Thursday, June 6, 2013
The information in this chapter is mainly an abstract from an article written by Dr B. Zuiderhoek entitled, “The approach to the leprosy problem in the past in Indonesia” (Tropical and Geographical Medicine 1993 Vol 45 No 1 / 2-5 and other references.
Dr Zuiderhoek states that leprosy has always been a disease which appealed to the imagination. This is mainly due to the externally visible mutilations, which develop when treatment is delayed. For this reason the disease has caught the attention of physicians as well as welfare workers for centuries. He cites Broes van Dort1 and Van Dorssen 2-4 who recapitulated the history of leprosy in Indonesia from different publications before the year 1942.
BONTINUS
Leprosy was reported for the first time by Jacobus Bontinus in his book “Medicina Indorum” (Medicine in the Indies) in 1642. Bontinus took his medical degree in Leiden. In 1627, at the age of 35, he left for Batavia, where he died four years later. It was indeed incredible that under extremely unfavourable circumstances such as his personal illness, deaths in his family as well as two sieges of Batavia, yet this physician was able to write manuscripts relating to all diseases that he observed and about nature. Javanese culture impressed him too. His annotations were published in Leiden in 1642, eleven years after his death.
TEN RHIJNE
Wilhelm Ten Rhijne published his “Verhandelingen van de Asiatise Melaattsheid” (Notes for Asiatic Leprosy) in Amsterdam in 1687.
In 1667, about 10 years before his arrival in Indonesia, the leprosy building Angke had been erected at the outskirts of Batavia (now Jakarta). Leprosy was then considered to be very contagious. Although it is likely that there was leprosy in Batavia long before, the leprosarium was built after a sudden spread of the disease. The spread was attributed to the influx of people from other territories like Ceylon (Sri Lanka), Lacca (Malaysia), Corromandel (south-east coast of India) and Malabar (South-west India), colonized by the Portuguese between 1640 and 1662. Prisoners of war, together with their families and slaves were transferred to Batavia. Chinese immigrants poured into the city. For safety all stayed crowded together inside the walls of the city and more and more people with leprosy were detected among the local population. At that time the population of Batavia numbered 21,000, including a garrison of 1000. Ten Rhijne was appointed trustee of the Leprosarium. In 1681 he moved it to a small island named Purmerend in the Bay of Batavia. He considered the old place was too near to the city and the water could be contaminated by the people with leprosy. Five physicians were nominated to trace people with leprosy and compulsory segregation was introduced. In this way Purmerend got 165 inmates. At the same time disabled persons, sufferers from syphilis and beggars were removed from the streets and put to work in the leprosarium. Ten Rhijne was an excellent and all-rounded physician and also a meticulous observer. Nowadays no symptom worth mentioning can be added to the symptomatology of leprosy as observed by him.
However, he was completely in the dark as to the true cause of the disease. Vague conceptions such as heredity, the use of contaminated food and drinks, and specific poisons could not account for the contagiousness. His advice was not to sleep outside during the night, especially when it is cold at moonlight and you are drunk. This could obstruct the evaporation of malignant internal winds through the sweat-pores.
There were various choices of therapy. Sweat-secretion was stimulated through hot baths and by swallowing pulverized snakes. Urine-secretion was activated by taking pulverized cockroaches. The bile of pigs was recommended as a laxative and leeches were used for sucking harmful poisons from armpits and groins. Castration should result in a strong body and spirit. Meat of black cats and porcupines and the pulverized horn of the rhinoceros were also recommended. The secretion of saliva could be stimulated by inhaling the smoke of candles containing mercury (quijlkkaarsjens). The intake of small lizards, or cicaks, had a regenerative effect.
Between the 17th and the 18th century the number of inmates of the leprosarium of Purnerend decreased gradually. In 1795 only 11 people affected by leprosy were left. The leprosy boom seemed to be over. The influx of people from outside territories had also come to an end as Ceylon, Malacca and the coastal areas of India were lost. Batavia became a less important trading centre, the place was unhealthy due to malaria and the population dropped towards 15,000. Purmerend was closed. However, the leprosy problem was not solved. During the next decades we noticed the establishment of new leprosaria elsewhere and outside Java.
