Star.
London, England, 1821-08-02 00:00:00

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OPHTHALMIC HOSPITAL.

The Sat-CT COMMITTEE appointed to inquire Into the Establish-
ment
of the OPHTHALMIC Hosereax in the Regent's Pact, and
the Claims of Sit W. ADAMS upon the Public, have inquired
into the matters referred to them, and have agreed to the
following REPORT:
(Ordered, by the House of Commons, to be printed, July 3,1821.)
Whatever may have bean the origin of the Ophthalmia in this
country, that disorder appears to have been greatly increased in
its prevalence, and aggravated in its severity, in consequence of
the infection communicated by our troops upon their return
from Egypt ; and, in the years 1808 and 1809, while it appeared
to be gaining ground among the general population of the coun-
try, its ravages in the Army seem to have attracted the attention,
and to have excited the alarms of the Military Deparunenfs of
the State.

Mr. Kam., the late Surgeon-General, in a letter addressed
to the Secretaty at War, on the Bth of August, 1808, says,
" Having fully satisfied myself of the contagious nature of the
" Ophthalmia, I beg leave humbly to represent, that the evils
" already produced by the disease, and the much greater ones
" likely to ensue, deserve the immediate and most serious eaten-
" tion of his Royal Highness the Commander-in-Chief, and of
" yourself, to devise means not only for arresting its progress, but
" also, if pos.ible, for exterminating it wholly from the Army.
" For, until this be done, there can be no security against its being
" propagated so rapidly and extensively, as to endanger the pub-
" lic safety."
Ile further states,
" That the number of soldiers who have been rendered totally
"4 blind by this affection since its introduction in and from Egypt,
" exceeds at present one thousand."
And he adds,
" It is impossible not to entertain the most disquieting appre-
" hensions respecting the future progress of the disorder.'
And he concludes by stating,
" In such circumstances it seems to me that no pains
" or expense likely to be requisite for eradicating this cones-
" gion should be regarded as too great for that purpose; and I
" beg leave humbly to suggest, for the determination of his
" Royal Highness and yourself, whether it might not be proper
" to refer the investigation of the best means of accomplishing
" this important object, to a Board especially appointed for that
" purpose, and which Board may consist of such members, be-
" sides the members of the Army Medical Board, as may be
" deemed competent, by their attainments and experience, to so
" important an inquiry."
In a subsequent letter, dated 29th August, 1808, after making
some further observations upon an instance of the extent to
which the disorder was then spreading, he stales,
" It will, I have no doubt, have great weight in the mind of
" his Royal Highness and yourself, to the considerations which
" I had the honour of submitting in my former letter, relative
" to the expediency of finding means, if possible, for the cons-
" piste extirpation of the Ophthalmia."
On the 28th October, 1809, Dr. Vetch, then Staff Surgebn of
the Ophthalmia Depot at Bognor (of whose knowledge and skill
in the treatment of this complaint, the Committee are induced
to think very highly front the evidence which they have re-
ceived in the course of this investigation), addressed a letter to
Mr. Knight, then Inspector-General of Hospitals, in which
there is the following passage :
" I took occasion some time back to represent to you the
alarming progress which the Ophthalmia was then making in
" the Army, and I took the liberty of suggesting the necessity of
" adopting some other and more powerful means of prevention."
In the beginning of the year 1810 a Board was appointed,
consisting of the three principal Officers of the Army Medical
Board, and of eight of the most distinguished Civil Practitioners
in London ; and their Report, which contained some highly 'va-
luable suggestions, as to the most effectual means of preventing
the di,order from spreading by communication from infected
persons, and as to the best mode of treating it in its early and
acute stages, was circulated in General Orders, for the guidance
and information of the Medical Officers of the Army.
It does not appear, however, that this Report contained any
instructions as to the mode of treating the chronic or third stage
of the Ophthalmia; nor did it direct the attention of those, for
whose guidance it was prepared, to the existence or treatment of
those effects, which the acute inflammation in the earlier stages'
lof the disorder generally produtes, upon the membrane that lines
the inner surface of the eye-lid.
In the beginning of 1810, and afterwards in 1812, Sir W.
Adams tendered to the 'Military Departments, information as to
the chronic or third stage of the disorder, and as to the mode of
treating that stage, which he considered to be important, and at
that time not generally known. In consequence of these corn-
munications from him, several Out-pensioners of Chelsea Hospi-
tal, afflicted with blindness, were at different times placed under
his care as subjects for experiment, as to the importance and effi-
cacy of the practice which he recommended; and the communi-
cations and experiments, ultimately led to the establishment of
the Ophthalmic Hospital, at the head of which Sir William
Adams was placed.
'File objects of this Institution have been stated to your Com-
mittee to have been three.
First, To diffuse, generally, among the Surgeons of the Army,
the knowledge of the best modes of treating the chronic and third
stage of the disorder.
Secondly, To diminish, if possible, the charge of the Out-pen-
sioners of Chelsea Hospital, by curing or relieving men who bad
received pensions for defective sight.
Thirdly, To check in some degree the annual augmentation
of the Pension List, by treating men about to be discharged for
defective sight, and by thus diminishing their claim to pension,
as far as it might be naiad:al upon the impaired state of their visien.
Yoi*Con:mittee are el opinion, that these objects were of
ffi suc importance to justify the steps which were taken for
their attainment.
With respect to the first point, your Committee have the sae
tisfaction to find, that this, which was the most important ob-

