Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 14-Day Trial for You or Your Team.

Learn More →

Blinking Sam

Blinking Sam The 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 dictionary 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.Samuel Johnson had a multitude of physical and psychological ailments. From the beginning of his life as a hypoxic newborn, he was troubled by numerous illnesses, including neonatal abscess of the buttocks, probable smallpox, and deafness in the left ear (and both ears later in life). As he put it, "My health has been, from my twentieth year, such as has seldom afforded me a single day of ease."(pp147,148)The most important of his ailments were scrofula (primary tuberculosis of the cervical lymph nodes, known during his lifetime as "the King's evil"); depression ("I inherited a vile melancholy from my father")(p215); possibly Gilles de la Tourette syndrome, since he experienced involuntary contortions, gesticulations, and oral outbursts; asthma; and dropsy (edema). In adulthood, he also experienced insomnia, a death phobia, intermittent excesses of alcohol and opiates, obesity, dyspepsia, flatulence, heart failure, gout, and stroke. It is hardly surprising that Johnson was led to comment, "Human life is everywhere a state in which much is to be endured, and little to be enjoyed."(p50)BIOGRAPHYA brief summary of Johnson's life is a daunting task, because he was a man of many remarkable accomplishments. He was born in the town of Lichfield in 1709, the son of a bookseller. He studied languages, literature, ethics, and theology at the University of Oxford, but, impoverished and depressed, he left before obtaining a degree. Nervousness, odd manners, and ill health made it difficult for Johnson to find work. Eventually, he became a schoolmaster and later was employed by a publisher. At the age of 26 years, he married a widow 20 years older than he. Later he would write, "Marriage has many pains, but celibacy has no pleasures."(p99)After a boarding school he established failed, Johnson moved to London in 1737 to begin his writing career. Once established, he wrote for Gentleman's Magazineand published a series of articles about important physicians in history, including Boerhaave and Sydenham. He collaborated with Robert James, MD, in creating the Medicinal Dictionary(1743-1745), a 1000-page compendium of pharmacology written for a general audience.Public recognition of Johnson's work came with the first edition of his Dictionary of the English Language(1755), which he compiled almost single-handedly and is a landmark of literary achievement. It defines more than 40 000 words, was the first important and precise English dictionary, and went through 5 editions during his lifetime. In honor of this accomplishment, he was granted a royal pension, even if he had defined the word pensionsarcastically in his dictionary as "pay given to a state hireling for treason to his country."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 background to become the preeminent literary figure of his era. He knew most of England's great thinkers, and his "supreme enjoyment was the exercise of reason."(p66)Johnson was more famous for his brilliant conversational remarks than for his writings (see Box). Although he was eccentric in some ways and unusual in appearance (Figure 1and Figure 2), his peculiarities were overlooked as soon as he began to speak. He mixed serious comments with a good sense of humor.(p269)Criticism did not faze him. He considered it better to be criticized than overlooked and degrading to respond to insults.A Johnson SamplerOn physicians:"I believe every man has found in physicians great liberality and dignity of sentiment, very prompt effusion of beneficence, and willingness to exert a lucrative art where there is no hope of lucre."(p223)"That the greatest physician of the age [Sydenham] arrived at so high a degree of skill without any assistance from his predecessors, and that a man eminent for integrity practiced medicine by chance and grew wise only by murder, is not to be considered without astonishment."On cataract:"A suffusion of the eye, when little clouds, motes, and flies, seem to float about in the air; when confirmed, the pupil of the eye is either wholly, or in part, covered, and shut up with a little thin skin, so that the light has no admittance."(quoting Quincy)To couch:"To depress the film that overspreads the pupil of the eye. Some artist, whose nice hand couches the cataracts, and clears his eyes, and all at once a flood of glorious light comes rushing on his eyes."(quoting Dennis)On glaucoma:"A fault in the eye, which changes the crystalline humor into a greyish colour, without detriment of sight, and therein differs from what is commonly understood by suffusion."(quoting Quincy)On sight:"Perception by the eye, the sense of seeing. O loss of sight, of thee I most complain! Blind among enemies, O worse than chains, Dungeon or beggary, decrepit age!"(quoting Milton)Figure 1.Sir Joshua Reynolds, English. Samuel Johnson, circa 1790. Oil painting. Reprinted by kind permission of Loren and Frances Rothschild.Figure 2.After Joshua Reynolds, English. Samuel Johnson, late 18th or early 19th century. Pastel. Reprinted by kind permission of the trustees of Dr Johnson's Birthplace.Dr Samuel Johnson had no medical degree, but because of his friendship with physicians, study of medical literature, and understanding of human behavior, people would occasionally ask if he were a physician or even an oculist.