The information in this chapter is mainly an abstract from an article written by Dr B. Zuiderhoek entitled, “The approach to the leprosy problem in the past in Indonesia” (Tropical and Geographical Medicine 1993 Vol 45 No 1 / 2-5 and other references.
Dr Zuiderhoek states that leprosy has always been a disease which appealed to the imagination. This is mainly due to the externally visible mutilations, which develop when treatment is delayed. For this reason the disease has caught the attention of physicians as well as welfare workers for centuries. He cites Broes van Dort1 and Van Dorssen 2-4 who recapitulated the history of leprosy in Indonesia from different publications before the year 1942.
BONTINUS
Leprosy was reported for the first time by Jacobus Bontinus in his book “Medicina Indorum” (Medicine in the Indies) in 1642. Bontinus took his medical degree in Leiden. In 1627, at the age of 35, he left for Batavia, where he died four years later. It was indeed incredible that under extremely unfavourable circumstances such as his personal illness, deaths in his family as well as two sieges of Batavia, yet this physician was able to write manuscripts relating to all diseases that he observed and about nature. Javanese culture impressed him too. His annotations were published in Leiden in 1642, eleven years after his death.
TEN RHIJNE
Wilhelm Ten Rhijne published his “Verhandelingen van de Asiatise Melaattsheid” (Notes for Asiatic Leprosy) in Amsterdam in 1687.
In 1667, about 10 years before his arrival in Indonesia, the leprosy building Angke had been erected at the outskirts of Batavia (now Jakarta). Leprosy was then considered to be very contagious. Although it is likely that there was leprosy in Batavia long before, the leprosarium was built after a sudden spread of the disease. The spread was attributed to the influx of people from other territories like Ceylon (Sri Lanka), Lacca (Malaysia), Corromandel (south-east coast of India) and Malabar (South-west India), colonized by the Portuguese between 1640 and 1662. Prisoners of war, together with their families and slaves were transferred to Batavia. Chinese immigrants poured into the city. For safety all stayed crowded together inside the walls of the city and more and more people with leprosy were detected among the local population. At that time the population of Batavia numbered 21,000, including a garrison of 1000. Ten Rhijne was appointed trustee of the Leprosarium. In 1681 he moved it to a small island named Purmerend in the Bay of Batavia. He considered the old place was too near to the city and the water could be contaminated by the people with leprosy. Five physicians were nominated to trace people with leprosy and compulsory segregation was introduced. In this way Purmerend got 165 inmates. At the same time disabled persons, sufferers from syphilis and beggars were removed from the streets and put to work in the leprosarium. Ten Rhijne was an excellent and all-rounded physician and also a meticulous observer. Nowadays no symptom worth mentioning can be added to the symptomatology of leprosy as observed by him.
However, he was completely in the dark as to the true cause of the disease. Vague conceptions such as heredity, the use of contaminated food and drinks, and specific poisons could not account for the contagiousness. His advice was not to sleep outside during the night, especially when it is cold at moonlight and you are drunk. This could obstruct the evaporation of malignant internal winds through the sweat-pores.
There were various choices of therapy. Sweat-secretion was stimulated through hot baths and by swallowing pulverized snakes. Urine-secretion was activated by taking pulverized cockroaches. The bile of pigs was recommended as a laxative and leeches were used for sucking harmful poisons from armpits and groins. Castration should result in a strong body and spirit. Meat of black cats and porcupines and the pulverized horn of the rhinoceros were also recommended. The secretion of saliva could be stimulated by inhaling the smoke of candles containing mercury (quijlkkaarsjens). The intake of small lizards, or cicaks, had a regenerative effect.
Between the 17th and the 18th century the number of inmates of the leprosarium of Purnerend decreased gradually. In 1795 only 11 people affected by leprosy were left. The leprosy boom seemed to be over. The influx of people from outside territories had also come to an end as Ceylon, Malacca and the coastal areas of India were lost. Batavia became a less important trading centre, the place was unhealthy due to malaria and the population dropped towards 15,000. Purmerend was closed. However, the leprosy problem was not solved. During the next decades we noticed the establishment of new leprosaria elsewhere and outside Java.
