J. Tijssen

Dr. J. Tijssen was a Dutch ophthalmologist who worked for sixteen years as a plantation doctor in the south of Atjeh and afterwards, from 1929, conducted at his own expense a series of village eye-surgery campaigns in the kampongs of Atjeh, Borneo and the Batak country. His conversations aboard the steamer Baloeran with the journalist C. Graadt van Roggen in February 1933 are the substance of the pamphlet Een strijd in Atjeh (1934), published by the Vereeniging SIMAVI.

Career

Tijssen had been sixteen years a plantersdokter in the south of Atjeh — at Langsa, which though in Atjeh belonged to the cultuurgebied of Deli. Like those before him and after him, he had seen blind people there. Afterwards he worked at Leiden as assistant to Prof. van der Hoeve. He returned to Atjeh in 1929, but not to the hospital.

The journalist noticed that Tijssen spoke long and with admiration of the work in the hospitals, as though conjuring away a dangerous thought or fearing to be misunderstood; only afterwards, when Tijssen brought him three Indies newspapers reporting his work, did he understand why. In those papers it was written that Dr. Tijssen no longer worked in the hospitals: he had gone with a Javanese boy into the Acehnese kampongs, had sought out the blind there “zooals een ander goud in Klondike,” and had set them in a row “zooals werkloozen om te stempelen.”

Before his Atjeh campaigns he had gone, at his own cost and after a short assistantship at Leiden, to Borneo and Atjeh.

Argument for kampong medicine

Tijssen’s case, as recorded, rested on the following propositions. There were many physicians in the Indies, but many worked for an almost exclusively European practice and many for the army; there remained millions, possibly forty million people, for whom little or no medical help was available. The equipment of the hospitals was beyond all praise, but “de Atjeher begrijpt moeilijk, dat hij zijn voeten moet wasschen, in het hospitaal, wanneer hem iets aan de oogen scheelt.” — the Acehnese finds it hard to understand that he must wash his feet, in the hospital, when there is something wrong with his eyes. He came into hospital only very rarely; he was different from Europeans: “Om een half jaar langer te leven, liggen wij twee jaar in een ziekenhuis. Want wij zijn erg bang voor den dood. Maar de Atjeher sterft goed, als hij maar in een kampong mag sterven onder zijn eigen menschen. Hij vreest de afzondering in het hospitaal net iets meer dan de gemeenzaamheid met den dood.” — To live half a year longer, we lie two years in a hospital. For we are very much afraid of death. But the Acehnese dies well, if only he may die in a kampong among his own people.

He held that alongside the hospitals, alongside the quarantine and alongside the struggle for general hygiene, there was need of physicians who went into the kampong: “Daar is, medisch gesproken, een niet-ontdekte wereld.” — There is, medically speaking, an undiscovered world. In the cataract operation, he said, the physician had “het wonder in handen” — simple in the scientific sense, but speaking by its direct effect to the simple of spirit and therefore a social thing of significance. The medical world was in his view too timid of joining science to primitive social work: wishing to give everything at once, only complete therapy on the basis of present-day science, it spent treasure for a result splendid in quality but nevertheless small.

His practical demand was modest: not money for his own labour, but a little for spectacles, travelling money and dressings; some idealism at home in Holland; young physicians; and above all the insight that in his manner thousands could be reached who otherwise remained unhelped. It would be enough, he said, if a number of young physicians were enabled to go and work a couple of years in the kampong; they would return with a widened outlook and much knowledge and be worth more for life.

On the missions

Tijssen was careful to say that he did not undervalue the work of the zending (Protestant mission). “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.” — 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. In the periodical Medische Nood, 1934, no. 1, he wrote: “Ik ken de zendingsziekenhuizen. Ik wenschte, dat er in Ned. Indië in plaats van 33 zendingsartsen 330 waren! Zijn er 20 zendingshospitalen, ik wenschte, dat „Simavi” het geld bij elkaar kreeg om het tot 200 te brengen! Maar ook dan zouden er menschen noodig zijn, die naast het mooie werk in de hospitalen het vuile werk in de kampong willen doen.” — I know the mission hospitals. I could wish that in the Netherlands Indies, instead of 33 mission physicians, there were 330! Are there 20 mission hospitals — I could wish that „Simavi” got the money together to bring it to 200!

Denial of originality

Tijssen expressly rejected the term “methode-Tijssen” used in the Indies press. The operation he performed was one thought out by great thinkers over the centuries and done every year in every eye hospital; in a middling university clinic as many operations were performed in a year as he did in a month, so rich was the material in the country where he worked. The idea of going into the villages was likewise not original: Hoogerheide, who died young, had taken his doctorate under Prof. van der Hoeve on three thousand eyelid operations on Java and had worked in the kampong; and Elliot had toured in Britsch-Indië delivering the blind of their cataract, coming to London with figures that first raised disbelief and then admiration.

Campaigns

The campaigns recorded are: the survey of 1923, when he had the blind of four small villages on the North Coast of Atjeh brought together and found two hundred and twenty-six of them; the operations at Idi in November 1931, where among twenty-five blind persons forty-five cataractous eyes were operated on and twenty-three people left with sight sufficient for their needs; the North Coast campaign of eighty-three persons in twenty-six days, including the dealings with Teukoe Oemar van Bernoen; the West Coast journey from 23 August 1933, with two hundred and forty-seven people helped and twenty-four cataract operations, among them the seven juvenile cataracts; the visit to Simaloer; and the Samosir trachoma campaign of more than two hundred operations in one month.

