OF THE OPHTHALMIA OF EGYPT.
The other endemic, and next to the plague in importance, is the ophthalmia of Egypt; which, though a less fatal, is a more distressing, malady.
In Egypt, at particular seasons, it is a most generally-prevailing disease. It is not confined to the human race; the animals of the country, particularly the dogs and camels, are subject to its attacks. Travellers (and, if I remember, Volney is one) describe the same disease as prevailing in Syria; and, I am informed, by my friend Dr Short, that, in Persia, ophthalmia is a most frequent and severe disease.
In Egypt this disease proved most distressing and obstinate. The French, it was said, sent from Egypt to France 1000 blind men.
The number sent home from the English army was very considerable likewise. Of the Indian army, 50 were sent home invalids from blindness; most of whom were from the 10th and 88th regiments.
Ophthalmia prevailed most in the 61st regiment; after them, in the 86th regiment: while the 8th dragoons, the artillery, and the 80th regiment, had very little of the disease.
It was remarked, at all times, that the disease was seen much less frequently, and with less violence, in the native Indian, than in the European, corps. Of the former, the 1st Bombay regiment had much more ophthalmia than any other corps of natives. It was said, that, in the English army, the disease prevailed most in the dragoon-regiments. The 26th dragoons was mentioned as a particular instance of this: that corps alone, I heard, sent home about 40 invalids from ophthalmia.
Several gentlemen thought that this disease, in Egypt, was contagious.[6] So singular an opinion I would hesitate to offer on slender grounds. However, the remarkable prevalence of the disease in particular regiments, and even in particular companies of regiments, while the same general causes prevailed every where, will not be easily accounted for, without admitting something of the kind. In some corps of the army from England, as well as that from India, this was observed. In the 54th regiment, my friend, Mr Ross, then the surgeon of it, informed me that the disease was for some time not only confined to particular companies, but to particular tents. It deserves mention, too, that, till the arrival of the Indian army at Ghiza, ophthalmia did not appear in the army. We found at Ghiza the 89th regiment and an ophthalmia-hospital of the English army.
I believe that several diseases are contagious, which are not suspected to arise from such a cause: the theory of contagion is but very imperfectly understood.
It was said, that the sailors, on-board the fleet at Aboukir-bay, had the disease at the same time that it prevailed in the army on-shore. Several cases appeared among the troops after we sailed from Suez.
Ophthalmia prevailed most from May to December. At Kossier the disease was hardly seen, nor at Ghenné. It was not till the army was encamped at Rhoda, in August, that cases crowded in on us. In that, and the two following months, most of the cases made their appearance.
It will be seen, in part the first of these sketches, that, in the months of January, February, March, and April, very few cases appear in the reports.
About the middle of May the disease began to appear in Alexandria.
Some of our medical gentlemen thought this disease very different from the ophthalmia which they had seen in Europe or in India. In several circumstances there certainly was a difference, and we were obliged to have recourse to a different mode of treatment, finding we did not succeed with that pursued in England or in India. The disease, I think, might generally be resolved into, 1st, either of Cullen’s two species, the ophthalmia tarsi and the ophthalmia membranarum; 2ndly, to a combination of these two; or, 3dly, to a species of ophthalmia, frequent in India, symptomatic of disease in the biliary secretion.
The appearance which the disease put on, particularly the two first species of it, was nearly what we have seen in other parts of the world; except that the symptoms advanced with alarming rapidity to the highest inflammatory stages. In most cases the attack was sudden, and very generally at night. Speedily, the patient complained of a burning heat of the eye-ball, or of a sensation of needles being passed through the eye. There was a considerable swelling of the ball of the eye, of the eye-lids, and sometimes of the neighbouring parts. Almost always, there was a copious flow of tears, which felt hot and scalding, and, as they flowed down, excoriated the face. Very frequently, there was a racking headach and general fever. Œdema of the eye-lids was frequently met with in the early stage of the disease, and inversion of the cilia in the last stages.
The disease very often continued two or three months: after it had continued some time, the general health became much impaired. It often terminated in diarrhœa or dysentery, and sometimes the patient became hectic.
In the third species of the disease, which I have mentioned, there was not so much active inflammation as in the other two species; and it was generally known by a yellow tinge of the adnata, or by dyspeptic symptoms being present; though, sometimes, we have seen those appearances absent: and no topical application had any effect in removing the ophthalmia, till the gums were affected by calomel or some mercurial preparation.
In the two first species of the disease, the inflammation, in a great many instances, induced fever of many days duration, and the disease too frequently terminated in opacity of the cornea or in suppuration of the eye-ball.
In the treatment, it appears, from the reports, that different gentlemen followed very different modes. We said, in general, that the European practice did not succeed. Scarification and astringent collyria, in the first stage, gave intolerable pain, and generally aggravated the symptoms.
The practice of the natives, was, to apply, in the first stage, emollient decoctions of their plants, and poultices of the kali. In the last stage, they rely much on the frequently bathing of the eye in the cold water of the Nile: they are likewise very fond of bleeding; and I understood that sometimes they use the actual cautery, burning behind the ear where we usually apply blisters.
