|HISTORY OF MEDICINE
|Year : 2014 | Volume
| Issue : 4 | Page : 136-139
Night blindness and ancient remedy
H.A. Hajar Al Binali M.D.
Department of Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
|Date of Web Publication||9-Feb-2015|
Source of Support: None, Conflict of Interest: None
| Abstract|| |
The aim of this article is to briefly review the history of night blindness and its treatment from ancient times until the present. The old Egyptians, the Babylonians, the Greeks and the Arabs used animal liver for treatment and successfully cured the disease. The author had the opportunity to observe the application of the old remedy to a patient. Now we know what the ancients did not know, that night blindness is caused by Vitamin A deficiency and the animal liver is the store house for Vitamin A.
Keywords: Night blindness, Vitamin A and liver oil
|How to cite this article:|
Al Binali HH. Night blindness and ancient remedy. Heart Views 2014;15:136-9
Over more than 3000 years ago, the ancients, not only knew night blindness but also knew how to cure it. They did not know vitamins and they did not know what we now know, that Vitamin A deficiency causes night blindness; but to be able to cure it, they must have been aware that there was a dietary factor deficient that caused the disease. Well, in my childhood days, which were not so ancient, I had the opportunity to witness the same successful ancient treatment of night blindness.
I was born in a small sea side town in the south of the Gulf called Ma'reed in the Emirate of Ras Al Khaimah (RAK), part of the present UAE. That was where I grew up, listening in the dark night to stories about genies and scary fairy tales. Before I enter the subject of night blindness in that town, it is appropriate to describe our life at night before the electricity era in RAK.
Our nights were really dark, except for the full and near full moon nights. During my childhood there was no electricity in RAK. After sunset, darkness creeps to engulf the town with absolute quietness; there were no sounds of cars, machineries or music. The only sound that could be heard at night was that of the wind, the sea waves, the call for prayer and occasional dog barking. Inside our so called "rooms," which were mostly tents made of palm tree sticks. We used kerosene lamps for lighting. Hence, darkness all over the town was the rule at night.
But even with such absolute darkness, we, the kids, were playing night games between houses and walking in narrow streets. Our eyes were adapted to darkness, like cats. We were part of nature which we no longer experience nowadays. The sky was fully decorated with so many stars.
When I was about 8 years old, my father became ill, malnourished, and suffered from night blindness. He could not see to walk between rooms in our house or go to the mosque for prayer without help. I used to lead him, to and from the mosque. He, however, continued to enjoy reading his books at night next to a kerosene lamp. From sunset until bedtime he stayed alone quietly in his room reading except for a few minutes of prayers at night. He loved his books. He had the biggest collection of books in the country then.
Why do people get night blindness? Nobody knew in RAK then. We had no medical doctors or pharmacies in the country. We had only ancient traditional medicine, practiced by some illiterate elderlies. So, my father sought therapeutic advice from one such elderly. His "prescription" was fish liver oil extracted by cooking on charcoal to be rubbed inside the eyes with a special stylet every night for 1-week. A neighboring fisherman, a friend of my father, supplied us after sunset with either a large fish liver or a whole fish. My mother would prepare the charcoal after sunset prayer and put the liver over it, while my sister and I sat with our father, watching the therapeutic preparation. When the liver was cooked, and the oil started seeping out, my mother would insert a silver stylet into the liver and then give to my father, who waited for it to cool down. My father would then apply the stylet saturated with fish liver oil flat over the inside of the eye. He would then close his eyelid on it while pulling it out. After that he would eat barbequed liver even though it was not part of the prescription. After a few days he improved and in 1-week he regained his night vision completely.
| History of Night Blindness Therapy|| |
In the history of treating night blindness, the ancient Egyptian, the Babylonians, the Greeks, and many other cultures after them, used animal liver as treatment, like what we did in RAK.
In the Egyptian papyrus Ebers (1500 B.C.) the recommended cure was:  "Roasted ox liver, pressed, applied (topical to the eye)." Another ancient Egyptian papyrus, Kahun 1 (1825 B.C.), a gynecological treatise, mentions "instructions for a woman, cannot see, to eat raw liver of an ass."
The Assyrian medical texts (700 B.C.) describe night blindness. They thought it was caused by rays of the moon and cured by application of ass's liver to the eyes. They did not put the liver itself in the eye but used the extracted oil and probably enjoyed eating the cooked liver. It is very likely that the ancient Egyptian ritual treatment also ended with the patient eating the liver.
The Greeks shifted the recommendation from topical application to frank eating "raw beef liver, soaked in honey, to be taken once or twice (daily) by mouth." Galen (130 AD-210 AD), recommends: "Continuous eating of… liver of goats."
It is clear that the choice of the animal is influenced by its availability in the community. The Chinese Sun-szu-mo (7 th century AD) in his 1000 Golden Remedies describes a cure by administration of pig's liver. 