(p96)James Boswell considered him a "great dabbler" in medicine.(p152)He noted that Johnson took "a peculiar pleasure in the company of physicians," some of whom were the leading practitioners of his day.(p293)If one of his friends would complain about physician's fees, he would challenge them to produce a single example of a large estate founded on a medical practice.(p223)In contrast to his friendly attitude toward physicians, "Johnson never had a good word for an attorney."(p151)Johnson even associated attorneys with street robbers and wrote this couplet: "There ambush here relentless ruffians lay, And here the fell attorney prowls for prey."(p126)Johnson defined the word patronhumorously in his dictionary as "a wretch who supports with insolence, and is paid with flattery."A decade after the dictionary came out, he came under the patronage of Henry Thrale, a wealthy brewer, and his literary wife, Hester, who wrote a biography of Johnson. But it was James Boswell, a young Scottish lawyer, who made his own fame with his Life of Samuel Johnson(1791). Undoubtedly, this is the best known and most widely read biography ever written. Johnson died a national celebrity and is buried in Westminster Abbey.JOHNSON'S EYES"My mother had a very difficult and dangerous labour . . . I was born almost dead, and could not cry for some time."(p3)He was placed with a wet nurse and 10 weeks later "taken home a poor, diseased infant, almost blind."(p5)Many commentators have felt the wet nurse gave Johnson scrofula, which affected his eyes, but this hypothesis is unlikely to be correct, because scrofula is not transmitted through breastfeeding, and tuberculosis in infancy is nearly always fatal.Johnson's first ocular problem may have been ophthalmia neonatorum.Johnson developed scrofula at approximately age 2 years from infected cow's milk, and this caused many problems during his childhood. His eyes were severely affected. Treatment included making an "issue" in his left arm, an incision that was kept open with a small foreign body such as a pea. This obsolete form of therapy was intended to drain away evil humors. He was taken the then–long distance of 20 miles to consult an oculist, Dr Thomas Attwood, but no records of his diagnosis or treatment have survived. At age 2½ years, his mother took him to London to be 1 of 200 individuals given the "royal touch," an ancient magical ceremony designed to treat scrofula. He was examined by the court physician, blessed by the court chaplains, and presented with a golden amulet by Queen Anne.(p8)He wore this charm around his neck ever after. Not surprisingly, Johnson's scrofulous sores were not cured, and the scars on his face and neck were visible for the rest of his life.Because of his poor eyesight, Johnson did not go to school until he was 8 years old. Although the school was fewer than 150 yards from his home, a servant would escort him there and back or even carry him. Boswell describes how once, when the servant was late, Johnson started off alone and was obliged to kneel down to see the gutter before he ventured to step over it.(p39)His mother was afraid he would fall into the drain in the street or even the sewer at the market. He often used his limited eyesight as a convenient excuse to avoid attending church and would wander off into the countryside instead, taking along something to read. Poor vision did not prevent him from doing well academically at school, but it kept him from playing the usual childhood sports.There is little new mentioned about his eyes until 1756, when 47-year-old Johnson wrote, "The inflammation is come again into my [right] eye, so that I can write very little."(pp132,133)He was relieved when improvement followed and thanked "Almighty God, who hast restored light to my eye, and enabled me to pursue again the studies which thou hast set before me."(p60)Unfortunately, the problem recurred later that year, and he attributed it to the scrofula he had acquired in childhood. Boswell first met Johnson in 1763, when the latter was 54 years old, and found his appearance dreadful due to inflamed eyes, ungainliness, strange movements, and scars from scrofula.Eye pain occurred during the next few years, and in letters written in 1773 Johnson wrote,"My fever has departed but has left me a very severe inflammation in the seeing [right] eye. . . . My eye is yet so dark that I could not read. . . . I read for a very short time, in a book of a minute print, and at night felt a pain in my eye, which was next day inflamed to a very great degree.(pp35,37,40)He was treated by bleeding and purging. A few months later he recorded, "My eye is almost recovered, but is yet a little dim, and does not like a small print by candlelight."(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."(p506)The recovery was not complete, but Johnson felt well enough to embark on a tour of Scotland 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."(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."