- Email: [email protected]
Charles Dickens, trachoma, and blindness in pre-Victorian England
Accepted Manuscript Charles Dickens, Trachoma and Blindness in Pre-Victorian England Curtis E. Margo, MD, MPH, Lynn E. Harman, MD PII:
S0039-6257(17)30228-X
DOI:
10.1016/j.survophthal.2017.10.004
Reference:
SOP 6763
To appear in:
Survey of Ophthalmology
Received Date: 28 August 2017 Revised Date:
3 October 2017
Accepted Date: 9 October 2017
Please cite this article as: Margo CE, Harman LE, Charles Dickens, Trachoma and Blindness in PreVictorian England, Survey of Ophthalmology (2017), doi: 10.1016/j.survophthal.2017.10.004. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
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Charles Dickens, Trachoma and Blindness in Pre-Victorian England
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Curtis E. Margo, MD, MPH Ϯ* and Lynn E. Harman, MD *
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Ϯ Departments of Pathology and Cell Biology, and *Ophthalmology, Morsani College of
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Medicine, University of South Florida, Tampa, Florida, U.S.A.
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Conflicts of interest: none
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Corresponding author: Dr. Curtis E. Margo, 12901 Bruce B. Downs Blvd., Box 21, Department of
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Ophthalmology, University of South Florida, Tampa, FL, USA
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E-mail address: [email protected]
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This paper will be presented at the 31st Cogan Ophthalmic History Society Meeting,
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March 24-25, 2018, Tampa, FL.
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Word count: 2,735; abstract: 159; references: 26; figures: 5
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Abstract
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In the early 1820s a Yorkshire boarding school was devastated by an outbreak of
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blinding ophthalmia. The cause of the epidemic was – in all likelihood – trachoma, then known
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as Egyptian ophthalmia. The headmaster of the Yorkshire school, William Shaw, was sued for
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gross negligence by two families whose sons went blind during the outbreak. The epidemic and
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trial would play a role in creating one of literatures most notorious fictional characters.
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Eighteen years after the trial, Charles Dickens modeled the vile schoolmaster Wackford Squeers
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in Nicholas Nickleby after Shaw, whose reputation and career would later be ruined by his
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thinly disguised portrayal in the novel. The original boarding school epidemic took place while
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London’s first eye hospital was moving to Lower Moorfields, an institution that 17 years earlier
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was established primarily to cope with Egyptian ophthalmia. We explore trachoma’s wide-
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ranging impact on pre-Victorian England, from inspiring an enduring literary villain to the
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creation of a renowned eye hospital.
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“Mr. Squeers’s appearance was not prepossessing. He had but one eye, and the popular
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prejudice runs in favor of two.” — Charles Dickens 8p16
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“The explosive impact of the Egyptian ophthamia elevated the importance of eye disease, so
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that every medical practitioner needed to know something about it.” – HR Taylor 20
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Introduction
On October 30, 1823, the Court of Common Pleas of London awarded damages of £300
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to Richard and William Jones, brothers who lost their sight while attending Bowes Academy in
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Yorkshire. 5,E The defendant was William Shaw, the one-eyed headmaster, who was deemed
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responsible for their injuries. The jury trial had been protracted and emotional. The following
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day, Shaw, sensing the futility of a second civil proceeding, settled financially with another
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family whose three boys also went blind. At least a dozen boys at the school had lost their sight
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during the epidemic, but lacking the advantage of supportive families, these children suffered
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their fates uncompensated. In retrospect, this epidemic was almost assuredly trachoma, a
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damaging ophthalmia that blighted England for decades after soldiers brought it home
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following the Egyptian campaign of 1798 to 1802. 3,11,13,18
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The initial trial received modest coverage in the newspaper, but this boarding school
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epidemic would have been largely forgotten was it not for the young writer Charles Dickens
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(1812 – 1870) who fashioned the wicked headmaster Wackford Squeers in Nicholas Nickleby
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after William Shaw (Fig. 1).1, 5,C,E,F Soon after the publication of Nicholas Nickleby in 1839, the
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similarities between the fictional Dotheboys Hall and Bowes Academy in Yorkshire, and the vile,
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one-eyed school master Wackford Squeers and the monocular headmaster Shaw were obvious.
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Although Dickens maintained any resemblances were coincidental, scholars would later
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uncover evidence they were not.1,5,F The role that this ocular epidemic played in dissuading
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Shaw from seeking redress for libel is often overlooked. His school would ultimately close due
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to inferences and innuendos tied to Nicholas Nickleby.
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Trachoma during the Industrial Revolution had sundry ramifications, including alerting
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the medical profession on how ill prepared it was to deal with large numbers of patients with
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serious ocular disease. Greater specialization in ophthalmology and the development of eye
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hospitals were the first encouraging responses, but these fell short of what was needed to
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contain this highly contagious disorder.
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Nickolas Nickleby and the Yorkshire Schools for Boys
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It seems fitting that Dickens, the quintessential author and social critic of mid-19th century England, would achieve his first commercial success with Pickwick Papers in 1837, the
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year Victoria succeeded to the monarchy. For a brief time after that, Dickens was writing
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monthly installments for both Oliver Twist and Nicholas Nickleby. Although each work exposed
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the vices of Victorian society, Nicholas Nickleby was decidedly less gloomy and was the first
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experience that Dickens had with writing a romance. A powerful part of the narrative occurs in
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early chapters when the protagonist, Nicholas Nickleby, is hired by the loathsome Squeers to
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teach at Dotheboys Hall, an all-boys boarding school in Yorkshire. Nickleby, whose father had
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just died and left his family penniless, assumes responsibility for supporting his mother and
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sister. The young Nickleby is disturbed by the cruelness of his new employer who allows the
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boys at the school to live in squalid conditions and who appears to delight in their gratuitous
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floggings. Most of his wards are unwanted boys, social cast offs, abandoned because they were
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crippled, deformed, or born out of wedlock. Although the chapters dealing with the Yorkshire
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school make up a minor portion of the serialized story, the vivid descriptions of this unsavory
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environment created a lasting negative impression on readers (Fig 2). Wackford Squeers was
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guaranteed a place in the pantheon of fictional villains.
