Oriënteerend oogheelkundig onderzoek bij de Atjehsche bevolking van Groot-Atjeh gedurende 1937

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tagsdocument, medicine, ophthalmology, public-health, colonial, dutch, atjeh, groot-atjeh, 1937, 1940, survey
aliasesOrienteerend oogheelkundig onderzoek, Gomperts 1937 eye survey, the Groot-Atjeh eye survey of 1937, Orienting ophthalmological survey of Groot-Atjeh, DLP-157

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Oriënteerend oogheelkundig onderzoek bij de Atjehsche bevolking van Groot-Atjeh gedurende 1937 (“Orienting ophthalmological survey among the Atjehnese population of Groot-Atjeh during 1937”) was the report by Dr. C. E. Gomperts of a house-to-house eye survey carried out in the afdeeling (district) Groot-Atjeh over ten months of 1937, in which 18,808 Atjehnese — 3,732 men, 3,830 women, 6,113 boys and 5,133 girls — were examined for xerophthalmie (xerophthalmia), keratomalacie (keratomalacia), blindness, pterygium, trachoom and other eye disease. It was received by the editors of the Geneeskundig Tijdschrift voor Nederlandsch-Indië on 25 October 1939 and printed in Afl. 19 of Deel 80 in 1940, and remains the most substantial statistical account of eye disease among the Acehnese population in the late colonial period.

The report is also the principal published criticism of the working method of Dr. J. Tijssen, the ophthalmologist who had operated in the Acehnese kampongs at his own expense from 1929; Gomperts adopted Tijssen’s practice of going out to the villages but rejected his practice of operating in them.

Origin and purpose

Gomperts opened by placing the survey in the work of the Dienst der Volksgezondheid (Public Health Service), which had for many years been combating the prevailing popular diseases in Groot-Atjeh, an activity considerably extended in the five years before 1937. Whereas the campaign against framboesia (yaws) had formerly stood at the centre of attention — a logical consequence of the striking successes obtained with salvarsan against that scourge — interest had over the years grown for other popular diseases, and the confidence of this population group in Western medicine had been won to an ever greater degree.

In the two years before the report a further step was taken, and a more extensive investigation and treatment of the prevailing eye diseases in the afdeeling was undertaken, “dank zij de roepstem van Tijssen en zijne activiteit op dit gebied” — thanks to the call of Tijssen and his activity in this field. Because Tijssen had worked only briefly in Groot-Atjeh, only a few small parts of the fairly large ressort had been able to profit by his treatment.

Gomperts acknowledged in a footnote his thanks to Professor Mulock Houwer “voor zijn opbouwende kritiek en de zeer gewaardeerde aanwijzingen” — for his constructive criticism and much-valued directions.

Method

Gomperts followed a modified version of Tijssen’s working method, consisting of: examination of the patients and the collection of statistical data; treatment of eye diseases on the spot so far as no hospital treatment was needed; while patients with eye diseases of a serious nature and those coming into consideration for operative treatment (cataract, pterygium and the like) received an admission note for nursing in the Militair Hospitaal te Koetaradja. Small interventions such as the removal of corpora aliena (foreign bodies) were carried out at the place of examination.

In order to draw as large a number of children, blind persons and old people as possible into the survey, the place of examination was chosen in cooperation with the Inheemsche Hoofden (indigenous chiefs) so that the kampongs to be examined lay at most within a radius of one kilometre from it. Small outlying kampongs fell, understandably, outside this scheme.

The eight questions

The scheme of the ophthalmological survey was drawn up under eight heads:

  1. the frequency of xerophthalmie among Atjehnese boys and girls;
  2. the collection of data on nutrition and infectious diseases, to study their influence on the frequency of xerophthalmia;
  3. the frequency of keratomalacie among Atjehnese boys and girls with florid xerophthalmia;
  4. the frequency of blindness in the male and female sex, and the causes of blindness;
  5. the frequency of pterygium among men and women;
  6. the tracing of the cause of the frequent complaint of young Atjehnese women and men about wazig zien (blurred vision);
  7. investigation of the results of the operations performed by Tijssen by his very primitive working method, and of the operative results achieved by the Officieren van gezondheid eye specialists over the years, whose operations were performed under better hygienic circumstances;
  8. investigation of the occurrence of trachoom among the Atjehnese.

Professor Mulock Houwer, asked in advance for suggestions, had directed his interest chiefly to the frequency of xerophthalmia and to the causes of blindness in Groot-Atjeh.

