These words, concluding Tennyson's poem about aging heroes of ancient Greece who express determination to undertake perilous journeys even as they are aware of losing the vigor of youth, appear on a wooden cross in Antarctica. The cross and its inscription were left by surviving members of Captain Robert Falcon Scott's second expedition to Antarctica, an expedition during which Scott himself died.
"To strive, to seek, to find, and not to yield."
-Alfred Tennyson, Ulysses
Scott returned to Antarctica in 1910. He wanted to reach the South Pole before the Norwegian explorer Roald Amundsen, who left at nearly the same time in hopes of becoming the first human to reach this goal.
I encourage you to read the account of one of Scott's "men" (i.e., a non-officer) named William Lashly. The "leading stoker," a skilled mechanic and very tough character, Lashly also was a keen observer, and he describes in his diary the various medical illnesses that afflicted the group. Scurvy was a major problem that afflicted Antarctic explorers, because the short summer and long brutal winters required expeditions to be 2 to 3 years in length.
Two interesting eye diseases afflicted these people. Snow blindness (ultraviolet [UV] photokeratitis) is mentioned repeatedly in Lashly's diary and incapacitated the men for as short as 4 days to as long as 1 week. Today this is not an issue, because the importance of UV protection against acute high-intensity exposures for the ocular surface is well understood.
At one time, we offered experimental evidence that it should be possible to add a UV light-absorbing chromophore to eye drops that are used chronically for other indications such as glaucoma or keratoconjunctivitis sicca, to reduce complications from UV-light exposure (e.g., cataract and pterygia), but this idea never caught on.
Lashly describes his appreciation for the taste of seal, a dietary staple of the expeditioners. "Seal meat 6 days a week . . . . Seal steak and kidney pie, fried seal liver or seal liver curry. It is very good and I think it is approved of by most [of the men]." All that seal liver consumed during the several-month-long Antarctic winter night appears to have put the explorers at risk for vitamin A-induced intracranial hypertension. Some diaries of arctic explorers (but apparently not Lashly's) describe disabling headaches and eventual blindness while hunkered down against the cold, eating liver and contemplating death. Today UV photokeratitis is well understood and completely preventable, but the condition known as pseudotumor cerebri remains a vexing problem.
The other vitamin A connection to ophthalmology, of course, is that ophthalmologist Alfred Sommer received the Lasker Award in 1997 for his discovery that vitamin A supplementation dramatically reduces childhood mortality (and xerophthalmia) in undernourished children.
The road of discovery, whether by Tennyson's Ulysses, Antarctic explorers, or modern scientists, does not always take us on the journey we expect.
Peter J. McDonnell, MD is director of The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, and chief medical editor of Ophthalmology Times. He can be reached at 727 Maumenee Building, 600 N. Wolfe St., Baltimore, MD 21287-9278 Phone: 443/287-1511 Fax: 443/287-1514 E-mail: firstname.lastname@example.org