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Research for Nicholas Nickleby
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The phantoms of Dickens’ troubled childhood haunted his prose. Perhaps the most emotionally traumatic period of Dicken’s early life occurred when his father was thrown into
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debtor’s prison, and he was forced from school at the age of 12 to work in a warehouse for five
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months. How exactly he developed a dislike of the Yorkshire boarding schools is a matter of
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debate. Dickens unmistakably valued education, having obtained his primary schooling in
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Chatham Kent and London.1,6,15,16,B The Yorkshire boarding school were general regarded as
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seedy, low-cost institutions that managed to survive because there was little to no protective
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oversight for minors. On one level Dickens likely envisioned the potential harm these
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disreputable schools inflicted on vulnerable youths based on his own interrupted schooling.1
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He probably learned about the Bowes Academy trial in the 1830s when working as a court
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reporter. Advertisements for Yorkshire schools were also common in The Times of London. An
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earlier ad from the Bowes Academy that captured Dickens’ attention boasted of the school’s
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ability to teach skills that would “qualify” boys “for any situation in life.” (Fig. 3) The school also
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taught French “in its greatest purity,” and pledged itself to “the strictest attention” to the
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“health, moral conduct, and intellectual improvements of its pupils.” Dickens detested such
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hyperbole, particularly from a headmaster who he knew was responsible for letting students
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under this charge go blind. Dickens borrowed parts of this ad almost verbatim for the 3rd
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chapter of Nicholas Nickleby, changing the name of the school (but not its location) to
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Dotheboys Hall. 8p14
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To prepare a realistic setting for the early chapters of Nicolas Nickleby, Dickens traveled
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to Bowes Academy during the winter of 1838 (Fig. 4). 5p16 Once in Yorkshire, he used an alias to
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avoid recognition as the author of Pickwick Papers. During the week-long trip, Dickens came
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upon a gravestone of a teenager that read “Here lies the remains of GEORGE ASHTON
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TAYLOR...who died suddenly at Mr. William Shaw’s Academy.” 1p252 The terse inscription on the
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marker would inspire the creation of the fictional character Smike, whose physical abuse at the
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hands of Squeers would make him one of Dickens’ most tragic literary figures. Dickens had
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gathered considerable material in his short visit to Yorkshire, but it long remained uncertain
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whether he ever met Shaw on that sojourn.
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Many years later, scholars discovered a letter Dickens wrote in December, 1839, to a colleague discussing his fact-finding trip and a meeting he had with Shaw.5,9 The encounter
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reinforced Dickens’ dislike of the man he had previously known only by reputation. The content
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of the letter left no doubt that Dickens transmogrified Shaw’s perceived character into
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Wackford Squeers.
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The serialized novel was completed in 18 months, and there was concern that the likeness between Wackford Squeers and William Shaw would be evident. To counter
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allegations of libel, Dickens explained in the Preface to the first edition of Nicholas Nickleby that
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similarities between Mr. Squeers and any specific Yorkshire schoolmaster were coincidental. 7
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He went on to say “that Mr. Squeers is the representation of a class [of schoolmasters], and not
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of an individual. Where imposture, ignorance, and brutal cupidity, are the stock in trade of a
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small body of men, all his fellows will recognize something belonging to themselves, and each
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will have a misgiving that the portrait is his own.”7
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Ten years later, the first cheap edition of Nicholas Nickleby was published. The tone of
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the new Preface was more indignant, adding that these schoolmasters were “traders in the
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avarice indifference, or imbecility of parents, and the helplessness of children.”8 To ensure
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Nicholas Nickleby was viewed with historical accuracy, Dickens described his 1838 journey to
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Yorkshire and how he inspected the schools under an assumed name, a practice he called a
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“pious fraud.” 8 Although still claiming that the Squeers was representative of a class of men
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and not one in particular, Dickens specifically cites as evidence of malfeasance a previous civil
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trial that resulted in reparations for “neglect, cruelty, and disease.”
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The Ocular Epidemic
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The best accounts of the boarding school epidemic came from 11-year-old William Jones
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and his older brother Richard during their civil trial. 5,F Both boys testified in their own behalf
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before a jury at Guildhall, London. Not only did they provide insight into the nature of the eye
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disorder, the boys gave detailed accounts of their diets and general living conditions. Between
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260 and 300 boys lived in Bowes Academy. The bothers had attended the school for less than a
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year before William wrote home complaining that his eyes were in a “bad state,” being able to
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see just daylight or the flame of a bright candle. William had recovered from smallpox the year
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before attending Bowes Academy, but both boys were otherwise healthy and had no previous
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problems with their eyes. Richard’s disorder started as a “cold” in his eyes. It lasted several
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months, got better then worse. His eyes were constantly blood-shot and a servant from the
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school was employed to wash away the collected “humors.” Richard, now 13, had lost all
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useful vision. William, at the time of the trial, could see out of just one eye. William knew of
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nine other boys at the school who were totally blind. There were no systemic illnesses,
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although Richard developed a pernicious itch (presumably scabies) after he had lost vision.
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The boys ate regularly, but the meals were meager and unappealing. Hasty-pudding for
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breakfast each morning with a second meal of meat and potatoes 4 times a week. Supper the
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remainder of the week consisted of dumplings and water, bread and milk, and black potatoes
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and butter. The residence hall had 30 beds to a room. Four to five boys shared a straw bed,
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one sheet and one quilt. The beds were infested with fleas, which each morning the boys were
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ordered to capture with a quill. They washed from a communal trough without soap (except on
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Sundays), shared towels, and were bathed once a week.
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opinions were peppered with inconsistencies, though there was no disagreement that the
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outbreak of ophthalmia was severe. Hygiene was never a topic of discussion. The concept was
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essentially non-existent. Attempts at isolating children turned into dreadful sentences of
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imprisonment. William Jones was initially confined to a washhouse, along with 18 other
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infected boys. When his condition worsened, he was transferred to another room that housed
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more severely afflicted students. William was confined to this room for two months, where he
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remembered a single doctor’s visit and no particular treatment, though the defense claimed an
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attendant was assigned to wash his eyes.
