• Contagion! Epidemics in Ophthalmic History

    Plague, pestilence and pandemic are words that have struck fear for centuries. Here we uncover the history of contagion.


    Humors

    Close living conditions and poor sanitation can lead to the spread of contagious diseases. Before the development of modern germ theory in the late 1800s, the causes of disease were largely a mystery. Many blamed the environment saying it was bad air, or “miasma,” that caused epidemics such as The Black Death and cholera. Just as likely to be blamed were the less desirable elements of society- the poor, non-whites or minority religions.

    How to fight disease was as mysterious as its cause, and treatments were often as bad as the disease itself. In ancient times, Hippocrates (c.460 – 370 BCE) developed the theory that a person had four basic humors: black bile, yellow bile, blood and phlegm. To remain healthy the humors were to be balanced by emetics, enemas, and bloodletting. This theory of balance would be the standard of care for centuries in Europe. Many have observed that there were similar ideas in Ayurvedic and Traditional Chinese Medicine.

    • Cupping

      This illustration from 1583 demonstrates the use of cupping in ophthalmic disease to balance the body’s humors. Note that the entire body was treated, not just the affected organ.

    • Bloodletting

      Through the 19th century bloodletting was often employed to create balance. Leeches were often utilized for this purpose, either real or artificial - such as this instrument: the Bacon artificial leech, c1890.

    Viruses

    Virus is the Latin word for venom. The Ebers papyrus from ancient Egypt describes the common cold suggesting that viral diseases have been recognized since antiquity. However, it took until the 1880s for viruses to be definitively discovered by Dmitri Ivanovsky (1864-1920) and to be named such by Martinus Beijerinck (1851-1931).

    A virus’s ability to commandeer the cellular machinery of other life forms and replicate itself makes it the fastest evolving thing on the planet. Viruses can be deadly, acting rapidly to kill its host, but also benign and even at times beneficial. Viruses are studied by virologists who classify them and their behaviors. Viruses are prevented by vaccines.

    The first attempts to inoculate against a virus was made by the Chinese as early as the 10th Century to fight small pox. The doctors in China understood that a mild case could prevent an even worse outbreak so they purposefully infected patients with a lesser disease to immunize them from a deadly virus. This process, known as variolation, was also practiced in other parts of Asia and Africa. It was then documented in 1796 by Edward Jenner (1749-1823) in his own patient using cow pox to ward off the deadly small pox virus. His patient’s immunity proved to the Western world that variolation worked.

    Bacteria

    Bacterium is the Greek word for staff or cane, so named for the way it looks under a microscope. They were first discovered by Antonie van Leeuwenhoek (1632-1723) in 1676 looking through his microscope and named in 1828 by Christian Ehrenberg (1795-1876).

    Bacteria are a diverse group of micro-organisms whose numbers far exceed that of plants and animals on earth. Bacteria are found all over the world, from the oceans to the desert; from the jungles to the frozen tundra. Certain kinds don’t even need oxygen to live. They are present inside plants and animals, including humans, and are remarkably adaptable to new conditions and drugs.

    Only a small percentage of bacteria are considered pathogenic- causing disease. Bacteria can be controlled through several methods including sterilization, static agents and antibiotics. The first antibiotic was introduced in 1899. Penicillin became widely available in 1945 alongside two additional antibiotics: sulfonamides (1939) and streptomycin (1943).

    • Silver nitrate

      One of the earliest known antiseptics was silver nitrate or lunar caustic; its use dates back to the 8th Century CE. In 1881 Dr. Karl Credé (1810-1892) argued silver nitrate should be placed in the eyes of newborns to prevent gonococcal infection - also known as ophthalmia neonatorum. Lucien Howe, MD (1848-1928) championed this cause and in 1890 the New York State legislature made the use of silver nitrate mandatory.

    • Yellow mercuric oxide

      Yellow mercuric oxide was another antiseptic developed by Alexander Pagenstecher in 1866 for treatment of conjunctivitis and corneal ulcer. By the 1930’s Pagenstecher’s ointment was advertised as a universal cure-all, causing some physicians to complain that its usefulness in preventing and curing infection was over rated.

    • Jonathan Hutchinson, MD

      Jonathan Hutchinson was the first to recognize the triad of keratitis, dental and hearing abnormalities as symptoms of congenital syphilis in this book. Dr. Hutchinson could not prove that his patients had syphilis at the time but his treatments met with some success. The bacterium responsible for syphilis was identified in 1905 and its first modern treatment discovered in 1910, almost 50 years after the publication of Hutchinson’s book.

    Yellow Fever

    Yellow fever is a particularly deadly virus with a long history in the United States. By one count, yellow fever was America’s most frequent epidemic between 1650 and 1918, quickly followed by cholera, measles and influenza. In its final stage “yellow jack,” as it was sometimes called, would cause fever, jaundice, bleeding from mouth, nose and even eyes, seizures, liver and kidney failure.