In the middle of the 19th century there was a revival of interest in tropical medicine as a part of the progress of medical science in general. In 1850 the Society for Medical Sciences was founded, which started publishing a medical journal, the Geneeskundig Tijdschrift voor Nederlands Indien .6 In this journal abstracts of all important international publications on leprosy were included. Physicians attended important international meetings. Since then government policy concerning leprosy could no longer be evaluated apart from international policy.
At that time there were 150 physicians employed by the government, mostly army medical officers, of whom 60% were of Dutch origin. The remainders were German, French, Belgian, Hungarian and Swiss. The job was hard, 53% died in the course of duty due to illness and military confrontations.
Physicians attached to the health resort Pelatoengan were active in leprosy. They published their observations and the results of their therapy trials regularly. Pelantoengan situated in the mountains 60 km west of Semarang in Central Java, was opened in 1844 and meant for recuperation of the military. The favourable climate and many hot springs seemed to have curative power and for that reason also people with leprosy were admitted, although accommodated separately. After bathing they were wrapped in blankets to stimulate sweating in order to release toxic substances from the body. However, the result was nil. Tons of medicines, recommended internationally, were tried, but without result. Chaulmogra-oil, squeezed from the seeds of a special tree, gained some result and was therefore the only therapy used for a long period of time.
In this period, internationally the opinion gained ground that leprosy was a hereditary disease and not contagious. As a result the government abandoned the idea of isolation of people affected by leprosy in 1865.
In 1873, Hansen discovered the leprosy-bacillus. Bacilli already known could be cultivated and transmitted to experimental animals. With the leprosy-bacillus, however, this was not the case and therefore many researchers did not accept it as the causative agent.
However, in 1879 at the First International Leprosy Congress in Berlin, Hansen’s conception was accepted and leprosy was declared a contagious disease. A humane system of isolation was recommended: if possible, voluntary admission into agricultural colonies. If sufficient supervision was available, the “Norwegian system”, a system of home-isolation, could be considered, which was less costly.
Yet the government preferred to follow the policy pursued in countries in Asia: compulsory registration and isolation in agricultural colonies. In 1907 leprosy was declared contagious by decree.
In 1911 when all medical facilities were in the hands of the Military Medical Service, a separate Civil Medical Service was established. As a consequence the government was now directly involved in the leprosy problem. There were only 20 leprosaria in 1911, but following the policy of segregation the number rapidly increased.
Not everybody was pleased with the establishment of expensive and more or less inhumane colonies. Moreover, experience showed that isolation did not prevent the spread of leprosy. People affected by leprosy were hiding themselves. That’s why Kayser and Kiewiet de Jonge founded an association which started domiciliary treatment in Batavia in 1906. Afterwards this system was extended to Surabaya, Semarang and Ambon. Although the results were encouraging, the experiment failed being opposed by the government.
In 1926, Sitanala, stationed in Semarang, made a plea for the system of home-isolation after his return from a study tour to Norway. Together with Sardjito and Mochtar, he argued for health education, followed by registration with cooperation of the civil authorities. People affected by leprosy should live at home in a separate room or in a hut in their own compound, looked after by members of the family, also for medical aid. In case home-isolation was not possible, voluntary admission into an agricultural colony had to be considered. Health education should promote voluntary registration and isolation. Sitanala did not object to legal decrees, but was convinced that it will only be successful if based on the traditions and sentiments of the people concerned.
Sitanalas’s view was not immediately accepted. In 1938, at the International Leprosy Congress in Cairo, home-isolation was not considered to be a generally effective method.
Meanwhile the number of leprosaria had increased to 45 with 4500 people affected by leprosy admitted without sufficient space.
In 1932 the government accepted Sitanala’s plan. The new approach, including health education, registration of people affected by leprosy, treatment at out-patient clinics and, if necessary, home isolation which was introduced in 6 districts in the eastern part of Java: Gersik, Blora, Lamongan, Nganjuk, Kediri and Jombang, as well as on the island of Madura. The government was impressed by the simplicity, practical and extreme economy of the method and close cooperation of the people. Many people affected by leprosy came forward voluntarily. The Indonesian physicians Tumbelaka, Mochtar, Soeparmo, Darwis, Koeslan, Sitanala and Kodyat were closely associated with these surveys.
