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History of Medicine

Night Blindness and Ancient Remedy

H.A. Hajar Al Binali, M.D.
Department of Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar

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.

Key words: 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.
© Gulf Heart Association 2014.

O
ver 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
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DOI:
Address for correspondence: H.A. Hajar Al Binali, M.D., F.A.C.C.
Director of Medical Education, Heart Hospital, Hamad Medical Corporation, Doha,
10.4103/1995-705X.151098
Qatar, P. O. Box 3050 Doha, Qatar

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H.A. Al Binali: Night blindness and ancient remedy
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: [1] “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.”[2]
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.”[3]
It is clear that the choice of the animal is influenced
by its availability in the community. The Chinese
Sun‑szu‑mo (7th century AD) in his 1000 Golden Remedies
describes a cure by administration of pig’s liver.[4]
As recently as 1978 Hussaini et al.:[5] 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
137
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[6] 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:[7]
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.[8]
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H.A. Al Binali: Night blindness and ancient remedy
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. [9]
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.[10] 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.[11] 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.[12]
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
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Oct-Dec 14 Issue 4 / Vol 15
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.
REFERENCES
1. Ebell B. The Papyrus Ebers. The Greatest Egyptian Medical
Document. Copenhagen: Munksgaard and Oxford University
Press; 1937.
2. Nunn JF. Ancient Egyptian Medicine. Landon: British Museum
Press; 1996. In press.
3. Littre E. Oeuvres Completes de Hippocrates, Vol. IX, pp. 156-160,
J. B. Balliere, Paris, (1861).
4. Lee T. Historical notes on some vitamin‑deficiency diseases in
China. In: Fothwell DB, editor. Diseases in Anuquizy. 1967.
5. Hussaini G, Tarwotjo I, Sommer A. Cure for night blindness. Am
J Clin Nutr 1978;31:1489..
6. Aykroyd WR. Vitamin A deficiency in Newfoundland. Ir Med
1928;28:161‑5..
7. Lindeboom, CA. Historical milestones in the treatment of night
blindness. Clio Med 1984;19:40‑9.
8. Ross AC. Vitamin A and retinoids. In: Shils M, Olson J, Shike M,
editors. Modern Nutrition in Health and Disease. Philadelphia:
Lippincott; 2000. p. 305.
9. Hornero-Méndez D. Carotenoid composition of Algerian date
varieties (Phoenix dactylifera) at different edible maturation stages.
Food Chem 2007;101:1372‑7.
10. Williams SR. Nutrition and Diet Therapy. 8th ed. St. Louis: Mosby;
1997. p. 159.
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H.A. Al Binali: Night blindness and ancient remedy

11. Janczewska I, Ericzon BG, Eriksson LS. Influence of orthotopic liver Database on Vitamin A Deficiency. Geneva: World Health
transplantation on serum vitamin A levels in patients with chronic Organization; 2009.
liver disease. Scand J Gastroenterol 1995;30:68‑71.
12. World Health Organization. Global Prevalence of Vitamin A
Source of Support: Nil, Conflict of Interest: None declared.
Deficiency in Populations at Risk 1995‑2005: WHO Global

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