The closing plea

At the end of the conversations Tijssen said: “Wanneer ik terugdenk aan wat ik in Indië door mijn werk zag, dan zie ik alles wat in Nederland gebeurt, in het licht van Indië.” — When I think back on what I saw in the Indies through my work, then I see everything that happens in the Netherlands in the light of the Indies. He asked that in the assembly halls of the country nothing in the field of education be carried through without every speaker closing his speech with the words “denk aan Indië.” There was, he said, a more serious ignorance than the ignorance in Holland about the Indies: in the last twenty years the number of Netherlanders in the Indies had multiplied, and the ideal of these later arrivals had been European life in the Indies — a European house, a European family — imitated with virtuosity by the educated native; so that the Indies fell more and more apart into two great groups, the mass covering the mountain slopes and filling the plains, and the group of Europeans with the intellectually associated group of native intellectuals, standing ever further from the first.

He closed: “Ik vraag dus met nadruk geen geld voor mijn eigen arbeid. Wanneer er maar belangstelling komt, is het mij onverschillig, welke organisatie zich ervoor spant, van welke richting de menschen zijn, die het werk zullen leiden en doen. Als het maar gebeurt. En zoo spoedig mogelijk.” — I therefore emphatically ask no money for my own labour. If only interest comes, it is indifferent to me what organisation exerts itself for it, of what tendency the people are who will lead and do the work.

Character

Wanting described him in the foreword as “de stille, teruggetrokken en bescheiden arts, dien de eenzaamheid ook al niet spraakzamer had gemaakt” — a pioneer who some years before had gone into the kampong on his own initiative to bring help and relief in often extremely primitive circumstances. It was Tijssen who put to Graadt van Roggen the question that gave the pamphlet its purpose: “Kunt U dat niet eens zeggen?” — meaning that in the Indies an intelligent population suffered terribly and needlessly.

Gomperts’s assessment of Tijssen’s work (1940)

Three years after Tijssen’s Acehnese campaigns, Dr. C. E. Gomperts carried out a systematic eye survey of Groot-Atjeh and published in Oriënteerend oogheelkundig onderzoek (1940) the first detailed evaluation of Tijssen’s method and results. The assessment was mixed: warm approval of the idea, firm rejection of the practice.

The occasion

Gomperts opened by acknowledging Tijssen’s initiative. In the two years before his own survey, more extensive investigation and treatment of eye disease had been undertaken in the afdeeling “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, however, only a few small parts of the fairly large ressort had profited by “zijne zoo zeer gewaardeerde behandeling.”

Approval of the kampong idea

“Het idee van Tijssen om de bevolking in de kampongs op te zoeken en onderzoek in hun milieu te verrichten, is zeer toe te juichen” — the idea of Tijssen to seek out the population in the kampongs and to conduct the examination in their own milieu is greatly to be applauded. Thereby, Gomperts wrote, contact with the population was increased, which benefited confidence in Western medicine, and a great part of serious eye disease could be taken in hand before it destroyed the sight. Gomperts followed “een gewijzigde werkwijze van Tijssen” in his own survey.

Rejection of kampong surgery

Gomperts nevertheless declined to operate in the villages, sending patients requiring surgery instead to the Militair Hospitaal te Koetaradja with an admission note. His comparison of results found that of 17 eyes operated on by Tijssen, 4 were lost, 3 gave moderate and 2 very moderate results, 2 were bad and 6 good — rather more than 35 per cent good results; against 2 eyes lost of 22 (9 per cent) and 91 per cent good results for the Officieren van gezondheid eye specialists, at least fourteen of whose sixteen patients were treated by operators with shorter practical experience than Tijssen. The full argument is set out at Methode-Tijssen.

Gomperts held that Tijssen’s fear that the population could not be brought to enter existing hospitals was groundless, adducing the graph of Atjehnese out-patients and admissions at the Koetaradja hospital from 1934 to 1937.

The clinical disputes

Gomperts also printed Tijssen’s propositions on keratomalacie and xerophthalmie in parallel columns with his own findings, agreeing on some points — that the sufferers were badly fed or sick individuals, that the therapy was a general treatment of mother and child, and that the therapy for xerophthalmia was levertraan — and dissenting on others. He disputed Tijssen’s confinement of keratomalacia to infants under two, his assertion of no sex preference, his dismissal of ascariasis, his figure of 240 xerophthalmia cases per 100,000 children in Atjeh, his association of the disease with areas of rijstovervloed (rice abundance), and above all his view that xerophthalmia was a constitutie-ziekte essentially distinct from keratomalacia.

On one point Gomperts sided with Tijssen against Mulock Houwer and Sie Boen Lian: that the greater frequency of blindness among boys was caused by more boys than girls being attacked by xerophthalmia — a supposition he shared “volkomen wat betreft het door verslaggever onderzochte gebied.”

Tijssen’s Acehnese vocabulary

Gomperts confirmed Tijssen’s record of the Acehnese name for xerophthalmia, noting that in the moekims Lhong, Lho-Nga and Lam-Kabeuë the condition was known as penjikit sisë — “TIJSSEN siseh” — while elsewhere in the surveyed area it bore no such name.

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. 1–16.

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.

tags	person, physician, dutch, ophthalmology, aceh, medicine, 1933, 1934, simavi, 1937, controversy, xerophthalmia
aliases	J. Tijssen, Dr. J. Tijssen, Tijssen, Doctor Tijssen, Tijssen the eye doctor of Atjeh, Tijssen the kampong operator

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