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Several noteworthy aspects of life in Bowes Academy were revealed during the trial. The boys were not wantonly beaten, but were threatened with corporal punishment if not
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obedient. This type of institutional violence was not unusual for the time. When adults were
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absent, older boys took advantage of the younger ones--a harsh reality of communal living.
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Perhaps what most resonated with Dickens was when William described his disappointment at
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being able to learn to only read and write. He valued, if not envied, how other boys at the
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school who had not been sick learned Latin and French.
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Egyptian Ophthalmia in Pre-Victorian England
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Trachoma can be traced to antiquity, but its emergence in Europe following the
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Egyptian Campaign was particularly devastating as it spread through susceptible populations as
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localized epidemics.2,3,11,25 Initially brought from Egypt by soldiers, it spread rapidly through
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civilian populations, especially those in urban centers. England was hit unusually hard since it
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was in the mist of its Industrial Revolution, when living conditions in cities were crowded and
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unhygienic. French physicians during the early 19th century were not convinced of its
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contagious nature. English physicians, on the other hand, thought Egyptian ophthalmia was
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spread by a miasma (poisonous vapor).2,20,25 This misconception would delay implementations
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in how to contain a disease transmitted through secretions.
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The diagnosis of “ophthalmia” was not specific, and applied to any superficial inflammation of the eye, including acute catarrhal and purulent conjunctivitis.18 The entity now
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recognized as trachoma was usually distinguishable from other ophthalmias by its tendency to
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cluster in families or occur among persons living in close quarters, bilateral occurrence,
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“granules” under the upper eyelid, which “resembled the villi of the small intestine”, protracted
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clinical course with propensity for recurrence and flare ups, and progression into a chronic
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scarring stage.4,18 Unlike other severe ophthalmias, the Egyptian variety destroyed the cornea
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“from the underside.” 4 Since management of all ophthalmia was supportive, scrupulous
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physicians were charged with relieving symptoms without causing harm. Those convinced they
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had discovered a cure risked making things worse with topical herbs or chemicals.
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As few physicians were adequately trained in diagnosing eye disease, the setting was ripe for charlatans and impostors. 20,23 Quacks and swindlers flourished during outbreaks as
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long as they didn’t catch the ocular infection. As the number of soldiers returning from Egypt
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with ophthalmia grew, it placed an increasing burden on the medical community.23 The
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number of disabled blind eventually prompted the development of the first eye hospital, which
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was established in 1805 as the London Dispensary for Curing Diseases of the Eye and
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Ear.17,19,23,D One medical historian notes that as many as 52 eye (or, eye and ear) hospitals in
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Britain were eventually established to deal with trachoma.19 A year before William Shaw was
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sued in the Court of Common Pleas, the London Dispensary was moved to Lower Moorfields, a
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district just north of the old City. The area was described by Treacher Collins as “a place of
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recreation and jollification for the City folk–a place of swings and roundabouts.”27p51 The
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Dispensary was renamed the London Ophthalmic Infirmary, but locals preferred to call it
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Moorfields (Fig. 5).23,D Early eye hospitals served largely as repositories for the blind and had no documented
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success in curbing outbreaks of Egyptians ophthalmia. 17 Unbeknownst to physicians of the
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time, infection from trachoma was chronic, halted eventually by poorly understood immune
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mechanisms or when the disease enters into its cicatricial stage.21,22 Patients were also prone
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to reinfection and recurrent bouts of inflammation if unhygienic conditions were not corrected.
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Even though studies in the early 1800s had shown Egyptian ophthalmia could be transferred
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through an ocular discharge, the miasma theory still guided how quasi-hygienic practices were
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carried out.4,10 After the discovery of bacteria in the 1860s, the role of personal hygiene (in the
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form of hand washing) started to gain adherents. Social reformer Edwin Chadwick (1800 –
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1890), who published The Sanitary Condition of the Labouring Population of Great Britain in
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1842, emphasized the role of cleanliness in an urban context, but not in hospitals or infirmaries.
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Ironically, the first major steps in changing medical behavior to reduce the spread of germs through direct contact was prompted by another British war– the Crimean (1854 –
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1856), when the military promoted washing with clean water and using clean towels and pillow
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cases to curb the incidence of ophthalmia.2,14,24
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The chronic recurrent nature of Egyptian ophthalmia and inability to culture bacteria
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from affected patients (except in the case of secondary infection) confounded attempts to
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understand the disease. Nearly 110 years after Egyptian ophthalmia arrived in England, the
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infectious organism was identified as an intracellular parasite.12 Although for a long time
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chlamydial organisms were confused with viruses, effective anti-bacterial therapy for trachoma
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would wait until 1938 when sulfanilamide was introduced.11 In retrospect, the critical
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importance of low-tech interventions like facial washing and the use of clean towels to prevent
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spread were agonizingly slow to advance. 14,20
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Summary
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Dickens transformed William Shaw through his literary artistry into the sinister
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Wackford Squeers, but without sufficient camouflage to conceal Shaw’s real identify. Shaw’s
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friends and family came to his defense, claiming he was neither heartless nor malicious.1,A,C.F
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He ran a cut-rate boarding school with few amenities at a time when society was not
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particularly concerned about the welfare of children. In the 1820s the Bowes Academy had the
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misfortune of running up against trachoma when no one knew how to deal with diseases that
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were transmitted through ocular secretions. Shaw, unable or unwilling to defend his reputation
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when besmirched by Dickens, lost his Academy and then witnessed the downfall of the other
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Yorkshire boarding schools.
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Epilogue
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Shaw eventually contracted trachoma during the boarding school epidemic, and Dickens
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would notoriously mock the scar it left him with through his fictional counterpart Wackford
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Squeers: “he had but one eye, and the popular prejudice runs in favor of two.” The negative
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portrayal of Dotheboys Hall in Nicholas Nickleby eventually drove all Yorkshire boarding schools
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out of business by the 1850s. 1,5,E,F Shaw retired in 1841 and died 9 years later at the age of 67.