At that time 1200 doctors were active in Indonesia (population 60 million), 45% in the Civil Medical Service, 15% in the Military Medical Service and 40% in the private sector. A third of them had the title of ‘Indonesia physician’. They had a practical training in Batavia or Surabaya and were of great value for the medical services.
In the thirties Semarang became a scientific centre for leprosy control. Many papers were published and medical journal published. The fieldwork was extended to other districts in Java and to areas outside Java. In 1938, 16,000 people with leprosy were registered.
Blood tests were conducted, as well as trials to cultivate the bacillus and to transmit the disease to animals. The physicians Sardjito, Boenyamin , Malaihollo. Soetomo, Soetopo, and Gramberg were experts on epidemiology in Surabaya and Semarang, respectively.
Many therapy trials were done. People affected by leprosy hoped for the best, but their patience was tested. How therapy trials could lead to conflicts is shown in the following example. In the leprosarium Pelantoengan people with leprosy were treated with ultraviolet rays. The radiologist Denis Mulder had built a shed with ultraviolet lamps at the ceiling, where radiation treatment was given to 50 undressed people at the same time. Mulder firmly believed in this treatment and thought to have good results. He failed to ground his experiment scientifically, however. In view of the negative results obtained in other countries, the government was sceptical and blamed Mulder for evoking false illusions. The conflict was aggravated by the publication of a 250-pages book, in which Mulder attacked the government unfavourably: ‘The government is not fighting leprosy, but fighting the patients’ 5. The subject was raised on the floor of the People’s Council (Volkstraad) in Batavia and the Parliament in Holland, committees were appointed and, finally, the treatment was stopped.
In 1935 the Central Institute for Leprosy Research was opened in Batavia. Buildings and inventory were paid by the Queen Wilhelmina Fund. Here Lame and De Moor made a study of rat-leprosy, a disease in rats caused by a bacillus resembling the human leprosy bacillus. An important epidemiological investigation was conducted by Boenyamin in thetown of Batavia. In 1941, when the first Japanese bombs fell on Indonesia, leprosy was still a disease with many mysterious aspects.
During the term of Dr JB Sitanala as head of the Indonesian Leprosy Control Program in Semarang, he reported 17,425 registered people with leprosy within a population of 60,731,025 in 1939. (Enkele aspecten van het voor komen van lepra in de geëxplodeerde lepra gebieden van den Ned. Indie Archipel door J.B Sitanala, 1939)10.
In 1943 during the Japanese occupation, the central office of leprosy control program in Semarang was moved to Jakarta, therefore Dr Sitanala also moved to Jakarta. Dr. G Rehatta was appointed to head the Kelet General Hospital (RSU Kelet). The hospital treated people suffering from reaction and wounds. It later became known as the Kelet Leprosy Hospital. At the same time the new General Hospital (RSU) was built in 1945 across the road opposite the Kelet Leprosy Hospital. In April 1943 Dr. Aminoeddin who was trained by Dr Sitanala later head the Leprosy Control Centre in Semarang, replacing Dr. Soetomo H.T
The Leprosy Control Program at that time helped to established leprosy clinics at every Sub-district and in several villages.
back to leprosy control
Not everybody was pleased with the establishment of expensive and more or less inhumane colonies. Moreover, experience showed that isolation did not prevent the spread of leprosy. People affected by leprosy were hiding themselves. That’s why Kayser and Kiewiet de Jonge founded an association which started domiciliary treatment in Batavia in 1906. Afterwards this system was extended to Surabaya, Semarang and Ambon. Although the results were encouraging, the experiment failed being opposed by the government.
In 1926, Sitanala, stationed in Semarang, made a plea for the system of home-isolation after his return from a study tour to Norway. Together with Sardjito and Mochtar, he argued for health education, followed by registration with cooperation of the civil authorities. People affected by leprosy should live at home in a separate room or in a hut in their own compound, looked after by members of the family, also for medical aid. In case home-isolation was not possible, voluntary admission into an agricultural colony had to be considered. Health education should promote voluntary registration and isolation. Sitanala did not object to legal decrees, but was convinced that it will only be successful if based on the traditions and sentiments of the people concerned.