Findings in summary

Gomperts closed with an eleven-point Samenvatting (summary):

  • Xerophthalmia occurred very widely in Groot-Atjeh, in some parts far more frequently than in others, for which no plausible explanation could be found.
  • It occurred in both sexes most frequently in the age group 0–5, and most of all among kleuters (toddlers, 2–5).
  • Among boys it was found more often than among girls in both the 0–5 and the 6–14 groups, a difference perhaps explained by the better-developed subcutaneous fatty tissue of girls, regarded as a reserve depot of vitamin A.
  • Xerophthalmia and keratomalacia were to be regarded as eye conditions with one common underlying cause — an a- or hypovitaminosis A — complicated by a coincidence more drastic in keratomalacia than in xerophthalmia.
  • As a preventive measure the combating of worm infection deserved great attention, since worms withdrew much food from the intestines.
  • In keratomalacia two degrees were to be distinguished: a pre-keratomalacia stage, and a stage in which the cornea wholly or partly melted away.
  • Measures for combating xerophthalmia and preventing blindness were set out in five parts (see below).
  • The operative treatment according to Tijssen’s method did not come into consideration for the population of Groot-Atjeh and was “zelfs ongewenscht” (even undesirable).
  • The most frequent cause of blindness among the youth of the surveyed area was in all probability xerophthalmia and keratomalacia.
  • Trachoma, according to the generally current conception, did not occur in the surveyed area.
  • Pterygium occurred in fairly great frequency in both sexes, chiefly in middle and old age.

Recommendations

For combating xerophthalmia and preventing blindness through keratomalacia, Gomperts proposed: a vigorous campaign against worm infections by the distribution of worm tablets; the distribution of levertraan (cod-liver oil) to the population “met royale hand” (with a liberal hand); kampongonderzoek (village survey) at favourably situated central points, at which the population would be instructed about nutrition and xerophthalmia cases demonstrated to them; the cooperation of the Binnenlandsch Bestuur in that survey, which “kan niet worden gemist” (cannot be dispensed with); and the stimulation of local agriculture, in particular the erfbouw (yard cultivation) of vitamin-A-rich crops, with instruction from the Landbouwdienst.

Costs

An itemised statement of expenditure for the survey from March to December 1937 gives the medicines supplied and their value in guilders: Oleum Chenopodii 2.58 kg (ƒ33.54); Oleum jecoris aselli (cod-liver oil) 404.1 kg (ƒ202.05); Sulfas magnesicus 102.1 kg (ƒ10.21); malaria after-treatment tablets (Wilson tablets) 292,000 pieces (ƒ116.80); tabletten santonini calomel 36,650 (ƒ113.615); Sol. acid. borici 3% 48.2 litres (ƒ33.74); Sol. Protargol 3% 31.3 litres (ƒ8.765); Sol. sulf. zinci ¼% 34 litres (ƒ2.04); Ung. oxyd. hydrarg. flavum 5% 1.2 kg (ƒ0.565); Sol. florescini 0.3 litres — total ƒ521.325. To this were added the salary of the mantri (ƒ200), travelling costs of the Officier van Gezondheid (ƒ1,256.20) and the ophthalmological equipment (ƒ209.60), giving a grand total of ƒ2,187.1155.

Illustrations

The offprint carries a sketch-map of the afdeeling Groot-Atjeh with the surveyed area hatched, showing the Straat van Malaka to the north, the Indische Oceaan to the west, and the Ooster Afdeeling and Zuidelijke Afdeeling van Atjeh adjoining; a graph of the numbers of Atjehnese out-patients and admissions at the eye-ear-nose-throat department of the Militair Hospitaal te Koetaradja from 1934 to 1937; and two photographs, Fig. 1 showing the ophthalmological equipment with the mantri-ziekenverpleger, and Fig. 2 showing the eye examination at Kroeëng-Raja.

Literature cited

Gomperts’s Geraadpleegde Literatuur lists eight items: Med. D.V.G. Ned.-Indië, year XXVI 1937 No. 3; Volkstelling 1930, part IV, “Inheemsche bevolking van Sumatra”; Klin. Wochenschrift 1937 No. 3 (abstracted in the N.T.v.G. of 24 April 1937); Geneeskundig Tijdschrift voor Nederlandsch-Indië years 1938, 1936, 1935 and 1937; and an offprint from the Handelingen van het 7e Nederlandsch-Indisch Natuurwetenschappelijk Congres, p. 198.

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.

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