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Egyptian ophthalmia accelerated the specialization of ophthalmology and eye hospitals
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in pre-Victorian England, but a real impact on curbing trachoma epidemics had to wait for
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rejection of the miasma theory and an appreciation of the role that basic hygiene plays in
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limiting person-to-person spread of the disease.
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References
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1_Ackroyd P. Dickens. New York, Harper Collins, 1990.
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2. al-Rifai KM. Trachoma through history. Int Ophthamol 1988;12(1):9-14.
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3. Bailey MS. A brief history of British military experiences with infectious and tropical disease.
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Army Med Corps 2013;159:150-7.
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4. Benedek TG. Gonorrhea and the beginnings of clinical research ethics. Perspect Biol Med
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2005;48(2):54-73.
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5. Clark C. Charles Dickens and the Yorkshire Schools. London, Chiswick Press. 1918.
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6. Crotch WW. Charles Dickens Social Reformer. London, Chapman & Hall, 1913.
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7. Dickens C. The Life & Adventures of Nicholas Nickleby, New York, Charles Scribener’s Sons,
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8. Dickens C. The Life & Adventures of Nicholas Nickleby, New York, Macmillan Publishing,
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1982 (Illustrated edition).
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9. Dickens, C. The Letters of Charles Dickens. The Pilgrim Edition. House M, Storey G (eds),
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Oxford, Clarendon Press, 1965.
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10. Feibel RM, John Vetch and the Egyptian ophthalmia. Surv Ophthalmol 1983;28(2):128-34.
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11. Feibel RM. Fred Loe, MD, and the history of trachoma. Arch Ophthalmol 2011;129(4):503-8.
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12. Halberstaedter L, von Prowazek S. Uber zelleinschusse parasitarer natur beim trachoma.
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Arb K Gesundh Amt 1907;26:44-7.
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13. Kelly C. Medicine and the Egyptian campaign: the development of the military medical
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officer during the Napoleonic Wars c. 1798-1801. Can Bull Med Hist 2010;27(2):321-42.
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14. MacCallan M. Arthur Ferguson MacCallan CBE, MD, FRCS (1872 – 1955), trachoma pioneer
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and the ophthalmic campaign in Egypt 1903 – 1923. J Med Biography 2016
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15. Markel H. The childhood suffering of Charles Dickens and his literary children. Pharos
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1985;48(2):4-5.
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16. Markel H. Charles Dickens’ work to help establish Great Ormond Street Hospital, London.
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17. Marmion VJ. The origin of eye hospitals. Br J Ophthalmol 2005;89:1396-97.
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18. Myerhof M. A short history of ophthalmia during the Egyptian campaigns of 1798 – 1807.
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Br J Ophthalmol 1932;16:129-52.
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19. Sorsby A, Sorsby M. A Short History of Ophthalmology. Staples Press, London, 1948.
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20. Taylor HR. Doyne Lecture: trachoma, is it history? Eye2009;23:2007-22.
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21. Taylor HR, Burton MJ, Haddad D, West S, Heathcote W. Trachoma. Lancet 2014;384:2142-
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22. Taylor HR, Siler JA, Mkocha HA, Munoz B, West S. The natural history of endemic trachoma:
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a longitudinal study. Am J Trop Med Hyg 1992;46(5):552-9.
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23. Treacher Collins E. The History and Traditions of the Moorfields Eye Hospital. One Hundred
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Years of Ophthalmic Discovery & Development. London, HK Lewis & Co, 1929.of Moorfields.
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24. Treacher Collins E. Introductory Chapter. In, Trachoma, Boldt J (ed), London, Hodder &
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Stoughton, 1904. (Translated by Herbert Parsons and Thos Snowball)
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25. Vagemans M, van Bijsterveld OP. The French Egyptian campaign and its effects on
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ophthalmology. Doc Ophthalmol 1988;68:135-44.
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Hist Rev 1997;5:159-60.
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Other Cited Material
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A. Lloyd HF. The Life of an Actor. An Autobiography.
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http://www.arthurlloyd.co.uk/horatiobiog/horatiolloydautobiographychapter1.htm. Accessed
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7/10/2017.
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B. Diniejko A. Charles Dickens as social commentator and critic.
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http://www.vicotiranweb.org/authors/dickens/diniejko.html. Accessed 4/18/2017.
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C. Edwardes C. The real Squeers was no Dickens brute, claims descendant.
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http://www.telegraph.co.uk/news/uknews/1316931/The-real-squeers-was-no-dickens-
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brute.html. Accessed 5/31/2017.
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D. Moorfields eye hospital website. http://www.moorfields.nhs.uk/contents/.
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E. Sutherland, John: Discovering literature: romantics and Victorians Nicholas Nickleby and the
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Yorkshire schools. https://www.bl.uk/romantics-and-victorians/. Accessed 5/31/2017.
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F. William Shaw and Bowes Academy. http://www.researchers.plus.com/shaw.htm. Accessed
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7-4-2017.
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Legends
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Fig. 1 Charles Dickens at age 27. The engraved reproduction by Daniel Maclise shows the
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author when he first came to national prominence with the publication of Pickwick Papers.
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(Courtesy of the British Library.)
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Fig. 2 An illustration from the 1839 Edition of Nicholas Nickleby showing the disheveled,
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crowded and chaotic environment of Dotheboys Hall. Sketch of these scrawny schoolboys was
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made by Dickens’ principal illustrator Hablot Browne (pseudonym Phiz). (Courtesy of British
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Library.)
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Fig. 3 An advertisement from The Times 1817 for Bowes Academy that scholars point out
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contains nearly verbatim claims of superior education and training as those created by Dickens
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for Dotheboys Hall. (Courtesy of British Library.)
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Fig. 4 A sketch of the Bowes Hall, labelled Dotheboys Hall 1841, shows how rapidly the
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fictional school was connected to the real institution. E (Courtesy of British Library.)
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Fig. 5 The London Ophthalmic Infirmary at Moorfields circa 1824, which was built at
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essentially the same time Egyptian ophthamia was devastating Bowes Academy. (Engraving by
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R. Acon from drawing of Tho H. Shepherd. Reproduced with permission courtesy of Ash Rare
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Books, London.)
