Leprosy and the Colonial Gaze: Comparing the Dutch West and East Indies, 1750-1950.

This article is looking at colonial governance with regard to leprosy, comparing two settings of the Dutch colonial empire: Suriname and the Dutch East Indies. Whereas segregation became formal policy in Suriname, leprosy sufferers were hardly ever segregated in the Dutch East Indies. We argue that the perceived needs to maintain a healthy labour force and to prevent contamination of white populations were the driving forces behind the difference in response to the disease. Wherever close contact between European planters and a non-European labour force existed together with conditions of forced servitude (either slavery or indentured labour), the Dutch response was to link leprosy to racial inferiority in order to legitimise compulsory segregation. This mainly happened in Suriname. We would like to suggest that forced labour, leprosy and compulsory segregation were connected through the 'colonial gaze', legitimising compulsory segregation of leprosy sufferers who had become useless to the plantation economy.

Control de la lepra y contagionismo en suriman / No disponible

La lepra, aunque actualmente está desapareciendo, no ha sido derrotada todavía en Surinam. En la época colonial fue un gran problema para el gobierno colonial y la población, siendo la mayoría de pacientes (en la época pre-abolicionista) esclavos. En el siglo XVIII se estableció un sistema de control que ya incluía la en la legislación la detección y el confinamiento como métodos importantes. Los médicos holandeses que ejercían en Surinam durante el siglo XVIII y primera mitad del siglo XIX propusieron modelos contagionistas de contención que sugieren que la lepra era causada por una mezcla de factores, siendo la infección uno de ellos. Pero durante la primera mitad del siglo XIX, los investigadores europeos rechazaron mayoritariamente la infección y prevaleció el anti-contagionismo, considerando la herencia y los factores medioambientales como su causa. Al mismo tiempo, en Surinam - puesto que la lepra estaba incontrolada - la lucha contra la lepra se reforzó promulgando leyes implacables para perseguir e identificar a los leprosos. A su vez, Charles Louis Drognat-Landré defendió el punto de vista (tesis Utrecht) de que solamente la infección es la causa de la lepra. Su argumento sobre el contagionismo fue rechazado en Holanda, pero posteriormente publicó sus ideas en francés y así llegaron a ser más conocidas internacionalmente e influyeron en el noruego Hansen. Este descubrió algunos años después el microorganismo causal. Se afirma que hay una relación entre el desarrollo de una forma de contagionismo típico surimanés, un sistema de control de la lepra brutal y la estructura política autocrática, no liberal (hacia los esclavos) de la colonia holandesa de Surinam

Leprosy is nowadays a disappearing but not yet defeated disease in Suriname. In colonial times it was a burden for colonial government and people, the majority of patients (in preabolition times) being slaves. In the 18th century a control system was established, with detection and isolation, anchored in legislation, as major methods. Dutch physicians working in Suriname in the 18th and first half of the 19th century proposed contingent contagionistic models, according to which leprosy was caused by a mixture of factors, infection being one of them. But in the first half of the 19th century European researchers generally denied infection as the cause of leprosy and the paradigm of anti-contagionism prevailed, considering heredity and environmental factors as its cause. At the same time in Suriname - because leprosy appeared uncontrollable - the fight against the disease was reinforced by promulgating more relentless laws to hunt and identify lepers. In line with this, the Suriname born Charles Louis Drognat-Landré defended the view (thesis Utrecht) that infection is the one and only cause of leprosy. His extreme contagionism was sharply rejected in The Netherlands, but then he published his ideas in French and so could reach the international scene and influence the Norwegian Hansen. The latter discovered the culpable micro-organism a few years later. We claim a correlation between the development of a typical Surinamese form of contagionism, the brutal leprosy control system and the autocratic, non-liberal (towards the slaves) political structure of the Dutch colony Suriname

Standardizing psychotropic drugs and drug practices in the twentieth century: paradox of order and disorder.

According to ongoing historical research, standardizing the production and consumption of psychotropic drugs is a process fraught with contradictions and inconsistencies. Both the construction and change of drug standards can be highly unsettling events and do not necessarily lead to more order. The balance between order and disorder appears to be rather fragile and paradoxically at all stages in the evolution of standards we see order-disorder transitions.

[Collecting medical knowledge during the Dutch expedition to Brazil in 1639]. / Verzamelen van medische kennis tijdens Nederlandse expeditie in Brazilië, 1639.

The Dutch expansion into tropical climates, starting in the 1590s, posed practical problems of prevention and therapy for the doctors and surgeons of the trading companies (the Dutch West India Company (WIC) and the Dutch East India Company (VOC)). The first specialised manual on tropical medicine was published in Dutch in 1694. It presented information that was based on practical experience and on knowledge obtained from earlier colonists and from the indigenous population. Obtaining information from the latter required the help of a specific kind of researcher, the so-called 'adventurer-scientists'. One of the most important among them was the German Georg Marcgraf, who in 1639 joined an expedition of slave traders to the inlands of Brazil to collect botanical and zoological information, including information on medicinal plants.

['Piracy of kowledge'--the role of a buccaneer-scientist in the knowledge circulation around diseases and drugs in the tropics]. / 'Kapers van kennis'. De rol van een boekaniersgeleerde in de circulatie van kennis over ziekten en geneesmiddelen in de tropen.

