Berthier
03-04-2013, 15:31
Well I was asked to post a copy of an article I wrote in 1998 in response to a claim Nelson was a malingerer in trying to claim compensation for his loss of sight.
I couldn't find the full article of the original story but here is the link to a report of it http://news.google.com/newspapers?nid=1241&dat=19980511&id=CI5TAAAAIBAJ&sjid=L4YDAAAAIBAJ&pg=6489,489286
Here is the article I wrote in reply:
Nelson a Malingerer?
by Daniel Duldig
B.Sc. Optom. (Melb.), B.Sc. (Melb.), President of the Australian Napoléonic Society
This article, which was previously published in the Communiqué of the Australian Napoléonic Society and The Waterloo Journal, a publication of the The Association of Friends of the Waterloo Committee and A.S.B.L. Pour Les Études Historiques de la Bataille de Waterloo, is reprinted here by kind permission of the author.
Dr. Milo Keynes, 73, a retired surgeon of Cambridge, and a nephew of the economist John Maynard Keynes, has examined medical evidence and Nelson’s letters, and has claimed in the Royal Society of Medicine’s Journal of Medical Biography that Britain’s greatest naval hero, Horatio Nelson, was a malingerer who exaggerated the eye damage he sustained at the siege of Calvi, Corsica, in 1794, to try to get a pension. As a practicing optometrist I can make some informed comment on this report.
Nelson was wounded when a French cannonball sent up a shower of earth and rock, some of which went into his eye. Despite at first making light of the damage, he wrote to the Admiralty in 1795 claiming that he was effectively blind in his right eye. A few days later, he told Admiral Lord Hood, his commander, that his eye was ‘much better’. However, Nelson later wrote to Hood asking him to tell King George III ‘of the loss of an eye in his service’. Subsequently, Nelson said he should receive £200 a year for his injury. He wrote to the authorities: ‘My eye you may conceive is now grown worse and is almost total darkness and very painful at times. But never mind, I can see very well with the other.’
The Injury
The nature of Nelson’s original injury would have been either a blow to the front surface of the eye or a penetrating injury to the globe whereby pieces of the stone or earth actually pierced the outer tunics of the eye and lodged within the eye itself. The latter case is unlikely, since, unless the piercing fragment was entirely sterile, there would have been certain risk of infection, and given the primitive medical care of the period, scarring and loss of the whole eye would have likely ensued. It is probable then that the original injury was not penetrating but rather consisted of a solid blow or shower of particles onto the exposed tissues of the eye. Accounts vary as to whether the ball threw up sand, or some stones, or both.
If this was the case then a number of sequelae are also possible.
Firstly, immediately after the injury there would normally have been pain, swelling and watering of the eye with the front surface of the eye (cornea) likely to have received an abrasion or scratch. These initial symptoms would have resolved over the next 24-72 hours depending on their severity, and vision would have returned to nearly normal in the absence of any other damage.
Nelson remained on duty for the rest of the day and his letters do not mention severe pain at the time, only that, ‘my head has been a good deal wounded and my right eye cut down’. Only later does pain from the eye become an issue.
In none of the commentaries on his injury is the precise meaning of ‘my right eye cut down’ addressed. This could mean a laceration to the front of the eye, or it could be a figurative expression to mean his eye was laid low by the explosion.
There is ample evidence to suggest however that the pupil of his eye was dilated at the time (consistent with a concussion injury) and at least for some months after. There are no reports of corneal scarring, nor of later changes to the front structure of the eye, that would suggest a perforating injury. Beyond this, writers have relied on the inspection of portraits (a somewhat perilous source of evidence) and on the remarks of his contemporaries that the eye appeared normal in later years.
Medical Evidence
On 12th October 1797 his eye was examined at the Company of Surgeons, and the Court of Examiners certified that the injury to the eye was ‘fully equal to the loss of a limb’. Unfortunately, no written account of the appearance of the eye seems to exist from this examination, so we are left ‘in the dark’ as to the nature and extent of his visual loss.