(p41)Boswell acknowledged that many of Johnson's friends knew he had an ocular defect,"though I never perceived it; I supposed 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 objects.(p41)Johnson once used his myopia as a convenient excuse to not go on an expedition, saying"I see but at a small distance. So it was not worth my while to go to see birds fly, which I should not have seen fly; and fishes swim, which I should not have seen swim.(p148)Traditional teaching is that Johnson's left eye was either blind or amblyopic from scrofula and the right eye had a lesser degree of damage. His myopia is well documented. On the other hand, some of his contemporaries' accounts give contradictory evidence and indicate his vision was reasonably good. Fanny Burney, who described his nearsightedness, also said, "he sees wonderfully at times."(p160)He was able to tell the time on the Lichfield town clock and could make out details inside a French cathedral. Surprisingly, there is no mention of his eyes during the 9 years he labored on his dictionary. Sir Joshua Reynolds noted his intermediate vision was subnormal, saying "pictures he could not well see."Johnson appeared to enjoy art for he left behind a collection of 146 portraits when he died.(p214)It is difficult to believe that at the age of 66 years, Johnson would have gone on a 100-day frolic around Scotland with Boswell if his visual impairment were severe.Johnson read with the material held very close to his face (Figure 1). His friend Thrale noted that Johnson's wigs were scorched from reading too close to a candle and was seriously afraid that Johnson might burn himself up while reading in bed.(p307)According to the sister of the artist Sir Joshua Reynolds, Johnson's sight was so poor that he could not distinguish faces half a yard away.(p92)Hester Thrale believed his crude eating habits owed something to his poor eyesight. Johnson confirmed as much to Boswell, saying "I am short-sighted, and afraid of bones, for which reason I am not fond of eating many kinds of fish, because I must use my fingers."(p206)Although willing to acknowledge that he was myopic, Johnson was defensive about the appearance of his eyes. After seeing a portrait of himself painted by Sir Joshua Reynolds that depicted him holding a book very close to his face (Figure 1), he protested that he "would not be known by posterity for his defects only . . . I will not be blinking Sam."(p273)Johnson defines blinkardin the fourth edition of his dictionary as "one that has bad eyes" and to him to blinkmeant "to see obscurely." (Modern dictionaries define blinkardas an archaic word meaning one who blinks with, or as if with, weak eyes.)There has long been uncertainty concerning the relative contribution of eye disease and refractive error to Johnson's visual impairment. According to an account published in 1784, Johnson did not wear glasses "because he was assured they would be of no service to him."(p343)He was well aware of the benefits of glasses. His friend Reynolds wore them, and Johnson was constantly mingling with physicians who would have advised him to try them. He states in his dictionary, "It is no fault in the spectacles that the blind man sees not."Johnson even discussed the action of lenses with King George III. Concave lenses for the correction of myopia were available in Johnson's day, but cylinders were not, and we assume he experimented with glasses but did not find them helpful.There are many paintings, etchings, pastels, and sculptures of Johnson, but it is difficult to use these to diagnose his ocular problems. Evidence from portraiture is apt to be unreliable, because artists often flatter their sitters to please them. Johnson may have had a congenital left superior oblique palsy, because a head tilt to the right shoulder is observable in several portraits of him (Figure 2).The ocular inflammation Johnson experienced as a child, which may have been phlyctenular keratoconjunctivitis, could have resulted in fine scarring of the cornea and astigmatism and reduced his visual acuity. No scarring of the ocular surface or strabismus is evident in his portraits. The defects were not severe enough to result in loss of binocularity, because he maintained a head tilt. The inflammation he encountered as an adult was probably a keratoconjunctivitis, which was not severe, because he maintained adequate functional vision for the rest of his life. His visual impairment, which seems to have been severe in childhood, appeared to be less of a problem when he was an adult, possibly as a result of slow clearing of phlyctenular disease and adaptation to his refractive error. He could read and write to the end of his life, and his penmanship was legible a week before he died. A postmortem examination was made 2 days after his death, which found emphysema, aortic sclerosis, gallstone, small kidney, hydrocele, and varicocele, but the head and eyes were not evaluated.Although there is much we can be sure of, a definitive ocular diagnosis is elusive. Much remains speculative, including the impact of his eye disease on his life and its severity. It is likely that his poor distance vision led him to concentrate on near work and influenced his career choices toward books and literature.OPHTHALMOLOGY IN THE JOHNSON HOUSEHOLDHis household included a strange collection