By Douglas Lanska, 2-12-13
OBJECTIVE: Determine whether night blindness among soldiers in the Crimean War and the U.S. Civil War was due to vitamin A deficiency (VAD) or to malingering as commonly attributed.
BACKGROUND: VAD can result in nutritional night blindness (from impaired phototransduction in retinal rod cells) and corneal epithelial disorders.
DESIGN/METHODS: Review of reports of night blindness and corneal epithelial disorders identified through compilations of the U.S. Surgeon General, electronic databases and search engines, bibliographic compilations, diaries, memoirs, medical journals, and monographs. Quantitative morbidity data were obtained from extensive tabulations of the U.S. Surgeon General from July 1861 through June 1866. Incident cases of night blindness, scurvy, and diarrheal diseases, and mean troop strength among Union troops, were abstracted by month, year, and race.
RESULTS: In both wars, medical officers commonly attributed night blindness to malingering among soldiers. However, a dietary deficiency basis is supported in both wars by: (1) the severely inadequate vitamin A content of military rations; (2) close correspondence of clinical descriptions with the full spectrum of VAD eye disease; (3) occurrence of night blindness in conjunction with other disorders that cannot be readily feigned, and that are now known to result from nutritional deficiencies (keratomalacia and scurvy); and (4) resolution of night blindness with appropriate dietary modification. Also, during the U.S. Civil War marked seasonal variation in night blindness incidence among Union soldiers corresponded closely to seasonal variations in both the availability of foodstuffs and the incidence of scurvy and diarrhea.
CONCLUSIONS: Nutritional night blindness occurred among soldiers forced to subsist on nutritionally inadequate diets during both the Crimean War and the U.S. Civil War. The seasonal pattern during the U.S. Civil War is consistent with seasonal variations in the availability of foodstuffs with high vitamin A content (or provitamin A carotenoid content) superimposed on marginal vitamin A reserves.
Supported by: Department of Veterans Affairs.
Disclosure: Dr. Lanska has received personal compensation from Medlink Neurology for medical publishing and editorial responsibilities.