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S0039-6257(17)30228-X
DOI:
10.1016/j.survophthal.2017.10.004
Reference:
SOP 6763
To appear in:
Survey of Ophthalmology
Received Date: 28 August 2017 Revised Date:
3 October 2017
Accepted Date: 9 October 2017
Please cite this article as: Margo CE, Harman LE, Charles Dickens, Trachoma and Blindness in PreVictorian England, Survey of Ophthalmology (2017), doi: 10.1016/j.survophthal.2017.10.004. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
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Charles Dickens, Trachoma and Blindness in Pre-Victorian England
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Curtis E. Margo, MD, MPH Ϯ* and Lynn E. Harman, MD *
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Ϯ Departments of Pathology and Cell Biology, and *Ophthalmology, Morsani College of
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Medicine, University of South Florida, Tampa, Florida, U.S.A.
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Conflicts of interest: none
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Corresponding author: Dr. Curtis E. Margo, 12901 Bruce B. Downs Blvd., Box 21, Department of
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Ophthalmology, University of South Florida, Tampa, FL, USA
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E-mail address: [email protected]
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This paper will be presented at the 31st Cogan Ophthalmic History Society Meeting,
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March 24-25, 2018, Tampa, FL.
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Word count: 2,735; abstract: 159; references: 26; figures: 5
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Abstract
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In the early 1820s a Yorkshire boarding school was devastated by an outbreak of
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blinding ophthalmia. The cause of the epidemic was – in all likelihood – trachoma, then known
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as Egyptian ophthalmia. The headmaster of the Yorkshire school, William Shaw, was sued for
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gross negligence by two families whose sons went blind during the outbreak. The epidemic and
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trial would play a role in creating one of literatures most notorious fictional characters.
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Eighteen years after the trial, Charles Dickens modeled the vile schoolmaster Wackford Squeers
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in Nicholas Nickleby after Shaw, whose reputation and career would later be ruined by his
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thinly disguised portrayal in the novel. The original boarding school epidemic took place while
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London’s first eye hospital was moving to Lower Moorfields, an institution that 17 years earlier
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was established primarily to cope with Egyptian ophthalmia. We explore trachoma’s wide-
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ranging impact on pre-Victorian England, from inspiring an enduring literary villain to the
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creation of a renowned eye hospital.
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“Mr. Squeers’s appearance was not prepossessing. He had but one eye, and the popular
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prejudice runs in favor of two.” — Charles Dickens 8p16
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“The explosive impact of the Egyptian ophthamia elevated the importance of eye disease, so
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that every medical practitioner needed to know something about it.” – HR Taylor 20
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Introduction
On October 30, 1823, the Court of Common Pleas of London awarded damages of £300
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to Richard and William Jones, brothers who lost their sight while attending Bowes Academy in
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Yorkshire. 5,E The defendant was William Shaw, the one-eyed headmaster, who was deemed
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responsible for their injuries. The jury trial had been protracted and emotional. The following
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day, Shaw, sensing the futility of a second civil proceeding, settled financially with another
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family whose three boys also went blind. At least a dozen boys at the school had lost their sight
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during the epidemic, but lacking the advantage of supportive families, these children suffered
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their fates uncompensated. In retrospect, this epidemic was almost assuredly trachoma, a
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damaging ophthalmia that blighted England for decades after soldiers brought it home
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following the Egyptian campaign of 1798 to 1802. 3,11,13,18
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The initial trial received modest coverage in the newspaper, but this boarding school
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epidemic would have been largely forgotten was it not for the young writer Charles Dickens
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(1812 – 1870) who fashioned the wicked headmaster Wackford Squeers in Nicholas Nickleby
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after William Shaw (Fig. 1).1, 5,C,E,F Soon after the publication of Nicholas Nickleby in 1839, the
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similarities between the fictional Dotheboys Hall and Bowes Academy in Yorkshire, and the vile,
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one-eyed school master Wackford Squeers and the monocular headmaster Shaw were obvious.
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Although Dickens maintained any resemblances were coincidental, scholars would later
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uncover evidence they were not.1,5,F The role that this ocular epidemic played in dissuading
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Shaw from seeking redress for libel is often overlooked. His school would ultimately close due
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to inferences and innuendos tied to Nicholas Nickleby.
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Trachoma during the Industrial Revolution had sundry ramifications, including alerting
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the medical profession on how ill prepared it was to deal with large numbers of patients with
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serious ocular disease. Greater specialization in ophthalmology and the development of eye
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hospitals were the first encouraging responses, but these fell short of what was needed to
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contain this highly contagious disorder.
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Nickolas Nickleby and the Yorkshire Schools for Boys
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It seems fitting that Dickens, the quintessential author and social critic of mid-19th century England, would achieve his first commercial success with Pickwick Papers in 1837, the
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year Victoria succeeded to the monarchy. For a brief time after that, Dickens was writing
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monthly installments for both Oliver Twist and Nicholas Nickleby. Although each work exposed
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the vices of Victorian society, Nicholas Nickleby was decidedly less gloomy and was the first
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experience that Dickens had with writing a romance. A powerful part of the narrative occurs in
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early chapters when the protagonist, Nicholas Nickleby, is hired by the loathsome Squeers to
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teach at Dotheboys Hall, an all-boys boarding school in Yorkshire. Nickleby, whose father had
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just died and left his family penniless, assumes responsibility for supporting his mother and
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sister. The young Nickleby is disturbed by the cruelness of his new employer who allows the
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boys at the school to live in squalid conditions and who appears to delight in their gratuitous
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floggings. Most of his wards are unwanted boys, social cast offs, abandoned because they were
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crippled, deformed, or born out of wedlock. Although the chapters dealing with the Yorkshire
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school make up a minor portion of the serialized story, the vivid descriptions of this unsavory
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environment created a lasting negative impression on readers (Fig 2). Wackford Squeers was
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guaranteed a place in the pantheon of fictional villains.