Sitanalas’s view was not immediately accepted. In 1938, at the International Leprosy Congress in Cairo, home-isolation was not considered to be a generally effective method.
Meanwhile the number of leprosaria had increased to 45 with 4500 people affected by leprosy admitted without sufficient space.
In 1932 the government accepted Sitanala’s plan. The new approach, including health education, registration of people affected by leprosy, treatment at out-patient clinics and, if necessary, home isolation which was introduced in 6 districts in the eastern part of Java: Gersik, Blora, Lamongan, Nganjuk, Kediri and Jombang, as well as on the island of Madura. The government was impressed by the simplicity, practical and extreme economy of the method and close cooperation of the people. Many people affected by leprosy came forward voluntarily. The Indonesian physicians Tumbelaka, Mochtar, Soeparmo, Darwis, Koeslan, Sitanala and Kodyat were closely associated with these surveys.
At that time 1200 doctors were active in Indonesia (population 60 million), 45% in the Civil Medical Service, 15% in the Military Medical Service and 40% in the private sector. A third of them had the title of ‘Indonesia physician’. They had a practical training in Batavia or Surabaya and were of great value for the medical services.
In the thirties Semarang became a scientific centre for leprosy control. Many papers were published and medical journal published. The fieldwork was extended to other districts in Java and to areas outside Java. In 1938, 16,000 people with leprosy were registered.
Blood tests were conducted, as well as trials to cultivate the bacillus and to transmit the disease to animals. The physicians Sardjito, Boenyamin , Malaihollo. Soetomo, Soetopo, and Gramberg were experts on epidemiology in Surabaya and Semarang, respectively.
Many therapy trials were done. People affected by leprosy hoped for the best, but their patience was tested. How therapy trials could lead to conflicts is shown in the following example. In the leprosarium Pelantoengan people with leprosy were treated with ultraviolet rays. The radiologist Denis Mulder had built a shed with ultraviolet lamps at the ceiling, where radiation treatment was given to 50 undressed people at the same time. Mulder firmly believed in this treatment and thought to have good results. He failed to ground his experiment scientifically, however. In view of the negative results obtained in other countries, the government was sceptical and blamed Mulder for evoking false illusions. The conflict was aggravated by the publication of a 250-pages book, in which Mulder attacked the government unfavourably: ‘The government is not fighting leprosy, but fighting the patients’ 5. The subject was raised on the floor of the People’s Council (Volkstraad) in Batavia and the Parliament in Holland, committees were appointed and, finally, the treatment was stopped.
In 1935 the Central Institute for Leprosy Research was opened in Batavia. Buildings and inventory were paid by the Queen Wilhelmina Fund. Here Lame and De Moor made a study of rat-leprosy, a disease in rats caused by a bacillus resembling the human leprosy bacillus. An important epidemiological investigation was conducted by Boenyamin in thetown of Batavia. In 1941, when the first Japanese bombs fell on Indonesia, leprosy was still a disease with many mysterious aspects.
During the term of Dr JB Sitanala as head of the Indonesian Leprosy Control Program in Semarang, he reported 17,425 registered people with leprosy within a population of 60,731,025 in 1939. (Enkele aspecten van het voor komen van lepra in de geëxplodeerde lepra gebieden van den Ned. Indie Archipel door J.B Sitanala, 1939)10.
In 1943 during the Japanese occupation, the central office of leprosy control program in Semarang was moved to Jakarta, therefore Dr Sitanala also moved to Jakarta. Dr. G Rehatta was appointed to head the Kelet General Hospital (RSU Kelet). The hospital treated people suffering from reaction and wounds. It later became known as the Kelet Leprosy Hospital. At the same time the new General Hospital (RSU) was built in 1945 across the road opposite the Kelet Leprosy Hospital. In April 1943 Dr. Aminoeddin who was trained by Dr Sitanala later head the Leprosy Control Centre in Semarang, replacing Dr. Soetomo H.T
The Leprosy Control Program at that time helped to established leprosy clinics at every Sub-district and in several villages.
back to leprosy control