of humanity. One resident in his home was a physician, Robert Levet, who treated some of London's poorest families. Another, Anna Williams, came initially as a visitor but ended up residing in the Johnson home for 35 years. She was often irksome, but Johnson enjoyed chatting with her over tea. She had cataracts and was treated by Samuel Sharp, a surgeon at Guy's Hospital who was an important pioneer in the history of cataract extraction. Two of his articles on cataract surgical technique were published by the Royal Society, and the composer Handel consulted him about his cataracts. Sharp operated on both of Mrs Williams' cataracts, but "the crystalline humor was not sufficiently inspissated for the needle to take effect."She became blind and was Johnson's responsibility for the rest of her life.Johnson was interested in the cataract problem of another friend, Bennet Langton. He wrote,I am very sincerely solicitous for the preservation or curing of Mr Langton's sight, and am glad that the chirurgeon gives him so much hope. Mr Sharp is of the opinion that the tedious maturation of the cataract is a vulgar error, and that it may be removed as soon as it is formed. This notion deserves to be considered; I doubt whether it be universally true; but if it be true in some cases, and those cases can be distinguished, it may save a long and uncomfortable delay.(p357)Johnson did not discuss cataracts with one of the most famous ophthalmologists of the day, Chevalier Taylor, oculist to the king, who was a skillful surgeon but also one of the most notorious quacks in the history of medicine.Johnson considered Taylor "the most ignorant man I ever knew," probably because he could not converse in Latin.(pp289,290)He also said of Taylor, undoubtedly due to his outrageous behavior, that he was "an instance how far impudence could carry ignorance."(p291)Johnson once commented, "It matters not how a man dies, but how he lives."(pp106,107)His own life, however, was made difficult by physical disabilities. Late in life he wrote, "My diseases are an asthma and a dropsy, and, what is less curable, 75."(p363)Had he lived 2 centuries later, he would have found that good health, which he considered the basis of happiness, was much easier to attain.As Boswell wrote,Such was Samuel Johnson, a man whose talents, acquirements, and virtues, were so extraordinary, that the more his character is considered, the more he will be regarded by the present age, and by posterity, with admiration and reverence.(pp429,430)JBoswellBoswell's Life of Johnson (1780-1784).Vol 4. Oxford, England: Clarendon Press; 1934.JBoswellJournal of a Tour to the Hebrides.Oxford, England: Clarendon Press; 1964.JMSPearceDoctor Samuel Johnson: "the Great Convulsionary" a victim of Gilles de la Tourette's syndrome.J R Soc Med.1994;87:396-399.http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&Dopt=r&uid=entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8046726&dopt=AbstractSJohnsonRassellas.In: Kolb GJ, ed. Yale Edition of the Works of Samuel Johnson.Vol 16. New Haven, Conn: Yale University Press; 1990.SJohnsonA Dictionary of the English Language.London, England: W Strahan; 1755.JBoswellBoswell's Life of Johnson (1709-1765).Vol 1. Oxford, England: Clarendon Press; 1934.GBHillJohnsonian Miscellanies.Vol 1. Oxford, England: Clarendon Press; 1897.GBHillWit and Wisdom of Samuel Johnson.Oxford, England: Clarendon Press; 1888:184.JBoswellBoswell's Life of Johnson (1776-1780).Vol 3. Oxford, England: Clarendon Press; 1934.JBoswellBoswell's Life of Johnson (1766-1776).Vol 2. Oxford, England: Clarendon Press; 1934.SJohnsonDiaries, Prayers, and Annuals.In: McAdam EL Jr, ed, with Donald and Mary Hyde. Yale Edition of the Works of Samuel Johnson.Vol 12. New Haven, Conn: Yale University Press; 1958.LCMcHenry JrRMacKeithSamuel Johnson's childhood illness and the King's evil.Med Hist.1966;10:386-399.http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&Dopt=r&uid=entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=5331695&dopt=AbstractMKeynesThe miserable health of Dr Samuel Johnson.J Med Biogr.1995;3:161-169.http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&Dopt=r&uid=entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11639834&dopt=AbstractBRedfordThe Letters of Samuel Johnson (1731-1772).Vol 1. Princeton, NJ: Princeton University Press; 1992.BRedfordThe Letters of Samuel Johnson (1773-1776).Vol 2. Princeton, NJ: Princeton University Press; 1992.JWiltshireSamuel Johnson in the Medical World.New York, NY: Cambridge University Press; 1991:19.JLCliffordDictionary Johnson.New York, NY: McGraw-Hill; 1979:101.PTrevor-RoperChevalier Taylor – Ophthalmiater Royal (1703-1772).Doc Ophthalmol.1989;71:113-122.http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&Dopt=r&uid=entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=2663393&dopt=AbstractCorrespondence: James G. Ravin, MD, MS, Medical College of Ohio, 3000 Regency Ct, Toledo, OH 43623 (jamesravin@aol.com). http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA Ophthalmology American Medical Association

Loading next page...
 
/lp/american-medical-association/blinking-sam-ac8nJ50QzT

References (24)

Publisher
American Medical Association
Copyright
Copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.