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Research for Nicholas Nickleby
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The phantoms of Dickens’ troubled childhood haunted his prose. Perhaps the most emotionally traumatic period of Dicken’s early life occurred when his father was thrown into
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debtor’s prison, and he was forced from school at the age of 12 to work in a warehouse for five
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months. How exactly he developed a dislike of the Yorkshire boarding schools is a matter of
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debate. Dickens unmistakably valued education, having obtained his primary schooling in
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Chatham Kent and London.1,6,15,16,B The Yorkshire boarding school were general regarded as
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seedy, low-cost institutions that managed to survive because there was little to no protective
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oversight for minors. On one level Dickens likely envisioned the potential harm these
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disreputable schools inflicted on vulnerable youths based on his own interrupted schooling.1
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He probably learned about the Bowes Academy trial in the 1830s when working as a court
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reporter. Advertisements for Yorkshire schools were also common in The Times of London. An
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earlier ad from the Bowes Academy that captured Dickens’ attention boasted of the school’s
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ability to teach skills that would “qualify” boys “for any situation in life.” (Fig. 3) The school also
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taught French “in its greatest purity,” and pledged itself to “the strictest attention” to the
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“health, moral conduct, and intellectual improvements of its pupils.” Dickens detested such
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hyperbole, particularly from a headmaster who he knew was responsible for letting students
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under this charge go blind. Dickens borrowed parts of this ad almost verbatim for the 3rd
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chapter of Nicholas Nickleby, changing the name of the school (but not its location) to
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Dotheboys Hall. 8p14
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To prepare a realistic setting for the early chapters of Nicolas Nickleby, Dickens traveled
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to Bowes Academy during the winter of 1838 (Fig. 4). 5p16 Once in Yorkshire, he used an alias to
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avoid recognition as the author of Pickwick Papers. During the week-long trip, Dickens came
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upon a gravestone of a teenager that read “Here lies the remains of GEORGE ASHTON
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TAYLOR...who died suddenly at Mr. William Shaw’s Academy.” 1p252 The terse inscription on the
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marker would inspire the creation of the fictional character Smike, whose physical abuse at the
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hands of Squeers would make him one of Dickens’ most tragic literary figures. Dickens had
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gathered considerable material in his short visit to Yorkshire, but it long remained uncertain
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whether he ever met Shaw on that sojourn.
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Many years later, scholars discovered a letter Dickens wrote in December, 1839, to a colleague discussing his fact-finding trip and a meeting he had with Shaw.5,9 The encounter
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reinforced Dickens’ dislike of the man he had previously known only by reputation. The content
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of the letter left no doubt that Dickens transmogrified Shaw’s perceived character into
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Wackford Squeers.
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The serialized novel was completed in 18 months, and there was concern that the likeness between Wackford Squeers and William Shaw would be evident. To counter
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allegations of libel, Dickens explained in the Preface to the first edition of Nicholas Nickleby that
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similarities between Mr. Squeers and any specific Yorkshire schoolmaster were coincidental. 7
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He went on to say “that Mr. Squeers is the representation of a class [of schoolmasters], and not
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of an individual. Where imposture, ignorance, and brutal cupidity, are the stock in trade of a
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small body of men, all his fellows will recognize something belonging to themselves, and each
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will have a misgiving that the portrait is his own.”7
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Ten years later, the first cheap edition of Nicholas Nickleby was published. The tone of
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the new Preface was more indignant, adding that these schoolmasters were “traders in the
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avarice indifference, or imbecility of parents, and the helplessness of children.”8 To ensure
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Nicholas Nickleby was viewed with historical accuracy, Dickens described his 1838 journey to
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Yorkshire and how he inspected the schools under an assumed name, a practice he called a
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“pious fraud.” 8 Although still claiming that the Squeers was representative of a class of men
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and not one in particular, Dickens specifically cites as evidence of malfeasance a previous civil
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trial that resulted in reparations for “neglect, cruelty, and disease.”
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The Ocular Epidemic
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The best accounts of the boarding school epidemic came from 11-year-old William Jones
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and his older brother Richard during their civil trial. 5,F Both boys testified in their own behalf
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before a jury at Guildhall, London. Not only did they provide insight into the nature of the eye
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disorder, the boys gave detailed accounts of their diets and general living conditions. Between
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260 and 300 boys lived in Bowes Academy. The bothers had attended the school for less than a
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year before William wrote home complaining that his eyes were in a “bad state,” being able to
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see just daylight or the flame of a bright candle. William had recovered from smallpox the year
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before attending Bowes Academy, but both boys were otherwise healthy and had no previous
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problems with their eyes. Richard’s disorder started as a “cold” in his eyes. It lasted several
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months, got better then worse. His eyes were constantly blood-shot and a servant from the
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school was employed to wash away the collected “humors.” Richard, now 13, had lost all
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useful vision. William, at the time of the trial, could see out of just one eye. William knew of
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nine other boys at the school who were totally blind. There were no systemic illnesses,
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although Richard developed a pernicious itch (presumably scabies) after he had lost vision.
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The boys ate regularly, but the meals were meager and unappealing. Hasty-pudding for
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breakfast each morning with a second meal of meat and potatoes 4 times a week. Supper the
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remainder of the week consisted of dumplings and water, bread and milk, and black potatoes
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and butter. The residence hall had 30 beds to a room. Four to five boys shared a straw bed,
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one sheet and one quilt. The beds were infested with fleas, which each morning the boys were
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ordered to capture with a quill. They washed from a communal trough without soap (except on
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Sundays), shared towels, and were bathed once a week.
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opinions were peppered with inconsistencies, though there was no disagreement that the
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outbreak of ophthalmia was severe. Hygiene was never a topic of discussion. The concept was
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essentially non-existent. Attempts at isolating children turned into dreadful sentences of
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imprisonment. William Jones was initially confined to a washhouse, along with 18 other
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infected boys. When his condition worsened, he was transferred to another room that housed
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more severely afflicted students. William was confined to this room for two months, where he
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remembered a single doctor’s visit and no particular treatment, though the defense claimed an
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attendant was assigned to wash his eyes.
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Several noteworthy aspects of life in Bowes Academy were revealed during the trial. The boys were not wantonly beaten, but were threatened with corporal punishment if not
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obedient. This type of institutional violence was not unusual for the time. When adults were
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absent, older boys took advantage of the younger ones--a harsh reality of communal living.
