Avitaminose — avitaminosis, deficiency disease — appears in Een strijd in Atjeh (1934) as one of the principal causes of blindness among Acehnese children, and as the disease whose treatment Dr. J. Tijssen singled out for praise in the work of the Protestant zending.
The mission’s cod-liver oil treatment
Tijssen was careful, in speaking of his own kampong work, not to disparage the missions: “Ik heb het werk van de zending gezien. Geloof niet, dat ik dien arbeid gering schat. Wanneer u schrijft, zeg dan vooral dit. De menschen van de zending weten zelf nauwelijks, hoe goed bijv. het werk is, dat zij deden door de behandeling der avitaminose met levertraan, waardoor bij honderden kinderen vroege blindheid is voorkomen.” — I have seen the work of the mission. Do not believe that I undervalue that labour. When you write, say this above all. The people of the mission themselves hardly know how good is the work they did, for instance, by the treatment of avitaminosis with cod-liver oil, whereby early blindness was prevented in hundreds of children.
The treatment referred to is the administration of levertraan — cod-liver oil — against the vitamin A deficiency whose ocular manifestation, xerophthalmia, was then a leading cause of childhood blindness in the Indies. Tijssen credited the mission with having prevented early blindness in hundreds of children by that means.
The West Coast observation
On the West Coast of Atjeh Tijssen made a contrary observation, of a district in which the disease was strikingly rare. Of the coastal strip around Bakongan he wrote that money the population did not have, “maar aan producten is het land rijk en daaruit alleen kan ik het opvallend weinig voorkomen van avitaminose verklaren.” — but the land is rich in produce, and from that alone can I explain the strikingly rare occurrence of avitaminosis. The voedselverhoudingen — the food conditions — were, he said, excellent there.
The observation is a rare instance in the literature of the period of a direct correlation drawn between local food supply and the incidence of deficiency blindness in Atjeh, and it stands in the account as a counterweight to the general picture of medical neglect.
Relation to Tijssen’s argument
Avitaminosis served Tijssen’s larger thesis in two ways. It showed that much blindness was preventable rather than curable, reinforcing his rule that “er vóór alles spoedig geholpen moet worden”; and it showed that non-hospital agencies — the missions in the villages, and the local food economy itself — could achieve results that the great hospitals could not. Both points supported his call for physicians willing to do “het vuile werk in de kampong” — the dirty work in the kampong alongside the fine work in the hospitals.
Gomperts’s account of vitamin A deficiency in Groot-Atjeh (1937)
Dr. C. E. Gomperts’s survey of 1937 gave the fullest statistical picture of deficiency eye disease in Groot-Atjeh: 459 cases of xerophthalmie among 11,400 children examined, about 4 per cent.
The chronic deficiency
Gomperts held that since the basic food of the Atjehnese kampong population consisted of rice, supplemented only very sparsely with vegetables and meat, the population of Groot-Atjeh suffered a chronic shortage of vitamin A — “of misschien beter gezegd, zich op een lager vitamine-A-gehalte van het bloed heeft ingesteld,” or perhaps better said, had adjusted itself to a lower vitamin A content of the blood.
Against a purely dietary explanation
He nevertheless denied that dietary deficiency alone explained the disease, quoting Zeeman’s warning against “een al te eenvoudige voorstelling.” Were diet the sole cause, a far higher percentage than 4 per cent would have been expected. He tested the proposition against the harvest data of 1936–1937: in the coastal moekims Lhong, where the rice supply was ample, the frequency was not visibly lower; in Moekim Lam-Teuba, with a rice surplus, it was practically equal to that in Indrapoeri, Seulimeum and Lam-Kabeuë where the harvest had failed; and in Montassie, with an almost complete crop failure from drought and walang sangit, it differed little from Baet with a much better harvest.
His conclusion was that xerophthalmia and keratomalacie were to be regarded as conditions with one common underlying cause — an a- or hypovitaminosis A — complicated by a coincidence, an interpretation he took from Mevrouw Van Stockum.
Mothers’ milk and infancy
The concentration of cases in the 0–5 age group he explained from the finding of Van Stockum, Dr. J. H. de Haas and Ir. Meulemans that the milk of indigenous mothers on Java was far lower in vitamin A than that of European women; Atjehnese nutrition being poorer still, and the Acehnese custom being protracted breast-feeding of eighteen to twenty months, the low level sufficed only to a point before growth and other factors depressed it into hypo- or avitaminosis “die de deur opendoet voor de xerophthalmie.”
Cod-liver oil and prevention
Gomperts distributed 404.1 kilogrammes of levertraan during the survey, and made its liberal distribution the second of his five recommended preventive measures — alongside a vigorous campaign against worm infection, village survey and instruction, the cooperation of the Binnenlandsch Bestuur, and the stimulation of vitamin-A-rich yard cultivation with instruction from the Landbouwdienst.
See Also
- J. Tijssen
- Kampong medicine in Atjeh
- Zending
- Bakongan
- Atjeh’s Westkust
- Een strijd in Atjeh (1934)
- Seven juvenile cataracts of Atjeh’s Westkust
- 1933
- Oriënteerend oogheelkundig onderzoek bij de Atjehsche bevolking van Groot-Atjeh gedurende 1937
- C. E. Gomperts
- Xerophthalmie
- Keratomalacie
- Levertraan
- Worminfectie
- Oogheelkundig kampongonderzoek in Groot-Atjeh (Maart-December 1937)
Source
Een strijd in Atjeh (Een oogarts op het oorlogspad), door Mr. C. Graadt van Roggen, met een voorrede van den heer H. Wanting, redacteur Nieuwe Rotterdamsche Courant (Rotterdam: N.V. Drukkerij Korteweg, uitgave van de Vereeniging „SIMAVI”, 1934), pp. 5, 11.
Acknowledgement of sources. The material in this article derives from Een strijd in Atjeh (Een oogarts op het oorlogspad) by Mr. C. Graadt van Roggen (Rotterdam: N.V. Drukkerij Korteweg for the Vereeniging „SIMAVI”, 1934). Dutch passages are quoted in the original with an English rendering.
Oriënteerend oogheelkundig onderzoek bij de Atjehsche bevolking van Groot-Atjeh gedurende 1937 (“Orienting Ophthalmological Survey among the Atjehnese Population of Groot-Atjeh during 1937”), by Dr. C. E. Gomperts, offprint from the Geneeskundig Tijdschrift voor Nederlandsch-Indië, Afl. 19, Deel 80 (1940), pp. 1191-1238 (Batavia-Centrum: G. Kolff & Co.). Received by the editors 25 October 1939. Offprint DLP-157, Bibliotheek KITLV.