Trachoom — trachoma, the chronic contagious conjunctivitis that was among the leading causes of blindness in the tropics — is described at length in Een strijd in Atjeh (1934) in Dr. J. Tijssen’s account of the Samosir campaign of 1933, where he encountered it in place of the cataract that had dominated his Acehnese work.
The encounter on Samosir
When Tijssen asked a native chief to bring the blind and eye-sick of his district on a given day, and visited the market-day centres of Samosir, it appeared that among the candidates there was not a single cataract, “maar trachoom en nog eens trachoom.” — but trachoma and again trachoma. He had never performed trachoma operations: “Zeker, ik wist uit de boeken precies wat trachoom is, maar alleen wie een trachoomstreek gezien heeft weet wat trachoom beteekent.” — Certainly, I knew from the books precisely what trachoma is, but only he who has seen a trachoma district knows what trachoma means.
The clinical description
His description is the fullest in either of the two books: “De oogleden vreeselijk ontstoken en verdikt, naar binnen omgebogen, bewegen de oogharen als een borstel over het oog. De haren vallen uit en de jonge sterke haartjes schuren als scherpe naaldjes de cornea kapot en vernietigen het laatste wat er na den haaruitval van het gezichtsvermogen overbleef. Na jaren plagerij, onduldbare pijnen, eindeloos getob, loopt tenslotte de ziekte uit op volslagen blindheid.”
The predominance of women
The patients were countless but preponderantly women. “Ik vond er, die de zieke oogleden met een touwtje opgebonden tegen het voorhoofd omgebogen droegen. Ik moest bij vrouwen de operatie zevenmaal meer verrichten dan bij mannen, hetgeen zeer merkwaardig is, omdat wij uit de litteratuur niet wisten, dat trachoom zich bij het vrouwelijk geslacht in grooter frequentie voordoet.” — I found there women who wore the diseased eyelids bent back against the forehead, tied up with a piece of string. I had to perform the operation on women seven times more often than on men, which is very remarkable, because from the literature we did not know that trachoma occurs with greater frequency in the female sex.
Tijssen offered an environmental explanation, arrived at only after he had seen the life of those women in their houses: in the Batak dwellings a thick stinking smoke met the visitor, with no air and no smoke-outlet; there the food was prepared; wood for burning was scarce and a kind of fern was burnt that gave enormous smoke; “en overal vindt men er de vrouwen van 40 jaar en ouder met halfblinde oogen bij het vuur,” — and everywhere one finds there the women of 40 years and older with half-blind eyes beside the fire, while the men were on the sawah’s and the younger women with them or caring for the children.
The operation
The operation performed was palliative and not curative: “De trachoom is niet genezen. Wij hebben de oogleden korter gemaakt en naar boven omgebogen. De sarrende pijn die elken oogopslag tot een bezoeking maakte, is voorbij. De verwoesting der oogen is tot staan gekomen.” — The trachoma is not cured. We have made the eyelids shorter and bent them upward. The nagging pain that made every glance a visitation is past. The destruction of the eyes has been brought to a stand. More than two hundred people were operated on in one month, some on all four eyelids. The operations were performed by the young Batak physician Gido Siregar, who had done trachoma work as assistant to Prof. Bakker at Batavia, with Tijssen assisting.
Comparison with Atjeh
The contrast between the trachoma country of Samosir and the cataract country of Atjeh is one of the organising oppositions of Tijssen’s account. In Atjeh he found cataract in numbers sufficient to operate on eighty-three persons in twenty-six days on the North Coast; on Samosir, among nearly a hundred thousand people, not a single cataract among the candidates presented. He noted also that on the West Coast of Atjeh he had looked for differences from the eye diseases of the North Coast and found little or none.
Absence of trachoma in Groot-Atjeh (Gomperts, 1937)
Where Tijssen had met “trachoom en nog eens trachoom” on Samosir in 1933, Dr. C. E. Gomperts found none at all in Groot-Atjeh four years later. The eighth question of his survey of 1937 was the occurrence of trachoma among the Atjehnese, and his conclusion was categorical: “Trachoom volgens de algemeen gangbare opvatting, komt in het onderzochte gebied van Groot-Atjeh niet voor.”
What he found instead was conjunctivitis follicularis, in 215 cases — about 2 per cent of the 11,400 children examined. He distinguished it from trachoma on four grounds: it occurred exclusively in children and very rarely in adults; in none of the 215 cases were corneal complications found; the granules occurred in the lower transitional fold alone or in both, but never above alone; and it was not concentrated, as trachoma would have been, in the districts of busy traffic and racial admixture. In Oelee-Lheuë 78 cases were found among 1,325 children (6 per cent), but in the exclusively Atjehnese Moekim Montassie 75 among 1,795 (rather more than 4 per cent).
He rejected outright the view that this form of conjunctivitis was a benign trachoma of the young tending to self-healing: that opinion “mist volgens schrijver elken grond.”
The finding bore directly on the causes of blindness. Trachoma was in Egypt an important cause, and the K.W. infection there implicated left room for doubt on that account; but in Groot-Atjeh “kan deze oorzaak zeker worden uitgeschakeld.” See Trachoma in Groot-Atjeh and Blindheid in Groot-Atjeh.
See Also
- Trachoma campaign on Samosir (1933)
- J. Tijssen
- Gido Siregar
- Samosir
- Ambarita
- Kampong medicine in Atjeh
- Een strijd in Atjeh (1934)
- 1933
- Oriënteerend oogheelkundig onderzoek bij de Atjehsche bevolking van Groot-Atjeh gedurende 1937
- C. E. Gomperts
- Trachoma in Groot-Atjeh
- Blindheid in Groot-Atjeh
- 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. 12–14.
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.