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Perhaps what most resonated with Dickens was when William described his disappointment at
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being able to learn to only read and write. He valued, if not envied, how other boys at the
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school who had not been sick learned Latin and French.
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Egyptian Ophthalmia in Pre-Victorian England
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Trachoma can be traced to antiquity, but its emergence in Europe following the
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Egyptian Campaign was particularly devastating as it spread through susceptible populations as
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localized epidemics.2,3,11,25 Initially brought from Egypt by soldiers, it spread rapidly through
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civilian populations, especially those in urban centers. England was hit unusually hard since it
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was in the mist of its Industrial Revolution, when living conditions in cities were crowded and
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unhygienic. French physicians during the early 19th century were not convinced of its
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contagious nature. English physicians, on the other hand, thought Egyptian ophthalmia was
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spread by a miasma (poisonous vapor).2,20,25 This misconception would delay implementations
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in how to contain a disease transmitted through secretions.
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The diagnosis of “ophthalmia” was not specific, and applied to any superficial inflammation of the eye, including acute catarrhal and purulent conjunctivitis.18 The entity now
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recognized as trachoma was usually distinguishable from other ophthalmias by its tendency to
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cluster in families or occur among persons living in close quarters, bilateral occurrence,
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“granules” under the upper eyelid, which “resembled the villi of the small intestine”, protracted
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clinical course with propensity for recurrence and flare ups, and progression into a chronic
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scarring stage.4,18 Unlike other severe ophthalmias, the Egyptian variety destroyed the cornea
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“from the underside.” 4 Since management of all ophthalmia was supportive, scrupulous
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physicians were charged with relieving symptoms without causing harm. Those convinced they
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had discovered a cure risked making things worse with topical herbs or chemicals.
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As few physicians were adequately trained in diagnosing eye disease, the setting was ripe for charlatans and impostors. 20,23 Quacks and swindlers flourished during outbreaks as
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long as they didn’t catch the ocular infection. As the number of soldiers returning from Egypt
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with ophthalmia grew, it placed an increasing burden on the medical community.23 The
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number of disabled blind eventually prompted the development of the first eye hospital, which
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was established in 1805 as the London Dispensary for Curing Diseases of the Eye and
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Ear.17,19,23,D One medical historian notes that as many as 52 eye (or, eye and ear) hospitals in
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Britain were eventually established to deal with trachoma.19 A year before William Shaw was
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sued in the Court of Common Pleas, the London Dispensary was moved to Lower Moorfields, a
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district just north of the old City. The area was described by Treacher Collins as “a place of
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recreation and jollification for the City folk–a place of swings and roundabouts.”27p51 The
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Dispensary was renamed the London Ophthalmic Infirmary, but locals preferred to call it
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Moorfields (Fig. 5).23,D Early eye hospitals served largely as repositories for the blind and had no documented
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success in curbing outbreaks of Egyptians ophthalmia. 17 Unbeknownst to physicians of the
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time, infection from trachoma was chronic, halted eventually by poorly understood immune
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mechanisms or when the disease enters into its cicatricial stage.21,22 Patients were also prone
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to reinfection and recurrent bouts of inflammation if unhygienic conditions were not corrected.
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Even though studies in the early 1800s had shown Egyptian ophthalmia could be transferred
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through an ocular discharge, the miasma theory still guided how quasi-hygienic practices were
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carried out.4,10 After the discovery of bacteria in the 1860s, the role of personal hygiene (in the
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form of hand washing) started to gain adherents. Social reformer Edwin Chadwick (1800 –
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1890), who published The Sanitary Condition of the Labouring Population of Great Britain in
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1842, emphasized the role of cleanliness in an urban context, but not in hospitals or infirmaries.
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Ironically, the first major steps in changing medical behavior to reduce the spread of germs through direct contact was prompted by another British war– the Crimean (1854 –
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1856), when the military promoted washing with clean water and using clean towels and pillow
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cases to curb the incidence of ophthalmia.2,14,24
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The chronic recurrent nature of Egyptian ophthalmia and inability to culture bacteria
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from affected patients (except in the case of secondary infection) confounded attempts to
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understand the disease. Nearly 110 years after Egyptian ophthalmia arrived in England, the
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infectious organism was identified as an intracellular parasite.12 Although for a long time
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chlamydial organisms were confused with viruses, effective anti-bacterial therapy for trachoma
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would wait until 1938 when sulfanilamide was introduced.11 In retrospect, the critical
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importance of low-tech interventions like facial washing and the use of clean towels to prevent
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spread were agonizingly slow to advance. 14,20
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Summary
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Dickens transformed William Shaw through his literary artistry into the sinister
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Wackford Squeers, but without sufficient camouflage to conceal Shaw’s real identify. Shaw’s
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friends and family came to his defense, claiming he was neither heartless nor malicious.1,A,C.F
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He ran a cut-rate boarding school with few amenities at a time when society was not
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particularly concerned about the welfare of children. In the 1820s the Bowes Academy had the
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misfortune of running up against trachoma when no one knew how to deal with diseases that
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were transmitted through ocular secretions. Shaw, unable or unwilling to defend his reputation
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when besmirched by Dickens, lost his Academy and then witnessed the downfall of the other
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Yorkshire boarding schools.
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Epilogue
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Shaw eventually contracted trachoma during the boarding school epidemic, and Dickens
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would notoriously mock the scar it left him with through his fictional counterpart Wackford
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Squeers: “he had but one eye, and the popular prejudice runs in favor of two.” The negative
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portrayal of Dotheboys Hall in Nicholas Nickleby eventually drove all Yorkshire boarding schools
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out of business by the 1850s. 1,5,E,F Shaw retired in 1841 and died 9 years later at the age of 67.
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Egyptian ophthalmia accelerated the specialization of ophthalmology and eye hospitals
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in pre-Victorian England, but a real impact on curbing trachoma epidemics had to wait for
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rejection of the miasma theory and an appreciation of the role that basic hygiene plays in
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limiting person-to-person spread of the disease.