ject, has been greatly promoted. The Ophthalmia having, upon
the return of our troops from Egypt, become, comparatively
speak in, a new disease in • this country, its proper treatment
was at Eon imperfectly understood. It appears, however, that
the attention of the Medical Department of the Army has of late
years been most successfully directed
,to this subject, and 'that
the best modes of treating all the different stages of the Ophthal-
mia are now well understood and practised in the Army ; sod
your Committee are satisfied, that the establishment of the Hoi-
,pital under Sir William Adants, has greatly contributed to pro-
mote this desirable object, not only by the direct opportunity it
afforded of studying the various mode of practice, but indirectly,
by the manner in which it appears to base excited the emulation
and attention of other practitioners.
With respect to the second point, indeed, it has been stated,
that valid doubts were suggested, how far it was in the power
of the Commissioners of Chelsea Ite:pital to take away or ding-
nish any pension which they had granted under the provisions
of the Act of the 46th Geo. 111. and consequently your Com-
mittee have not thought it necessary to direct their inquiries to
this point, as no diminution cf pen,ions already granted could,
under any circumstances, have been effected.
With respect to the third point, as but a few men so circum-
stanced have been placed in the Hospital, it does not appear to
your Committee that Sir William Adams has had sufficient op-
portunity of shewing how fa: he could have effected this object,
Upon the scale originally proposed • but the gereral diffosson of
knowledge among the Medical Officers cf the Army muit neves-
urily lead to the accomplishment of this end.
With regard to the future continuance of this Establishment,
it has been stated to your Committee by the Department with
which it originated, that the main obj. .'s for which it was in-
stituted having thus been attained, it goes not appear that any
public inconvenience would now arise from its discontinuance.
In this opinion your Committee are disposed to concur, and they
therefore recommend that the Establishment should e discon-
tinued, as soon as the proper arrangements can cunveniently be
effected.

Upon the claim: of Sir William Adams upon the Public, your
Committee have to report, that he has rested those claims upon
two grounds.

First, hpon his having been the means of promulgating to the
Army, and to the Public, certain information as to ;he third or
chronic: stag of the Ophthalmia and its consequences; namely,
that it is the general, if not invariable, effect of the inflammation
kn the acute stage of the disorder, to produce in a greater or less
degree, what ate termed granulations on the inner surface of the
eye-lid; that these granulations render the patient subject to re-
lapses, and arc frequently the cause of blindness • that during the
relapses so happening, the patient is liable to become again infec-
tious : and therefore, that these granulations must invariably be
Lacked for, and removed, before the patient can be effectually
cured.

Secondly, upon his having attended the Ophthalmic Hospital
since its first formation in 1817, witliotat having hitherto received
any remuneration for that duty.
Upon the first point, your Committee have to report, That
the existence of these granulations, and the necessity of removing
them, seems to have been known in very early times, and are
adverted to in the works of Cclsus, in the first century, of Paw
lug of Egina in the seventh,of Mates the Arabian in the tenth,
and in the works of Sir William Reid, in the reign of Queen
Anne. That consequently no person of the present day, can
claim more than the merit of having revived knowledge which
had fallen into neglect.
Your Committee do not it necessary to pronounce between
the conflicting claims upon this bead, or, by recommending a
Parliamentary reward for such revival, to decide to whom the
merit properly belongs. They conceive that question is best leR
to the decision of the Profession and of the Public. But they are
of opinion that Sir William Adams has, ar long others, been
greatly instrumental in promulLasing this knowledge, and in
tendering it generally available.
Upon the second point your Committee have to report, that
since the first establishment of the Hospital, in 1817, Sir William
Adams has devoted to the duties arising out of his appointment,
a large portion of that time which, to a professional man, is the
source of income ; and that, inasmuch as the time which he could
apply to his private practice has thereby been much curtailed,
his professional emoluments must also have been proportionally
lessened. That he has performed the difficult duties of his ap-
pointment with the greatest zeal and assiduity; and that your
Committee have been led to form the highest opinion of his skill
and abilities as an Oculist.

Your Committee, taking into consideration all the dream-
stances of the ease, are induced to recommend that the sum of
Four Thousand Pounds should be paid to Sit William Adams,
as a reward for the services which he has rendered to the Public.
July 3,1821.