    Finding the cure for yellow fever required discovering its cause and for this we can thank a Cuban ophthalmologist named Carlos Juan Finlay (1833-1915). Dr. Finlay theorized that the mosquito was the vector for the disease and published his findings on August 14, 1881. Twenty years later, Walter Reed, MD and his commission confirmed these findings which were then implemented during the construction of the Panama Canal. U.S. General Leonard Wood noted, “The confirmation of Dr. Finlay’s doctrine is the greatest step forward made in medical science since [Edward] Jenner’s discovery of vaccination.”

    • Coin

      Dr. Finlay was commemorated with this coin minted by Panama, 1975

    • Stamp

      Dr. Finlay was commemorated with this stamp issued by Cuba, 1965

    Trachoma

    Trachoma, also known as granular conjunctivitis or Egyptian ophthalmia, is one of the oldest known eye diseases. Caused by the bacteria Chlamydia trachomatis, infection often happens in childhood. If untreated, the condition becomes chronic, causing scarring of the cornea. Today, trachoma is the world’s leading cause of infectious blindness.

    In an oral history recorded by the Museum of Vision in partnership with the UC Berkeley Regional Oral History Office, Dr. Phillips Thygeson described how he proved trachoma was caused by bacteria. In 1934 Dr. Thygeson purposely infected a human volunteer named Clarence Brown; Mr. Brown was then treated with copper sulfate for one year, after which he made a full recovery. Dr. Thygeson noted, “He survived and showed the whole trachoma picture from beginning to end...” This preceded the culture of the organism, which was finally accomplished by a team of researchers in China in 1957.

    • Thygeson experiment

      Dr. Thygeson and his patient, Clarence Brown, 1934.

    • Sulfonamides

      In 1935 Gerhard Domagk (1895-1964) discovered synthetic antibiotics (sulfonamides) which were then successfully used to treat trachoma infections. This was heralded at the 1937 Annual Meeting of the American Academy of Ophthalmology and Otolaryngology as “the greatest advance in the treatment of trachoma in 100 years.”

    Pneumococcus

    A pneumococcal ulcer is caused by the bacterium Streptococcus pneumoniae. S. pneumoniae was once the most common cause of bacterial keratitis in the world. Although no longer true in the United States, it remains a problem in the developing world.

    Today local antibiotics are powerful tools against infection, but prior to their introduction physicians relied on cautery and antiseptics. One commercial instrument for the cure of pneumococcal ulcer was the thermophore, introduced in June 1917 by W.E. Shahan, MD. The thermophore killed pneumococcus ulcers by applying short applications of increasing heat. According to Shahan, a probe should be fitted to his instrument then heated to approximately 152° F and finally applied for one minute to the pneumococcus ulcer. Dr. Shahan recommended anesthetizing the eye with a mixture of cocaine and adrenalin prior to application and cleansing the eye with a solution of silver nitrate afterward.

    • Thermophore

      In describing his technique, Dr. Shahan warned practitioners to avoid the words “burn” or “heat” with their patients as “these are terrifying words in connection with so sensitive an organ as the eye…If any explanation at all is necessary, state that just enough warmth is applied to the ulcer to stop the poison without hurting the eye.” Other than pneumococcus, thermophores were also used to treat other ulcers and tumors of the cornea.

    2015 Nobel Prize in Physiology or Medicine

    Onchocerciasis

    On October 5, 2015 the Nobel Assembly announced the recipients of the 2015 Nobel Prize in Physiology or Medicine. One half of the prize was awarded jointly to William C. Campbell and Satoshi Omura. This team’s discoveries led to a therapy for onchocerciasis, better known as river blindness.

    River blindness is caused by the roundworm parasite found in swift moving fresh water rivers and streams. Flies that breed in this water become carriers of the roundworm and then deliver the parasites to human hosts. The parasites are common in Central and South America, sub-Saharan Africa and South Asia. Roundworm causes a number of problems for their human hosts. Approximately half of all those infected become blind. In 2004, Stanford University noted that onchocerciasis was the second leading cause of preventable blindness in the world.

    Starting in the 1970s, governments tried to control fly populations in order to keep humans from being infected with the parasites. However, Campbell and Omura discovered a more direct route. Satoshi Omura isolated specific soil bacteria. William Campbell experimented with the Omura cultures, further isolating an agent that attacked parasites. Together their discoveries led to a new class of drugs - an oral dosage that could be distributed through local clinics and hospitals to people in desperate need.

    Hugh R. Taylor, MD predicted this new drug would end river blindness during his 2012 talk at the Museum of Vision history symposium. His lecture, entitled “Parasites in the Eye: on the River and Elsewhere” can be obtained from the museum.

    According to the Nobel Committee, the 2015 recipients of the Nobel Prize in Physiology or Medicine “have provided humankind with powerful new means to combat these debilitating diseases that affect hundreds of millions of people annually. The consequences in terms of improved human health and reduced suffering are immeasurable.”

    • Commemorative stamp

      This stamp was issued by Togo in 1976 to commemorate one of the many campaigns to eradicate river blindness.