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References
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1_Ackroyd P. Dickens. New York, Harper Collins, 1990.
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2. al-Rifai KM. Trachoma through history. Int Ophthamol 1988;12(1):9-14.
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3. Bailey MS. A brief history of British military experiences with infectious and tropical disease.
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Army Med Corps 2013;159:150-7.
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4. Benedek TG. Gonorrhea and the beginnings of clinical research ethics. Perspect Biol Med
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2005;48(2):54-73.
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5. Clark C. Charles Dickens and the Yorkshire Schools. London, Chiswick Press. 1918.
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6. Crotch WW. Charles Dickens Social Reformer. London, Chapman & Hall, 1913.
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7. Dickens C. The Life & Adventures of Nicholas Nickleby, New York, Charles Scribener’s Sons,
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1911.
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8. Dickens C. The Life & Adventures of Nicholas Nickleby, New York, Macmillan Publishing,
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1982 (Illustrated edition).
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9. Dickens, C. The Letters of Charles Dickens. The Pilgrim Edition. House M, Storey G (eds),
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Oxford, Clarendon Press, 1965.
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10. Feibel RM, John Vetch and the Egyptian ophthalmia. Surv Ophthalmol 1983;28(2):128-34.
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11. Feibel RM. Fred Loe, MD, and the history of trachoma. Arch Ophthalmol 2011;129(4):503-8.
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12. Halberstaedter L, von Prowazek S. Uber zelleinschusse parasitarer natur beim trachoma.
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Arb K Gesundh Amt 1907;26:44-7.
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13. Kelly C. Medicine and the Egyptian campaign: the development of the military medical
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officer during the Napoleonic Wars c. 1798-1801. Can Bull Med Hist 2010;27(2):321-42.
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14. MacCallan M. Arthur Ferguson MacCallan CBE, MD, FRCS (1872 – 1955), trachoma pioneer
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and the ophthalmic campaign in Egypt 1903 – 1923. J Med Biography 2016
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15. Markel H. The childhood suffering of Charles Dickens and his literary children. Pharos
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1985;48(2):4-5.
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16. Markel H. Charles Dickens’ work to help establish Great Ormond Street Hospital, London.
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Lancet 1999;354:673-5.
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17. Marmion VJ. The origin of eye hospitals. Br J Ophthalmol 2005;89:1396-97.
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18. Myerhof M. A short history of ophthalmia during the Egyptian campaigns of 1798 – 1807.
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Br J Ophthalmol 1932;16:129-52.
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19. Sorsby A, Sorsby M. A Short History of Ophthalmology. Staples Press, London, 1948.
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20. Taylor HR. Doyne Lecture: trachoma, is it history? Eye2009;23:2007-22.
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21. Taylor HR, Burton MJ, Haddad D, West S, Heathcote W. Trachoma. Lancet 2014;384:2142-
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22. Taylor HR, Siler JA, Mkocha HA, Munoz B, West S. The natural history of endemic trachoma:
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a longitudinal study. Am J Trop Med Hyg 1992;46(5):552-9.
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23. Treacher Collins E. The History and Traditions of the Moorfields Eye Hospital. One Hundred
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Years of Ophthalmic Discovery & Development. London, HK Lewis & Co, 1929.of Moorfields.
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24. Treacher Collins E. Introductory Chapter. In, Trachoma, Boldt J (ed), London, Hodder &
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Stoughton, 1904. (Translated by Herbert Parsons and Thos Snowball)
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25. Vagemans M, van Bijsterveld OP. The French Egyptian campaign and its effects on
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ophthalmology. Doc Ophthalmol 1988;68:135-44.
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26. Widerquist JG. Sanitary reform and nursing. Edwin Chadwick and Florence Nightingale. Nurs
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Hist Rev 1997;5:159-60.
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Other Cited Material
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A. Lloyd HF. The Life of an Actor. An Autobiography.
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http://www.arthurlloyd.co.uk/horatiobiog/horatiolloydautobiographychapter1.htm. Accessed
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7/10/2017.
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B. Diniejko A. Charles Dickens as social commentator and critic.
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http://www.vicotiranweb.org/authors/dickens/diniejko.html. Accessed 4/18/2017.
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C. Edwardes C. The real Squeers was no Dickens brute, claims descendant.
305
http://www.telegraph.co.uk/news/uknews/1316931/The-real-squeers-was-no-dickens-
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brute.html. Accessed 5/31/2017.
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D. Moorfields eye hospital website. http://www.moorfields.nhs.uk/contents/.
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E. Sutherland, John: Discovering literature: romantics and Victorians Nicholas Nickleby and the
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Yorkshire schools. https://www.bl.uk/romantics-and-victorians/. Accessed 5/31/2017.
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F. William Shaw and Bowes Academy. http://www.researchers.plus.com/shaw.htm. Accessed
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7-4-2017.
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Legends
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Fig. 1 Charles Dickens at age 27. The engraved reproduction by Daniel Maclise shows the
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author when he first came to national prominence with the publication of Pickwick Papers.
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(Courtesy of the British Library.)
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Fig. 2 An illustration from the 1839 Edition of Nicholas Nickleby showing the disheveled,
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crowded and chaotic environment of Dotheboys Hall. Sketch of these scrawny schoolboys was
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made by Dickens’ principal illustrator Hablot Browne (pseudonym Phiz). (Courtesy of British
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Library.)
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Fig. 3 An advertisement from The Times 1817 for Bowes Academy that scholars point out
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contains nearly verbatim claims of superior education and training as those created by Dickens
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for Dotheboys Hall. (Courtesy of British Library.)
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Fig. 4 A sketch of the Bowes Hall, labelled Dotheboys Hall 1841, shows how rapidly the
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fictional school was connected to the real institution. E (Courtesy of British Library.)
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Fig. 5 The London Ophthalmic Infirmary at Moorfields circa 1824, which was built at
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essentially the same time Egyptian ophthamia was devastating Bowes Academy. (Engraving by
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R. Acon from drawing of Tho H. Shepherd. Reproduced with permission courtesy of Ash Rare
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Books, London.)
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