Barras, in his 1986 paper on the issue of Nelson’s eye injury, implies that the Surgeons relied on Nelson’s own statements of visual loss as they did not have the means to examine the eye internally, and the external appearance was normal. At that date, Nelson had already been granted an annual pension for the loss of his arm and no further pension was ever paid for the loss of his sight. The implication then is that the surgeons accepted that the eye had been damaged, since it would have had no material impact on his pension and they may have been reluctant to refuse the hero of the day. Without the actual report of their findings we will never know one way or the other.
After the initial eye injury there was always a risk of secondary visual problems developing, as a direct result of the concussion effects of the original blow. These include traumatic cataract, glaucoma, retinal detachment, traumatic retinopathy and uveitis.
Traumatic Cataract
When the eye is subjected to a considerable force it may later develop what is called a traumatic cataract. This is a situation wherein the crystalline lens inside the eye, that sits suspended behind the iris, becomes progressively more cloudy and opaque with time. The visual effect is to make images less and less distinct, to increase problems experienced in seeing under high-glare situations (e.g. at sea), and to render the sufferer effectively blind at a later date.
In this respect we encounter a common problem of what do we mean by the term blindness. The popular conception of total loss of sight as being the definition for blindness is a poor description at best. A better description would be the loss of vision to the extent that little or no useful visual information can be obtained by the blind eye. Thus an eye with tunnel vision, an eye that can only see light and dark or shadows, an eye that has only blotches of good sight scattered across the whole visual field, all these situations may today be considered legally blind. In these cases the disability is so great that it renders the sufferer unable to obtain reliable and useful information from their eye and requires them to use other means to maintain mobility and to function normally.
Thus it may be true to say that Nelson was not totally blind in his right eye, but rather that he had a severe visual impairment that either developed over the months and years following his injury, or was present from the time of injury.
Finally when discussing blindness it is important to remember that the impact on the sufferer is maximised at the time of loss, and as time passes and the victim adapts to and grows used to the impairment, their perception of the degree of that impediment reduces. This would be especially true in the case where only one eye was affected. As a consequence of this it would not be unusual for the complaints of the loss of his vision to be less frequent and less forceful as the years passed.
Normally the presence of a cataract is an entirely painless condition, which does not accord with Nelson's own claims of periodic pain. However, the discomforting glare produced by cataract can be distressing and this may be what Nelson was describing.
Nelson made the comment in a letter to the First Lord of the Admiralty in July 1795 that ‘a total deprivation of sight for every common occasion in life, is the consequence of the loss of the crystal of my right eye.’ This is a fascinating comment in two respects. Firstly he is clearly stating that he is not totally blind but rather has no useful vision for the common occasions of life: a perfect definition of visual impairment which today could be considered legally blind. Secondly, his remark on the crystal of the eye being partial lost is interesting in that the lens of the eye has for centuries been thought of as ‘crystalline’, and the only alternative to his reference to the eye’s lens is possibly that of the cornea, which we know to have been normal.
Pterygia
The pain from his eye could have come from a co-existing eye complaint or another condition altogether. Again there is ample evidence that Nelson suffered from pterygia in both eyes, a fleshy growth of skin across the front of the eye usually from the nasal side, and a common enough condition both then and today.
There is at least one account from 1801 of Nelson experiencing an episode
of inflammation of these pterygia, which certainly would have been painful, but typically would have resolved over several days, which was the case. The presence of pterygia would have been unrelated to his earlier injury and today we believe them to be primarily due to excessive exposure to dust, wind and sun - specifically ultra-violet radiation, and consequently Australia has one of the highest rates of pterygia in the world. Other possibilities of secondary visual problems are:
Retinal Detachment
Retinal detachment is a condition in which the retina, the inside lining of the eye, tears, splits or otherwise detaches from the underlying eyeball. It can produce anything from little to total loss of vision, and can occur immediately after trauma, or days, weeks or months later. It is typically not associated with pain by itself and the visual loss may become less severe over time. It is unlikely that this is what Nelson suffered, since the loss of vision is generally not progressive and is painless.