The practice, which appeared to be by far the most successful, was the following:
For the first twenty-four or thirty-six hours after admission, the eyes of every patient were carefully syringed with tepid water, which had been filtered carefully. The syringing was performed from three to six times in the day; the light was carefully excluded, the patient kept cool, and every other part of the anti-phlogistic regimen strictly enforced. After the above period, a weak solution of sugar of lead, or of camphor, or vitrolated zinc, was applied. Where the pain was much complained of, a solution of opium was added to the collyrium; opium was applied in a cataplasm, or two or three drops of laudanum were let fall into the eye.
If there was much swelling, a saturnine poultice, or the coagulum alluminosum, was applied to the eyes. I observed, that blistering a large surface, and as near as possible to the seat of the pain, if kept discharging for some time, always afforded great relief.
To remove the fever and to alleviate the distressing pain, we often gave opium internally in a considerable quantity, and with great advantage.
Setons in the neck and the free use of bark appeared to be of the greatest service, when the disease was of long standing.
In opacity of the cornea, and when there were specks, several gentlemen thought highly of the aqua phagedænica of the old pharmacopeias, after having divided the vessels which went to the speck. It gave very pungent pain; but I have seen great relief from it, and also from a solution of lunar caustic.
As a collyrium in Egypt, I often gave with considerable benefit what I found in the hands of the black doctors in India, viz. a tea spoonful of lime-juice to four table spoonfuls of water, or a tea spoonful of arrack to two table spoonfuls of water. In the first stage, I would have applied leeches, but never could procure them.
In Persia, Dr Short, informs me, that he was very successful in the general use of an ointment, composed of white vitriol, tuttey, and cinnabar, after the application of leeches and scarification.
From the days of Prosper Alpinus, the salts contained in the soil of Egypt have been supposed to be among the principal causes of the ophthalmia of the country. Though the various modifications of light and heat no doubt act as existing causes; yet to the particular soil of Egypt, and to the constitution of the air there, we must look for the regular and the principal causes of this disease.
In Egypt several causes occurred, which in any country, separately applied, would be adequate to the production of violent ophthalmia. The dry, white, dazzling, soil, and the fine sand and dust constantly thrown about in whirlwinds and entering every crevice. If an ophthalmia is epidemical or is endemic in Egypt, the above causes will render it a very violent disease.
But I conceive, that, of themselves and alone, these circumstances do not produce the violent ophthalmia seen in Egypt. In no place did these circumstances exist in greater force than at Kossier, on the march across the Great Desert, and at Ghenné. Yet, till our arrival at Ghiza, the disease did not appear. These circumstances likewise exist in great force in most places of India, where the ophthalmia occasionally occurs from them, yet it is different from the two first species of the Egyptian ophthalmia.
For the production of the third species of this disease, the same causes will account, which produce dysentery, hepatitis, and other diseases of the liver. In Egypt, I remarked, that most of the cases of this species occurred at the time that dysentery prevailed the most.
It should be mentioned, that, in Egypt, the natives are universally impressed with the idea, that sleeping in the night-air brings on the disease.
In the ophthalmia of Egypt, as in the plague, it would appear, that very much may be done in the prevention.
It could not escape observation, how rarely officers were the subjects of this disease. In accounting for this, I lay most stress on the attention which officers pay to cleanliness. In the 88th regiment, where, I believe, forty men did not escape an attack, only two officers out of thirty had ophthalmia.
In the whole of the Indian army, only one officer lost an eye by it, and this was Ensign Paton, of the 86th regiment.
The exemption of the officers from the ophthalmia gives more weight to the opinion, that in Egypt this disease is communicated by contagion.
Mr Paton, previously to embracing the military profession, had studied medicine; and, when medical assistance was much wanted, and a great many of his corps were laid up with the ophthalmia, he very humanely offered to attend them. When employed in this duty, he was himself attacked with the disease and suffered most severely by it for many months.
Mr Bellars, about this time, joined the 86th regiment at Ghiza; he took charge of the sick, and was attacked in the same manner as Mr Paton had been, and he likewise suffered most severely by it for several months.
Dr Whyte, who fell a martyr to his zeal in the investigation of the history of the plague, from a residence of some years in the Levant and some time in Egypt, had good opportunities of being acquainted with the diseases of that country, informed me, that, by making those under his charge, frequently during the day, wash the eyes with cold water in the season of the ophthalmia, he never failed in preventing the disease. He instanced particularly the sailors of the transports, of about one thousand of whom he had the medical charge. The captains of the different transports carried Dr Whyte’s preventive instructions into execution; and, though the disease raged both in the army and the navy, few of the sailors of the transports had it. By an attention to this mode of prevention, and in the season when the ophthalmia prevails most, making the soldiers wear something over the eyes, I think we should have the prospect of passing a second campaign, or season in Egypt, with less loss from ophthalmia.