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  • 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

    An colored illustration of six diseased human eyes. From top the bottom, the eyes get progressively more red, and the last eye is extremely red and the eyelids are swollen shut.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
    A woodcut illustration of three men sitting on benches in a wooden room. The men are nude except for a towel over their waists, and two of them have large circular boils covering their chests. One man applies a glass cup to the skin of the others.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

    A cylindrical silver-colored medical tool. The tool is a few inches long. One end has a handle, and the other end is open with several small, short needles sticking out of it.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

    A black and white photograph of a nurse administering a shot to a child. The nurse is a young, white woman wearing a white dress and white cap. She is giving a shot in the arm of a young, crying child wearing overalls. The child is being held by a woman wearing a sweater and a skirt, with short dark hair in a 1950s bob hairstyle.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.

    Cow Pox
    A faded, black and white photograph of two men cutting or working on the carcass of a cow. The carcass is laying on a wooden table with ropes from the ceiling holding the back legs up. The men both wear long white lab coats, and one man leans on to the table while the other stands behind him.This is a rare photograph of the harvest of cow pox in order to make the small pox vaccine in Florence, Italy c1900. Photographed by Giacomo Brogi. Image courtesy of Archivio Storico dell'Instituto degli Innocenti.

    Bacteria

    Three colored illustrations of a diseased human eye. The top eye has a red spot across the iris. The middle eye has a large white spot in the middle of the eye. The bottom eye is milky and white and has red, swollen eyelids.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
    A sepia-toned photograph of an older white man with a large white mustache. He has white hair and wears a dark suit with an ascot-style tie. He looks to the right, past the camera.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