Traumatic Retinopathy (Komotio Retinae)
Traumatic retinopathy is a sudden blindness caused by a blow to the eye that disturbs the most sensitive part of the retina: the macula. The condition improves over months and vision is not typically severely affected. Because the visual loss occurs immediately after the injury and improves over months, this would also fail to fit the description of Nelson’s condition, unless he experienced it in combination with another complication.
Glaucoma
Glaucoma is a condition historically described as an increase in the fluid pressure within the eye. This pressure increase causes the atrophy (loss) of the nerve fibres that make up the optic nerve head (which carries the electrical impulses that make up images to the brain), and consequently produces blindness over several years. The condition can have associated pain and can be the result of injury to the eye. As with early cataract there is no outward sign to any observer of a problem with the eye.
Uveitis
Uveitis is an inflammation of the internal tissues of the eye. There was almost certainly some degree of uveitis immediately after the injury and this may have led to a secondary glau-coma at a later date. The uveitis would normally have resolved over the following weeks; however, glaucoma could have developed at any later time.
Medical Summary
In summary, Nelson may have suffered from traumatic cataract, secondary glaucoma, or other complication, subsequent to his injury in 1794. Both of the first two conditions could have produced a decline in vision over time, possibly with occasional pain, and neither would have affected the outward appearance of the eye.
Alternatively, the pain he complained of may have been due to periodic inflammation of his pterygia. Certainly he would have noted the decline in his ability to read fine print as he aged (presbyopia), and he may have attributed this incorrectly to the injury suffered in 1794.
There is not enough evidence to determine the true extent of his visual loss, nor to determine whether he was temporarily or permanently affected. It is unlikely that he was totally blind in his right eye, however this is misleading in the extreme. As already pointed out, he would not have had to have been totally blinded to be effectively blinded in that eye, and it is perhaps mischievous to suggest that because he was not totally blind he was in any way ‘malingering’.
Other Evidence
Nelson’s case is not helped, as Barras points out, by the fact that he failed to name himself in the List of Injured rendered to Admiral Lord Hood after the siege, a list Nelson had himself compiled. Here again though there are some confusing aspects to the critics’ accounts.
Barras states that Nelson didn’t list himself among the injured after the end of the siege (10th August). He then goes on to relate that Nelson did have two Certificates drawn up in respect to his blind eye by the medical staff, one dated 9th August and the other 12th August, but that these were not submitted to Hood until around 2nd October.
Both of the certificates, and a letter Nelson wrote to his wife, incorrectly state the injury date as 10th July instead of 12th July. Could it not be that he failed to list himself amongst the injured because he was already preparing a separate and independent claim to Hood and saw no need to repeat this? Hood does not mention Nelson’s injuries in his despatches, so we are left to wonder what the true sequence of events was.
The principal evidence suggesting malingering is the report from The Times of 4th October 1804, stating that Nelson had said his eyesight had recovered, and that his bad right eye in fact saw better than his left:
Lord Nelson is not blind of either eye. It is true that he, for a short period, lost the sight of one eye but it has been happily restored. He also has a speck on the other eye but that he could see with both at no very distant date we are assured from the best authority - that of his Lordship’s own information.
Barras argues that this was never disputed and should be the last word in the argument. However, it is interesting that Nelson was blockading Toulon for some months before and after this report, and therefore The Times could not have had a first-hand account of his injury from Nelson himself, unless it was given months before the newspaper report. It is conceivable that Nelson never even saw the report and thus could hardly have disputed it even if he had had the time and inclination.
I think the case for ‘malingering’ is unconvincing at present, and until more concrete evidence can be produced regarding the state of vision of Nelson’s right eye, he should be given the benefit of the doubt.
