised him severe enough to result in loss of bin- to try them. He states in his dictio- ocularity, because he maintained a OPHTHALMOLOGY IN THE nary, “It is no fault in the spectacles head tilt. The inflammation he en- JOHNSON HOUSEHOLD that the blind man sees not.”5 countered as an adult was probably Johnson even discussed the action a keratoconjunctivitis, which was His household included a strange of lenses with King George III. Con- not severe, because he maintained collection of humanity. One resi-

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©2004 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 09/27/2021 dent in his home was a physician, Johnson did not discuss cata- REFERENCES Robert Levet, who treated some of racts with one of the most famous London’s poorest families. An- ophthalmologists of the day, Cheva- 1. Boswell J. Boswell’s Life of Johnson (1780- other, Anna Williams, came ini- lier Taylor, oculist to the king, who 1784). Vol 4. Oxford, England: Clarendon Press; tially as a visitor but ended up re- was a skillful surgeon but also one 1934. 2. Boswell J. Journal of a Tour to the Hebrides. Ox- siding in the Johnson home for 35 of the most notorious quacks in the ford, England: Clarendon Press; 1964. years. She was often irksome, but history of medicine.18 Johnson con- 3. Pearce JMS. Doctor Samuel Johnson: “the Great Johnson enjoyed chatting with her sidered Taylor “the most ignorant Convulsionary” a victim of Gilles de la Tourette’s syndrome. J R Soc Med. 1994;87:396-399. over tea. She had cataracts and was man I ever knew,” probably be- 4. Johnson S. Rassellas. In: Kolb GJ, ed. Yale Edi- treated by Samuel Sharp, a surgeon cause he could not converse in tion of the Works of Samuel Johnson. Vol 16. New 9(pp289,290) Haven, Conn: Yale University Press; 1990. at Guy’s Hospital who was an im- Latin. He also said of Tay- 5. Johnson S. A Dictionary of the English Lan- portant pioneer in the history of cata- lor, undoubtedly due to his outra- guage. London, England: W Strahan; 1755. ract extraction. Two of his articles geous behavior, that he was “an in- 6. Boswell J. Boswell’s Life of Johnson (1709- 1765). Vol 1. Oxford, England: Clarendon Press; on cataract surgical technique were stance how far impudence could 1934. 9(p291) published by the Royal Society, and carry ignorance.” 7. Hill GB. Johnsonian Miscellanies. Vol 1. Oxford, the composer Handel consulted him Johnson once commented, “It England: Clarendon Press; 1897. 8. Hill GB. Wit and Wisdom of Samuel Johnson. Ox- about his cataracts. Sharp operated matters not how a man dies, but how ford, England: Clarendon Press; 1888:184. on both of Mrs Williams’ cataracts, he lives.”10(pp106,107) His own life, how- 9. Boswell J. Boswell’s Life of Johnson (1776- but “the crystalline humor was not ever, was made difficult by physical 1780). Vol 3. Oxford, England: Clarendon Press; 1934. sufficiently inspissated for the needle disabilities. Late in life he wrote, “My 10. Boswell J. Boswell’s Life of Johnson (1766- to take effect.”17 She became blind diseases are an asthma and a dropsy, 1776). Vol 2. Oxford, England: Clarendon Press; and was Johnson’s responsibility for and, what is less curable, 75.”1(p363) 1934. 11. Johnson S. Diaries, Prayers, and Annuals.In: the rest of her life. Had he lived 2 centuries later, he McAdam EL Jr, ed, with Donald and Mary Hyde. Johnson was interested in the would have found that good health, Yale Edition of the Works of Samuel Johnson. Vol 12. New Haven, Conn: Yale University Press; 1958. cataract problem of another friend, which he considered the basis of hap- 12. McHenry LC Jr, MacKeith R. Samuel Johnson’s Bennet Langton. He wrote, piness, was much easier to attain. childhood illness and the King’s evil. Med Hist. As Boswell wrote, 1966;10:386-399. 13. Keynes M. The miserable health of Dr Samuel I am very sincerely solicitous for the pres- Such was Samuel Johnson, a man Johnson. J Med Biogr. 1995;3:161-169. whose talents, acquirements, and vir- 14. Redford B, ed. The Letters of Samuel Johnson ervation or curing of Mr Langton’s sight, (1731-1772). Vol 1. Princeton, NJ: Princeton Uni- and am glad that the chirurgeon gives him tues, were so extraordinary, that the versity Press; 1992. so much hope. Mr Sharp is of the opin- more his character is considered, the 15. Redford B, ed. The Letters of Samuel Johnson ion that the tedious maturation of the more he will be regarded by the pre- (1773-1776). Vol 2. Princeton, NJ: Princeton Uni- cataract is a vulgar error, and that it may sent age, and by posterity, with admi- versity Press; 1992. 1(pp429,430) 16. Wiltshire J. Samuel Johnson in the Medical World. be removed as soon as it is formed. This ration and reverence. New York, NY: Cambridge University Press; 1991: notion deserves to be considered; I doubt 19. whether it be universally true; but if it be Correspondence: James G. Ravin, MD, 17. Clifford JL. Dictionary Johnson. New York, NY: MS, Medical College of Ohio, 3000 McGraw-Hill; 1979:101. true in some cases, and those cases can 18. Trevor-Roper P. Chevalier Taylor – Ophthalmia- be distinguished, it may save a long and Regency Ct, Toledo, OH 43623 ter Royal (1703-1772). Doc Ophthalmol. 1989; uncomfortable delay.6(p357) ([email protected]). 71:113-122.

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