As recently as 1978 Hussaini et al.:  Observed several treatment sessions of night blindness in rural Java. The juice of lamb liver was applied topically to the eyes of night-blind children. The procedure was exactly as described by the ancient Egyptians, "except for one small addition: Rather than discarding the remaining organ, the (practitioners) fed it to the affected child… This was never considered part of the therapy itself." Similarly, in 1928 Aykroyd  wrote: "I have been told of a custom of steaming the eyes over cooking liver, which is then eaten," as a remedy for night blindness in the Canadian Newfoundland Island.
With respect to Arab civilization I found that the Abbasid Physician Hunayn Ibn Ishaq (809-873) recommended in his book "Seven Articles on the Eye" the same procedure of rubbing the liver oil in the eye, but also added two more suggestions: "Get the smoke from the cooking liver goes into the eye" plus eat the liver. He specified goat liver.
Now we know that the cause of night blindness is deficiency in Vitamin A and the real therapeutic benefit comes from eating the liver. Animal liver, including that of fish, is very rich with Vitamin A, because the liver is the store house of Vitamin A in the body. Some ancient medical practitioners prescribed rubbing the liver oil in the eye, but patients could not resist eating the tasty barbequed liver. The Greeks frankly recommended eating the liver as treatment for night blindness. Hunayn Ibn Ishaq took the idea from them because he is credited for translating several Greek medical books to Arabic. In ancient time, they must have realized that there was a nutritional deficiency as the cause of that disease. Arabic poetry written by Hunayn's contemporary poet ibn Duraid (837-933) who lived in the same city of Bagdad, said that night blindness (asha) was caused by dinner (asha), that is, lack of dinner:
The eye asha
Is caused by asha.
The two words in Arabic not only rhyme together but actually sound the same, hence the poetic effect.
In the later middle ages, the Dutch Physician Jacob van Maerlandt (1235-1299) wrote the following poem recommending eating the liver: 
Who does not at night see right
Eats the liver of the goat
He will then see better at night.
So, from the above historical review, it was not surprising that such ancient treatment of night blindness was transmitted over centuries to the Arabs and reached RAK for me to witness.
| Vitamin A|| |
In the late 1920s, the fat-soluble compound in liver was isolated by Karrer a Swiss scientist and his colleagues, and termed Vitamin A. 
There are two main forms of Vitamin A: Provitamin A and preformed Vitamin A.
Provitamin A carotenoids are found in plants. There are many forms of provitamin A, but beta-carotene is the only one that is metabolized by mammals into Vitamin A. So, after ingestion, the body converts the provitamin into vitamin.
Preformed Vitamin A (retinol, retinal, retinoic acid, and retinyl esters) is the most active form of Vitamin A; it is mostly found in animal sources of food, e.g., liver, and toxicity can occur if excessive quantities are ingested. The liver is rich with Vitamin A because about 50-85% of the total body retinol is stored in the liver.
The top food sources of Vitamin A in our area in the Gulf are dairy products, liver, and fish. The top sources of provitamin A are carrots, dates, cantaloupe, and squash. Dates are very rich with carotenoid.  Because people in our region consume a lot of dates, night blindness is not very common.
| Vitamin A and The Eye|| |
In the eye, Vitamin A has two major roles: Prevention of xerophthalmia (abnormalities in corneal and conjunctival development) and photo-transduction (transforming light into electrical signals for the brain).
Two types of retinal photoreceptor cells are involved in the visual process. The cone cells are responsible for the absorption of light and color vision in bright light. The rod cells detect motion and are responsible for night-vision.
| Vitamin A Deficiency|| |
Vitamin A deficiency is rarely seen in the rich communities and industrialized countries. However, it is still the third most common nutritional deficiency in the world.  In a large part of the third world (Southern and Southeast Asia, Africa, and South America), night blindness, complete blindness, and advanced stages of xerophthalmia occur in many malnourished children and adults.  According to the World Health Organization, 190 million preschool-aged children and 19.1 million pregnant women around the world have a serum retinol concentration below 0.70 μmol/l. 
In our area, the Arabian Gulf, citizens rarely get night blindness, not only during these days of wealth, but also during the preoil days. The reasons are mainly because their diet was dominated by fish and dates. Both are rich with Vitamin A and provitamin A. So, why did my father develop night blindness while the rest of the family, eating the same food, did not? The answer is that, at that time, he was ill with gallbladder disease. Fat soluble vitamins like Vitamin A needs to be mixed with bile salts to form small aggregates before it could be absorbed by the gut. People with insufficient bile flow are usually deficient in Vitamin A and hence the night blindness.
| The Myth of Vitamin A as Antioxidant for Cardiovascular Health|| |
In populations where dietary intake of Vitamin A is adequate, there is no evidence that supplementation of Vitamin A as an antioxidant is helpful for preventing cardiovascular disease. Randomized trials of Vitamin A and beta-carotene have shown no benefit for primary or secondary prevention of coronary heart disease. Such supplementation may even have harmful effects on cardiovascular mortality, cancer, and bone health. The lesson from the above story of the ancients and how they cured night blindness with food, tells us to avoid unnecessary vitamin supplements and get our nutritional requirement through balanced and healthy food.
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Hussaini G, Tarwotjo I, Sommer A. Cure for night blindness. Am J Clin Nutr 1978;31:1489..
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