Bibliography
T. C. Barras, ‘Vice Admiral Lord Nelson’s Lost Eye’, in the Transactions of the Ophthalmological Society U.K. (1986) 105, 351
Milo Keynes, ‘Horatio Nelson never was blind: his woundings and his frequent ill-health’, in the Journal of Medical Biography 1998; 6: 114-9
Alan Schom, Trafalgar, Penguin 1992
Julian Corbett, The Campaign of Trafalgar, Longmans, Green and Co., 1910
Kanski, Clinical Ophthalmology, Butterworths, 1984
I couldn't find the full article of the original story but here is the link to a report of it http://news.google.com/newspapers?nid=1241&dat=19980511&id=CI5TAAAAIBAJ&sjid=L4YDAAAAIBAJ&pg=6489,489286
Here is the article I wrote in reply:
Nelson a Malingerer?
by Daniel Duldig
B.Sc. Optom. (Melb.), B.Sc. (Melb.), President of the Australian Napoléonic Society
This article, which was previously published in the Communiqué of the Australian Napoléonic Society and The Waterloo Journal, a publication of the The Association of Friends of the Waterloo Committee and A.S.B.L. Pour Les Études Historiques de la Bataille de Waterloo, is reprinted here by kind permission of the author.
Dr. Milo Keynes, 73, a retired surgeon of Cambridge, and a nephew of the economist John Maynard Keynes, has examined medical evidence and Nelson’s letters, and has claimed in the Royal Society of Medicine’s Journal of Medical Biography that Britain’s greatest naval hero, Horatio Nelson, was a malingerer who exaggerated the eye damage he sustained at the siege of Calvi, Corsica, in 1794, to try to get a pension. As a practicing optometrist I can make some informed comment on this report.
Nelson was wounded when a French cannonball sent up a shower of earth and rock, some of which went into his eye. Despite at first making light of the damage, he wrote to the Admiralty in 1795 claiming that he was effectively blind in his right eye. A few days later, he told Admiral Lord Hood, his commander, that his eye was ‘much better’. However, Nelson later wrote to Hood asking him to tell King George III ‘of the loss of an eye in his service’. Subsequently, Nelson said he should receive £200 a year for his injury. He wrote to the authorities: ‘My eye you may conceive is now grown worse and is almost total darkness and very painful at times. But never mind, I can see very well with the other.’
The Injury
The nature of Nelson’s original injury would have been either a blow to the front surface of the eye or a penetrating injury to the globe whereby pieces of the stone or earth actually pierced the outer tunics of the eye and lodged within the eye itself. The latter case is unlikely, since, unless the piercing fragment was entirely sterile, there would have been certain risk of infection, and given the primitive medical care of the period, scarring and loss of the whole eye would have likely ensued. It is probable then that the original injury was not penetrating but rather consisted of a solid blow or shower of particles onto the exposed tissues of the eye. Accounts vary as to whether the ball threw up sand, or some stones, or both.
If this was the case then a number of sequelae are also possible.
Firstly, immediately after the injury there would normally have been pain, swelling and watering of the eye with the front surface of the eye (cornea) likely to have received an abrasion or scratch. These initial symptoms would have resolved over the next 24-72 hours depending on their severity, and vision would have returned to nearly normal in the absence of any other damage.
Nelson remained on duty for the rest of the day and his letters do not mention severe pain at the time, only that, ‘my head has been a good deal wounded and my right eye cut down’. Only later does pain from the eye become an issue.
In none of the commentaries on his injury is the precise meaning of ‘my right eye cut down’ addressed. This could mean a laceration to the front of the eye, or it could be a figurative expression to mean his eye was laid low by the explosion.
There is ample evidence to suggest however that the pupil of his eye was dilated at the time (consistent with a concussion injury) and at least for some months after. There are no reports of corneal scarring, nor of later changes to the front structure of the eye, that would suggest a perforating injury. Beyond this, writers have relied on the inspection of portraits (a somewhat perilous source of evidence) and on the remarks of his contemporaries that the eye appeared normal in later years.
Medical Evidence
On 12th October 1797 his eye was examined at the Company of Surgeons, and the Court of Examiners certified that the injury to the eye was ‘fully equal to the loss of a limb’. Unfortunately, no written account of the appearance of the eye seems to exist from this examination, so we are left ‘in the dark’ as to the nature and extent of his visual loss.