ISSN
2168-6165
eISSN
2168-6173
DOI
10.1001/archopht.122.9.1370
pmid
15364718
Publisher site
See Article on Publisher Site

Abstract

The 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 dictionary 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.Samuel Johnson had a multitude of physical and psychological ailments. From the beginning of his life as a hypoxic newborn, he was troubled by numerous illnesses, including neonatal abscess of the buttocks, probable smallpox, and deafness in the left ear (and both ears later in life). As he put it, "My health has been, from my twentieth year, such as has seldom afforded me a single day of ease."(pp147,148)The most important of his ailments were scrofula (primary tuberculosis of the cervical lymph nodes, known during his lifetime as "the King's evil"); depression ("I inherited a vile melancholy from my father")(p215); possibly Gilles de la Tourette syndrome, since he experienced involuntary contortions, gesticulations, and oral outbursts; asthma; and dropsy (edema). In adulthood, he also experienced insomnia, a death phobia, intermittent excesses of alcohol and opiates, obesity, dyspepsia, flatulence, heart failure, gout, and stroke. It is hardly surprising that Johnson was led to comment, "Human life is everywhere a state in which much is to be endured, and little to be enjoyed."(p50)BIOGRAPHYA brief summary of Johnson's life is a daunting task, because he was a man of many remarkable accomplishments. He was born in the town of Lichfield in 1709, the son of a bookseller. He studied languages, literature, ethics, and theology at the University of Oxford, but, impoverished and depressed, he left before obtaining a degree. Nervousness, odd manners, and ill health made it difficult for Johnson to find work. Eventually, he became a schoolmaster and later was employed by a publisher. At the age of 26 years, he married a widow 20 years older than he. Later he would write, "Marriage has many pains, but celibacy has no pleasures."(p99)After a boarding school he established failed, Johnson moved to London in 1737 to begin his writing career. Once established, he wrote for Gentleman's Magazineand published a series of articles about important physicians in history, including Boerhaave and Sydenham. He collaborated with Robert James, MD, in creating the Medicinal Dictionary(1743-1745), a 1000-page compendium of pharmacology written for a general audience.Public recognition of Johnson's work came with the first edition of his Dictionary of the English Language(1755), which he compiled almost single-handedly and is a landmark of literary achievement. It defines more than 40 000 words, was the first important and precise English dictionary, and went through 5 editions during his lifetime. In honor of this accomplishment, he was granted a royal pension, even if he had defined the word pensionsarcastically in his dictionary as "pay given to a state hireling for treason to his country."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 background to become the preeminent literary figure of his era. He knew most of England's great thinkers, and his "supreme enjoyment was the exercise of reason."(p66)Johnson was more famous for his brilliant conversational remarks than for his writings (see Box). Although he was eccentric in some ways and unusual in appearance (Figure 1and Figure 2), his peculiarities were overlooked as soon as he began to speak. He mixed serious comments with a good sense of humor.(p269)Criticism did not faze him. He considered it better to be criticized than overlooked and degrading to respond to insults.A Johnson SamplerOn physicians:"I believe every man has found in physicians great liberality and dignity of sentiment, very prompt effusion of beneficence, and willingness to exert a lucrative art where there is no hope of lucre."(p223)"That the greatest physician of the age [Sydenham] arrived at so high a degree of skill without any assistance from his predecessors, and that a man eminent for integrity practiced medicine by chance and grew wise only by murder, is not to be considered without astonishment."On cataract:"A suffusion of the eye, when little clouds, motes, and flies, seem to float about in the air; when confirmed, the pupil of the eye is either wholly, or in part, covered, and shut up with a little thin skin, so that the light has no admittance."(quoting Quincy)To couch:"To depress the film that overspreads the pupil of the eye. Some artist, whose nice hand couches the cataracts, and clears his eyes, and all at once a flood of glorious light comes rushing on his eyes."(quoting Dennis)On glaucoma:"A fault in the eye, which changes the crystalline humor into a greyish colour, without detriment of sight, and therein differs from what is commonly understood by suffusion."(quoting Quincy)On sight:"Perception by the eye, the sense of seeing. O loss of sight, of thee I most complain! Blind among enemies, O worse than chains, Dungeon or beggary, decrepit age!"