22 O INANITION AND MALNUTRITION 



ous observers, such as Seefelder ('19) and Feilchenfeld ('20), have noted various 

 ocular lesions resulting from malnutrition during the war. Among these lesions 

 are conjunctivitis and keratomalacia, which we are now justified in assuming 

 to be due to the same vitamin deficiency causing xerophthalmia in the lower 

 animals. Hess and linger ('19), however, found no eye trouble in 5 infants 

 fed on a diet considered deficient in vitamin A for periods of 8 or 9 months. 



On the other hand, Mori ('04), Bloch ('18, '19, '21, '24) and others have 

 found typical eye lesions following this dietary deficiency, especially in infants. 

 Bloch ('21) states that: "Xerophthalmia is considered a rare disease. Only 

 amongst the negro slaves of Brazil and amongst the poorest and most ignorant 

 inhabitants of Russia is it said to have been observed to any extent. The 

 disease is generally described as follows: the first symptoms are dryness of the 

 ocular conjunctiva, which becomes wrinkled and shrunken. Later on, small 

 yellowish white spots appear, as though the conjunctiva had been dotted with 

 paraffin wax. At this stage the disease is termed Xerosis conjunctivae. The 

 dryness rapidly spreads over the whole conjunctiva and over the cornea, which 

 becomes dull, uniformly hazy and insensitive. Later the cornea turns greyish 

 and still later yellowish, until at last a more or less extensive necrosis of the 

 cornea sets in, followed by ulceration (keratomalacia). The necrosis and 

 ulceration may appear in the course of a few hours . . . All authors agree 

 that the keratomalacia is due to insufficient nutrition of the cornea, and that 

 this again is the consequence of the disorganisation of the whole mechanism 

 of nutrition. The disease therefore occurs only amongst children who have 

 been ailing for a considerable time and is often met with amongst infants who 

 have been insufficiently nourished." Bloch finds this disorder, which he terms 

 Dystrophia alipogenica, due to a deficiency in vitamin A. It is fairly common 

 in Denmark, and is probably an important factor in causing permanent blind- 

 ness. Bloch ('24) has recently reviewed the subject in detail. Xerophthalmia 

 may occur in children during the late stages of various malnutritional disorders. 

 Death may be caused by secondary infections, especially bronchopneumonia. 

 In case of recovery, if the cornea is only partly damaged, the child can usually 

 be saved from complete blindness. The resultant scars are always hazy 

 and opaque. 



Ross ('21) describes 4 cases of keratomalacia in infants with a dietary 

 malnutrition corresponding closely to Czerny's "Mehlnahrschaden." Both 

 clinically and histologically the eye lesions are very similar to those produced 

 in animals by dietary deficiency in vitamin A. A similar keratomalacia is 

 described by Stolte ('22). Wright ('22) observed numerous cases of human 

 xerophthalmia. 



Blegvad ('24) has recently given the subject a thorough discussion, based 

 on 434 cases of keratomalacia in children and 19 in adults (also 148 cases of 

 xerosis conjunctivae without keratomalacia), all observed by Danish oculists 

 between 1909 and 1920. He also gives a full review of the literature, with a 

 bibliography of 200 titles. 



Scorbutus. — The ocular lesions in scurvy (due to deficiency in vitamin C) 

 are chiefly connected with the general hemorrhagic condition associated with 