Barras, in his 1986 paper on the issue of Nelson’s eye injury, implies that the Surgeons relied on Nelson’s own statements of visual loss as they did not have the means to examine the eye internally, and the external appearance was normal. At that date, Nelson had already been granted an annual pension for the loss of his arm and no further pension was ever paid for the loss of his sight. The implication then is that the surgeons accepted that the eye had been damaged, since it would have had no material impact on his pension and they may have been reluctant to refuse the hero of the day. Without the actual report of their findings we will never know one way or the other.
After the initial eye injury there was always a risk of secondary visual problems developing, as a direct result of the concussion effects of the original blow. These include traumatic cataract, glaucoma, retinal detachment, traumatic retinopathy and uveitis.
Traumatic Cataract
When the eye is subjected to a considerable force it may later develop what is called a traumatic cataract. This is a situation wherein the crystalline lens inside the eye, that sits suspended behind the iris, becomes progressively more cloudy and opaque with time. The visual effect is to make images less and less distinct, to increase problems experienced in seeing under high-glare situations (e.g. at sea), and to render the sufferer effectively blind at a later date.
In this respect we encounter a common problem of what do we mean by the term blindness. The popular conception of total loss of sight as being the definition for blindness is a poor description at best. A better description would be the loss of vision to the extent that little or no useful visual information can be obtained by the blind eye. Thus an eye with tunnel vision, an eye that can only see light and dark or shadows, an eye that has only blotches of good sight scattered across the whole visual field, all these situations may today be considered legally blind. In these cases the disability is so great that it renders the sufferer unable to obtain reliable and useful information from their eye and requires them to use other means to maintain mobility and to function normally.
Thus it may be true to say that Nelson was not totally blind in his right eye, but rather that he had a severe visual impairment that either developed over the months and years following his injury, or was present from the time of injury.
Finally when discussing blindness it is important to remember that the impact on the sufferer is maximised at the time of loss, and as time passes and the victim adapts to and grows used to the impairment, their perception of the degree of that impediment reduces. This would be especially true in the case where only one eye was affected. As a consequence of this it would not be unusual for the complaints of the loss of his vision to be less frequent and less forceful as the years passed.
Normally the presence of a cataract is an entirely painless condition, which does not accord with Nelson's own claims of periodic pain. However, the discomforting glare produced by cataract can be distressing and this may be what Nelson was describing.
Nelson made the comment in a letter to the First Lord of the Admiralty in July 1795 that ‘a total deprivation of sight for every common occasion in life, is the consequence of the loss of the crystal of my right eye.’ This is a fascinating comment in two respects. Firstly he is clearly stating that he is not totally blind but rather has no useful vision for the common occasions of life: a perfect definition of visual impairment which today could be considered legally blind. Secondly, his remark on the crystal of the eye being partial lost is interesting in that the lens of the eye has for centuries been thought of as ‘crystalline’, and the only alternative to his reference to the eye’s lens is possibly that of the cornea, which we know to have been normal.
Pterygia
The pain from his eye could have come from a co-existing eye complaint or another condition altogether. Again there is ample evidence that Nelson suffered from pterygia in both eyes, a fleshy growth of skin across the front of the eye usually from the nasal side, and a common enough condition both then and today.
There is at least one account from 1801 of Nelson experiencing an episode
of inflammation of these pterygia, which certainly would have been painful, but typically would have resolved over several days, which was the case. The presence of pterygia would have been unrelated to his earlier injury and today we believe them to be primarily due to excessive exposure to dust, wind and sun - specifically ultra-violet radiation, and consequently Australia has one of the highest rates of pterygia in the world. Other possibilities of secondary visual problems are:
Retinal Detachment
Retinal detachment is a condition in which the retina, the inside lining of the eye, tears, splits or otherwise detaches from the underlying eyeball. It can produce anything from little to total loss of vision, and can occur immediately after trauma, or days, weeks or months later. It is typically not associated with pain by itself and the visual loss may become less severe over time. It is unlikely that this is what Nelson suffered, since the loss of vision is generally not progressive and is painless.