(quoting Milton)Figure 1.Sir Joshua Reynolds, English. Samuel Johnson, circa 1790. Oil painting. Reprinted by kind permission of Loren and Frances Rothschild.Figure 2.After Joshua Reynolds, English. Samuel Johnson, late 18th or early 19th century. Pastel. Reprinted by kind permission of the trustees of Dr Johnson's Birthplace.Dr Samuel Johnson had no medical degree, but because of his friendship with physicians, study of medical literature, and understanding of human behavior, people would occasionally ask if he were a physician or even an oculist.(p96)James Boswell considered him a "great dabbler" in medicine.(p152)He noted that Johnson took "a peculiar pleasure in the company of physicians," some of whom were the leading practitioners of his day.(p293)If one of his friends would complain about physician's fees, he would challenge them to produce a single example of a large estate founded on a medical practice.(p223)In contrast to his friendly attitude toward physicians, "Johnson never had a good word for an attorney."(p151)Johnson even associated attorneys with street robbers and wrote this couplet: "There ambush here relentless ruffians lay, And here the fell attorney prowls for prey."(p126)Johnson defined the word patronhumorously in his dictionary as "a wretch who supports with insolence, and is paid with flattery."A decade after the dictionary came out, he came under the patronage of Henry Thrale, a wealthy brewer, and his literary wife, Hester, who wrote a biography of Johnson. But it was James Boswell, a young Scottish lawyer, who made his own fame with his Life of Samuel Johnson(1791). Undoubtedly, this is the best known and most widely read biography ever written. Johnson died a national celebrity and is buried in Westminster Abbey.JOHNSON'S EYES"My mother had a very difficult and dangerous labour . . . I was born almost dead, and could not cry for some time."(p3)He was placed with a wet nurse and 10 weeks later "taken home a poor, diseased infant, almost blind."(p5)Many commentators have felt the wet nurse gave Johnson scrofula, which affected his eyes, but this hypothesis is unlikely to be correct, because scrofula is not transmitted through breastfeeding, and tuberculosis in infancy is nearly always fatal.Johnson's first ocular problem may have been ophthalmia neonatorum.Johnson developed scrofula at approximately age 2 years from infected cow's milk, and this caused many problems during his childhood. His eyes were severely affected. Treatment included making an "issue" in his left arm, an incision that was kept open with a small foreign body such as a pea. This obsolete form of therapy was intended to drain away evil humors. He was taken the then–long distance of 20 miles to consult an oculist, Dr Thomas Attwood, but no records of his diagnosis or treatment have survived. At age 2½ years, his mother took him to London to be 1 of 200 individuals given the "royal touch," an ancient magical ceremony designed to treat scrofula. He was examined by the court physician, blessed by the court chaplains, and presented with a golden amulet by Queen Anne.(p8)He wore this charm around his neck ever after. Not surprisingly, Johnson's scrofulous sores were not cured, and the scars on his face and neck were visible for the rest of his life.Because of his poor eyesight, Johnson did not go to school until he was 8 years old. Although the school was fewer than 150 yards from his home, a servant would escort him there and back or even carry him. Boswell describes how once, when the servant was late, Johnson started off alone and was obliged to kneel down to see the gutter before he ventured to step over it.(p39)His mother was afraid he would fall into the drain in the street or even the sewer at the market. He often used his limited eyesight as a convenient excuse to avoid attending church and would wander off into the countryside instead, taking along something to read. Poor vision did not prevent him from doing well academically at school, but it kept him from playing the usual childhood sports.There is little new mentioned about his eyes until 1756, when 47-year-old Johnson wrote, "The inflammation is come again into my [right] eye, so that I can write very little."(pp132,133)He was relieved when improvement followed and thanked "Almighty God, who hast restored light to my eye, and enabled me to pursue again the studies which thou hast set before me."(p60)Unfortunately, the problem recurred later that year, and he attributed it to the scrofula he had acquired in childhood. Boswell first met Johnson in 1763, when the latter was 54 years old, and found his appearance dreadful due to inflamed eyes, ungainliness, strange movements, and scars from scrofula.Eye pain occurred during the next few years, and in letters written in 1773 Johnson wrote,"My fever has departed but has left me a very severe inflammation in the seeing [right] eye. . . . My eye is yet so dark that I could not read. . . . I read for a very short time, in a book of a minute print, and at night felt a pain in my eye, which was next day inflamed to a very great degree.(pp35,37,40)He was treated by bleeding and purging. A few months later he recorded, "My eye is almost recovered, but is yet a little dim, and does not like a small print by candlelight."(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."(p506)The recovery was not complete, but Johnson felt well enough to embark on a tour of Scotland 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."