The vlekken van Bitôt — Bitôt’s spots, the foamy grey triangular patches on the conjunctiva characteristic of vitamin A deficiency — were the diagnostic sign of xerophthalmie whose reliability was debated in the Netherlands-Indies literature discussed by Dr. C. E. Gomperts in his report of 1940.
Sie Boen Lian’s finding
Sie Boen Lian published several articles proving that these spots, especially in adults, were “nog geen conditio sine qua non” for the existence of xerophthalmia. He made this plausible by determining the vitamin A content of the blood, and by reporting that the spots remained unchanged despite a vitamin-A-rich diet and therapy.
Gomperts’s reservation
Gomperts accepted the finding but regretted that Sie Boen Lian had not stated whether, in these deviant cases, the conjunctiva showed the other marks of xerophthalmia — “de xerotische toestand met de voor xerophthalmie typische vuile verkleuring.” For the general practitioner and for the ophthalmologist conducting an orienting survey, he observed, only the clinical local signs offered a hold for the diagnosis.
He recorded his own confirming case: in a seventeen-year-old youth complaining of hemeralopie (night blindness) he found Bitôt’s spots together with xerotic conjunctival changes, and both subjective and objective signs disappeared promptly on a vitamin-A-rich diet and cod-liver oil therapy, so that the diagnosis of xerophthalmia could be made with fair certainty without a blood determination.
He did not share Dr. J. H. de Haas’s fear that Sie Boen Lian’s observation would make diagnosis difficult in children showing all the typical conjunctival changes.
In the field data
Bitôt’s spots appear in Gomperts’s tabulation of the local signs among the kampong xerophthalmia cases, alongside other conjunctival changes and corneal changes; and in his hospital series two cases presented corneal appearances resembling Bitôt’s spots — case 7, where the lower half of both corneas had “het aspect van Bitôtsche vlekken” with staphylomatous distension, and case 14, where the other eye showed centrally a large opacity “met het aspect van Bit. vlek.”
Acehnese nomenclature
The Acehnese themselves knew xerophthalmia in the moekims Lhong, Lho-Nga and Lam-Kabeuë as penjikit sisë; elsewhere in the surveyed area sisë meant only kulit ikan, the scales of a dead fish, or kaki ajam, a chicken’s foot — a comparison close to the clinical appearance of the dried and wrinkled conjunctiva.
See Also
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.