Traumatic Retinopathy (Komotio Retinae)
Traumatic retinopathy is a sudden blindness caused by a blow to the eye that disturbs the most sensitive part of the retina: the macula. The condition improves over months and vision is not typically severely affected. Because the visual loss occurs immediately after the injury and improves over months, this would also fail to fit the description of Nelson’s condition, unless he experienced it in combination with another complication.
Glaucoma
Glaucoma is a condition historically described as an increase in the fluid pressure within the eye. This pressure increase causes the atrophy (loss) of the nerve fibres that make up the optic nerve head (which carries the electrical impulses that make up images to the brain), and consequently produces blindness over several years. The condition can have associated pain and can be the result of injury to the eye. As with early cataract there is no outward sign to any observer of a problem with the eye.
Uveitis
Uveitis is an inflammation of the internal tissues of the eye. There was almost certainly some degree of uveitis immediately after the injury and this may have led to a secondary glau-coma at a later date. The uveitis would normally have resolved over the following weeks; however, glaucoma could have developed at any later time.
Medical Summary
In summary, Nelson may have suffered from traumatic cataract, secondary glaucoma, or other complication, subsequent to his injury in 1794. Both of the first two conditions could have produced a decline in vision over time, possibly with occasional pain, and neither would have affected the outward appearance of the eye.
Alternatively, the pain he complained of may have been due to periodic inflammation of his pterygia. Certainly he would have noted the decline in his ability to read fine print as he aged (presbyopia), and he may have attributed this incorrectly to the injury suffered in 1794.
There is not enough evidence to determine the true extent of his visual loss, nor to determine whether he was temporarily or permanently affected. It is unlikely that he was totally blind in his right eye, however this is misleading in the extreme. As already pointed out, he would not have had to have been totally blinded to be effectively blinded in that eye, and it is perhaps mischievous to suggest that because he was not totally blind he was in any way ‘malingering’.
Other Evidence
Nelson’s case is not helped, as Barras points out, by the fact that he failed to name himself in the List of Injured rendered to Admiral Lord Hood after the siege, a list Nelson had himself compiled. Here again though there are some confusing aspects to the critics’ accounts.
Barras states that Nelson didn’t list himself among the injured after the end of the siege (10th August). He then goes on to relate that Nelson did have two Certificates drawn up in respect to his blind eye by the medical staff, one dated 9th August and the other 12th August, but that these were not submitted to Hood until around 2nd October.
Both of the certificates, and a letter Nelson wrote to his wife, incorrectly state the injury date as 10th July instead of 12th July. Could it not be that he failed to list himself amongst the injured because he was already preparing a separate and independent claim to Hood and saw no need to repeat this? Hood does not mention Nelson’s injuries in his despatches, so we are left to wonder what the true sequence of events was.
The principal evidence suggesting malingering is the report from The Times of 4th October 1804, stating that Nelson had said his eyesight had recovered, and that his bad right eye in fact saw better than his left:
Lord Nelson is not blind of either eye. It is true that he, for a short period, lost the sight of one eye but it has been happily restored. He also has a speck on the other eye but that he could see with both at no very distant date we are assured from the best authority - that of his Lordship’s own information.
Barras argues that this was never disputed and should be the last word in the argument. However, it is interesting that Nelson was blockading Toulon for some months before and after this report, and therefore The Times could not have had a first-hand account of his injury from Nelson himself, unless it was given months before the newspaper report. It is conceivable that Nelson never even saw the report and thus could hardly have disputed it even if he had had the time and inclination.
I think the case for ‘malingering’ is unconvincing at present, and until more concrete evidence can be produced regarding the state of vision of Nelson’s right eye, he should be given the benefit of the doubt.
Bibliography
T. C. Barras, ‘Vice Admiral Lord Nelson’s Lost Eye’, in the Transactions of the Ophthalmological Society U.K. (1986) 105, 351
Milo Keynes, ‘Horatio Nelson never was blind: his woundings and his frequent ill-health’, in the Journal of Medical Biography 1998; 6: 114-9
Alan Schom, Trafalgar, Penguin 1992
Julian Corbett, The Campaign of Trafalgar, Longmans, Green and Co., 1910
Kanski, Clinical Ophthalmology, Butterworths, 1984