(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."(p41)Boswell acknowledged that many of Johnson's friends knew he had an ocular defect,"though I never perceived it; I supposed 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 objects.(p41)Johnson once used his myopia as a convenient excuse to not go on an expedition, saying"I see but at a small distance. So it was not worth my while to go to see birds fly, which I should not have seen fly; and fishes swim, which I should not have seen swim.(p148)Traditional teaching is that Johnson's left eye was either blind or amblyopic from scrofula and the right eye had a lesser degree of damage. His myopia is well documented. On the other hand, some of his contemporaries' accounts give contradictory evidence and indicate his vision was reasonably good. Fanny Burney, who described his nearsightedness, also said, "he sees wonderfully at times."(p160)He was able to tell the time on the Lichfield town clock and could make out details inside a French cathedral. Surprisingly, there is no mention of his eyes during the 9 years he labored on his dictionary. Sir Joshua Reynolds noted his intermediate vision was subnormal, saying "pictures he could not well see."Johnson appeared to enjoy art for he left behind a collection of 146 portraits when he died.(p214)It is difficult to believe that at the age of 66 years, Johnson would have gone on a 100-day frolic around Scotland with Boswell if his visual impairment were severe.Johnson read with the material held very close to his face (Figure 1). His friend Thrale noted that Johnson's wigs were scorched from reading too close to a candle and was seriously afraid that Johnson might burn himself up while reading in bed.(p307)According to the sister of the artist Sir Joshua Reynolds, Johnson's sight was so poor that he could not distinguish faces half a yard away.(p92)Hester Thrale believed his crude eating habits owed something to his poor eyesight. Johnson confirmed as much to Boswell, saying "I am short-sighted, and afraid of bones, for which reason I am not fond of eating many kinds of fish, because I must use my fingers."(p206)Although willing to acknowledge that he was myopic, Johnson was defensive about the appearance of his eyes. After seeing a portrait of himself painted by Sir Joshua Reynolds that depicted him holding a book very close to his face (Figure 1), he protested that he "would not be known by posterity for his defects only . . . I will not be blinking Sam."(p273)Johnson defines blinkardin the fourth edition of his dictionary as "one that has bad eyes" and to him to blinkmeant "to see obscurely." (Modern dictionaries define blinkardas an archaic word meaning one who blinks with, or as if with, weak eyes.)There has long been uncertainty concerning the relative contribution of eye disease and refractive error to Johnson's visual impairment. According to an account published in 1784, Johnson did not wear glasses "because he was assured they would be of no service to him."(p343)He was well aware of the benefits of glasses. His friend Reynolds wore them, and Johnson was constantly mingling with physicians who would have advised him to try them. He states in his dictionary, "It is no fault in the spectacles that the blind man sees not."Johnson even discussed the action of lenses with King George III. Concave lenses for the correction of myopia were available in Johnson's day, but cylinders were not, and we assume he experimented with glasses but did not find them helpful.There are many paintings, etchings, pastels, and sculptures of Johnson, but it is difficult to use these to diagnose his ocular problems. Evidence from portraiture is apt to be unreliable, because artists often flatter their sitters to please them. Johnson may have had a congenital left superior oblique palsy, because a head tilt to the right shoulder is observable in several portraits of him (Figure 2).The ocular inflammation Johnson experienced as a child, which may have been phlyctenular keratoconjunctivitis, could have resulted in fine scarring of the cornea and astigmatism and reduced his visual acuity. No scarring of the ocular surface or strabismus is evident in his portraits. The defects were not severe enough to result in loss of binocularity, because he maintained a head tilt. The inflammation he encountered as an adult was probably a keratoconjunctivitis, which was not severe, because he maintained adequate functional vision for the rest of his life. His visual impairment, which seems to have been severe in childhood, appeared to be less of a problem when he was an adult, possibly as a result of slow clearing of phlyctenular disease and adaptation to his refractive error. He could read and write to the end of his life, and his penmanship was legible a week before he died. A postmortem examination was made 2 days after his death, which found emphysema, aortic sclerosis, gallstone, small kidney, hydrocele, and varicocele, but the head and eyes were not evaluated.Although there is much we can be sure of, a definitive ocular diagnosis is elusive. Much remains speculative, including the impact of his eye disease on his life and its severity. It is likely that his poor distance vision led him to concentrate on near work and