Blindheid in Groot-Atjeh — blindness among the Atjehnese population of Groot-Atjeh — was one of the two subjects to which Professor Mulock Houwer had directed Dr. C. E. Gomperts’s attention before the survey of 1937, and the subject of four statistical tables in the resulting report. Gomperts examined 240 patients blind in one eye and 125 blind in both, and concluded that xerophthalmie with keratomalacie was in all probability the most frequent cause of blindness among the Acehnese young.
Criterion and numbers
The criterion of blindness was the inability to see hand movements at a short distance from the eye. Gomperts noted that the manner of the survey, and the fact that before beginning it he had successfully operated on various Atjehnese in the district, gave a certain guarantee that a large part of the blind of the ressort would answer the call for examination.
Of the 240 one-eyed blind: 108 men, 106 women, 18 boys, 8 girls. Of the 125 blind in both eyes: 46 men, 46 women, 21 boys, 12 girls. The number of blind among men and women was thus practically equal, while between boys and girls some difference was to be noted.
Expressed against the estimated population of the surveyed area (51,122): one-eyed blindness 240, about 5 per thousand; double-sided 125, about 2½ per thousand; together 365, rather more than 7 per thousand. Calculated on the numbers examined and by sex: men 154 of 3,732 (over 40 per thousand); women 152 of 3,830 (about 40 per thousand); boys 39 of 6,113 (over 6 per thousand); girls 20 of 5,133 (about 4 per thousand).
The percentage of blind among children of both sexes was thus far lower than among adults. Gomperts warned that superficial consideration would draw false conclusions from this: seen in the right light it was only appearance, since the blindness of a great part of the adults dated from their youth. And since xerophthalmia and keratomalacia were with fair certainty the most frequent cause of blindness among the Acehnese young, “is het niet denkbeeldig, dat een groot deel dezer blinde kinderen zijne blindheid niet lang overleeft en zoodoende aan het onderzoek ontsnapt” — it is not inconceivable that a large part of these blind children do not long survive their blindness and thus escape the survey.
Causes
The causes were established from the anamnese (case history) and the result of examination.
Ontstekingen (inflammations) covered all cases of blindness with corneal changes and atrophic eyes where the history clearly showed that signs of inflammation had preceded. Some cases in this class would have had corpora aliena as the direct cause without the patient remembering it, so that no far-reaching conclusions could be drawn about foreign bodies as a cause of blindness.
Herpes zoster was diagnosed where patients stated that they had gone blind after penjakit tjatjar (pox disease) in the face, and pockmarked scars were found on one half of the face only.
Pokken (smallpox) covered all blind showing clear pockmarked scars in the face or over the rest of the body. Gomperts noted the difficulty of distinguishing true smallpox scars from the residues of chickenpox with secondary infection, and observed that chickenpox, which usually affects the eyes only slightly, could in undernourished children and with secondary infection or via an avitaminosis give serious complications.
Gevallen E.C.I. — the class of unexplained cases — comprised a fairly large number of both one- and two-sided blind, for which Gomperts attempted a probable diagnosis from the history and the observed eye changes. In most of these the blindness dated from youth and the changes consisted of corneal alterations and atrophic eyes; the conditions capable of producing these in youth were gonorrhoeal and other infections, and xerophthalmia with keratomalacia.
Gonorrhoeal infection discounted
Gomperts argued that the share of gonorrhoeal infection must be very small. A Gouvernements-Indisch arts born and bred in Groot-Atjeh, who spoke Atjehnese well, was charged with the general D.V.G. service, which gave a guarantee that patients with venereal infections would turn to him sooner than to a European physician — for towards a European physician the indigenous population undoubtedly had a great maloegevoel (sense of shame), so that they would not easily decide to consult one for diseases of the genital apparatus. In the parts of the surveyed area where Western influence had penetrated further and traffic was busier — Oeloe-Lheuë, Seulimeum, Sibreh, Indrapoeri, Lho-Nga and Kroeëng-Raja — the annual report of the Gouvernements-Indisch arts for 1937 and the year before gave a total of eight and nine gonorrhoeal infections, while the skin specialist at Koetaradja reported rather more than forty gonorrhoeal patients among the Atjehnese population in 1937.
Trachoma and corneal ulcers discounted
Trachoma, “een belangrijke oorzaak voor blindheid” in Egypt, could in Groot-Atjeh certainly be excluded, since it did not occur in the surveyed area — see Trachoma in Groot-Atjeh. The share of ulcera corneae was difficult to determine, but taking as a measure the seven active corneal processes found during the survey, Gomperts concluded that they did not play so important a part.
Xerophthalmia and keratomalacia as the leading cause
Taking only the cases approaching certainty, blindness from this cause was found in one eye in 15 male against 10 female patients, and in both eyes in 26 male against 18 female — practically one and a half times as many males as females in each case. Blindness certainly acquired in childhood was found in one eye in 21 male and 20 female patients, and in both eyes in 37 male against 24 female.
Age reckoning
Since the Atjehnese population had no era-reckoning, the statement of age presented difficulty. To determine approximately the age at which blindness arose, the age was given in the number of poeasa’s (the Mohammedan fast, once a year): if three poeasa’s were given, the patient was two years and some months old. Up to the fourth year this was fairly accurate; beyond that the school age of six served as a measure.
The paradox of the sexes
Gomperts noted a contradiction requiring explanation: maculae corneae occurred more often among boys than girls (56 of 6,113 boys, 32 of 5,133 girls), but the complicated form — leucoma adhaerens, which brings great danger of blindness — was proportionally more often seen among girls (9 of 56, or 16 per cent, among boys; 6 of 32, or 19 per cent, among girls), while the number of blind among boys was proportionally the greater. Among men and women the ratio of maculae was the same as among boys and girls, but the complicated maculae stood in a higher percentage among men.
His explanation was that among girls, whether through their better-developed subcutaneous fatty tissue as a reserve vitamin A depot or through other factors, keratomalacia ran a less fatal course than among boys, so that corneal complications not yet leading to complete blindness were more often encountered among them.
Tijssen’s supposition that the more frequent blindness among boys was caused by more boys than girls being attacked by xerophthalmia was one Gomperts shared entirely for his own surveyed area, though he could not judge whether it held for the whole gewest of Atjeh. Mulock Houwer and Sie Boen Lian did not share Tijssen’s supposition; Sie Boen Lian argued that severe cases of xerophthalmia were most often seen at ages where the disease was not much more frequent in boys than in girls. Gomperts’s statistics did not agree: “De verhoudingen schijnen dus in Groot-Atjeh anders te zijn dan op Java.”
See Also
- Xerophthalmie
- Keratomalacie
- Trachoma in Groot-Atjeh
- Maloe
- Poeasa
- C. E. Gomperts
- Oriënteerend oogheelkundig onderzoek bij de Atjehsche bevolking van Groot-Atjeh gedurende 1937
Source
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.