influenced his career choices toward books and literature.OPHTHALMOLOGY IN THE JOHNSON HOUSEHOLDHis household included a strange collection of humanity. One resident in his home was a physician, Robert Levet, who treated some of London's poorest families. Another, Anna Williams, came initially as a visitor but ended up residing in the Johnson home for 35 years. She was often irksome, but Johnson enjoyed chatting with her over tea. She had cataracts and was treated by Samuel Sharp, a surgeon at Guy's Hospital who was an important pioneer in the history of cataract extraction. Two of his articles on cataract surgical technique were published by the Royal Society, and the composer Handel consulted him about his cataracts. Sharp operated on both of Mrs Williams' cataracts, but "the crystalline humor was not sufficiently inspissated for the needle to take effect."She became blind and was Johnson's responsibility for the rest of her life.Johnson was interested in the cataract problem of another friend, Bennet Langton. He wrote,I am very sincerely solicitous for the preservation or curing of Mr Langton's sight, and am glad that the chirurgeon gives him so much hope. Mr Sharp is of the opinion that the tedious maturation of the cataract is a vulgar error, and that it may be removed as soon as it is formed. This notion deserves to be considered; I doubt whether it be universally true; but if it be true in some cases, and those cases can be distinguished, it may save a long and uncomfortable delay.(p357)Johnson did not discuss cataracts with one of the most famous ophthalmologists of the day, Chevalier Taylor, oculist to the king, who was a skillful surgeon but also one of the most notorious quacks in the history of medicine.Johnson considered Taylor "the most ignorant man I ever knew," probably because he could not converse in Latin.(pp289,290)He also said of Taylor, undoubtedly due to his outrageous behavior, that he was "an instance how far impudence could carry ignorance."(p291)Johnson once commented, "It matters not how a man dies, but how he lives."(pp106,107)His own life, however, was made difficult by physical disabilities. Late in life he wrote, "My diseases are an asthma and a dropsy, and, what is less curable, 75."(p363)Had he lived 2 centuries later, he would have found that good health, which he considered the basis of happiness, was much easier to attain.As Boswell wrote,Such was Samuel Johnson, a man whose talents, acquirements, and virtues, were so extraordinary, that the more his character is considered, the more he will be regarded by the present age, and by posterity, with admiration and reverence.(pp429,430)JBoswellBoswell's Life of Johnson (1780-1784).Vol 4. Oxford, England: Clarendon Press; 1934.JBoswellJournal of a Tour to the Hebrides.Oxford, England: Clarendon Press; 1964.JMSPearceDoctor Samuel Johnson: "the Great Convulsionary" a victim of Gilles de la Tourette's syndrome.J R Soc Med.1994;87:396-399.http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&Dopt=r&uid=entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8046726&dopt=AbstractSJohnsonRassellas.In: Kolb GJ, ed. Yale Edition of the Works of Samuel Johnson.Vol 16. New Haven, Conn: Yale University Press; 1990.SJohnsonA Dictionary of the English Language.London, England: W Strahan; 1755.JBoswellBoswell's Life of Johnson (1709-1765).Vol 1. Oxford, England: Clarendon Press; 1934.GBHillJohnsonian Miscellanies.Vol 1. Oxford, England: Clarendon Press; 1897.GBHillWit and Wisdom of Samuel Johnson.Oxford, England: Clarendon Press; 1888:184.JBoswellBoswell's Life of Johnson (1776-1780).Vol 3. Oxford, England: Clarendon Press; 1934.JBoswellBoswell's Life of Johnson (1766-1776).Vol 2. Oxford, England: Clarendon Press; 1934.SJohnsonDiaries, Prayers, and Annuals.In: McAdam EL Jr, ed, with Donald and Mary Hyde. Yale Edition of the Works of Samuel Johnson.Vol 12. New Haven, Conn: Yale University Press; 1958.LCMcHenry JrRMacKeithSamuel Johnson's childhood illness and the King's evil.Med Hist.1966;10:386-399.http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&Dopt=r&uid=entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=5331695&dopt=AbstractMKeynesThe miserable health of Dr Samuel Johnson.J Med Biogr.1995;3:161-169.http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&Dopt=r&uid=entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11639834&dopt=AbstractBRedfordThe Letters of Samuel Johnson (1731-1772).Vol 1. Princeton, NJ: Princeton University Press; 1992.BRedfordThe Letters of Samuel Johnson (1773-1776).Vol 2. Princeton, NJ: Princeton University Press; 1992.JWiltshireSamuel Johnson in the Medical World.New York, NY: Cambridge University Press; 1991:19.JLCliffordDictionary Johnson.New York, NY: McGraw-Hill; 1979:101.PTrevor-RoperChevalier Taylor – Ophthalmiater Royal (1703-1772).Doc Ophthalmol.1989;71:113-122.http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&Dopt=r&uid=entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=2663393&dopt=AbstractCorrespondence: James G. Ravin, MD, MS, Medical College of Ohio, 3000 Regency Ct, Toledo, OH 43623 (jamesravin@aol.com).

Journal

JAMA OphthalmologyAmerican Medical Association

Published: Sep 1, 2004

There are no references for this article.