Knowledge circulation in the seventeenth and eighteenth centuries was not only stimulated by the mutual interaction of trade and science. In the context of territorial expansion, war, and the activities of privateers and pirates, knowledge of diseases and drugs in the tropics was increased as well. An important part in this process was performed by so-called 'buccaneer-scientists': adventurers with medical and scientific backgrounds and/or interest who operated on the cultural borders in different parts of the hemisphere. The characteristics of this type of contributor to Early Modern knowledge circulation are explored and analyzed in the example of Scottish surgeon and pirate Lionel Wafer (c. 1660 - c. 1705). The buccaneer scientist had to share the passions of other scientists, resulting in accurate and detailed empirical observation; be able to judge the relevance of observations and 'facts'; be part of a context that stimulates these observations; be capable of describing of these observations; and be part of a network of dissemination of observations. His activities should have an important practical and pragmatic component stimulating trade, expansion and even piracy. And he should possess personal characteristics such as perseverance, a healthy constitution, and ruthlessness, to work and survive in a violent and traumatic environment. Wafer is typical for other 'buccaneer-scientists' of this period--not only pirates and privateers, but also physicians and natural explorers operating in other and more 'respectable' areas of the European overseas expansion.

[Coping with leprosy in the Dutch West Indies in the 19th century; opposing but meaningful views from Suriname]. / Omgang met lepra in 'de West' in de negentiende eeuw. Tegendraadse maar betekenisvolle geluiden vanuit Suriname.

Leprosy was highly prevalent among African slaves in the Dutch West Indian colony of Suriname. Largely based on observations in Suriname, Dutch physicians described the aetiology of leprosy in terms of'a substrate' to which all sorts of mixtures of infection, heredity and hygiene contributed ('seed and soil'). This explanatory model with multiple options for prevention and treatment left room for different developmental trajectories to control the spread of the disease in the various tropical colonies of the Dutch empire. In Suriname there was a growing worry in the 19th century regarding the spread of leprosy, threatening the health of slaves, settlers and colonial administrators. And this could be harmful to an already weakening plantation economy. This concern prompted the local administration to develop a rigorous policy of strict isolation of leprosy sufferers. This, in turn, intersected with a changing insight in Europe - including the Netherlands - that leprosy was non-contagious. However,'in splendid isolation' in the economically and politically marginal colony Suriname, Dutch physicians like Charles Landre and his son, Charles Louis Drognat Landré, could afford to ignore the European non-contagious approach and continue to support the strict isolation policies. Moreover, they developed a dissident radical explanation of leprosy as a disease caused only by contagion. In the absence of a receptive Dutch audience Drognat Landré published his contagion theory in French and so succeeded in inspiring the Norwegian Hansen, who subsequently discovered the culpable micro-organism. At the same time colonial administrators and physicians in the economically and politically important Dutch colonies in the East Indies adhered to the prevailing European concept and changed policies: the system of isolation was abolished. Given the rather different trajectories of leprosy health policies in the Dutch East and West Indies we point out the importance of a comparative approach.

The plot against cancer: heredity and cancer in German and Dutch medicine, 1933-1945.

In the Third Reich hereditarian approaches and their eugenic implications seemed to offer possibilities for fundamental progress in the fight against cancer. This did not lead to an exclusive emphasis on genetics in theory or practice. The concept of a hereditary predisposition for cancer, the Krebs-disposition or Krebsbereitschaft, led to flexible multifactor approaches, including proposals for both eugenic and social-hygienic measures. These approaches were not typical of German medicine alone. In the Netherlands hereditarian approaches did not play a central role in the 1930s. They lacked institutional support in a country where health policies were characterised by indirect strategies working through intermediaries such as general practitioners and home nursing organisations. However, potentially the elements for similar anti-cancer policies as in Germany were present. The German occupation offered opportunities to develop these elements (concepts, institutions, personnel). This development was blocked because of the political radicalisation during the war and the German defeat.

From King Kong pills to mother's little helpers--career cycles of two families of psychotropic drugs: the barbiturates and benzodiazepines.

This article compares the careers of two families of 20th-century psychotropic drugs, the barbiturates and the benzodiazepines, in five different countries. Both families of drugs were used as so-called hypnotics and sedatives, and later as minor tranquillizers. In addition these drugs were extensively used as self-medication. The careers show a cyclical temporal course and generally encompass three phases: first, an expanding use of the drugs, accompanied by high expectations; then, rising criticism and disappointment; and finally contracting use and limited application. These phases need not have been sequential: they often overlapped. The cycle sometimes ended by the disappearance of the drug from mental health care, only to be replaced by new drugs with a profile of promise and hope. These cycles, which we term Seige cycles, are generally typical for the careers of psychotropic drugs. The analytical concept of the Seige cycle facilitates a comparative perspective on the commonalities as well as the differences between the various drug careers under consideration.

[Creating a 'Germanic' public health: national-socialism, human genetics, and eugenics in the Netherlands]. / Op weg naar een 'Germaansche' volksgezondheid. Nationaalsocialisme, erfelijkheidsleer en eugenetica in Nederland 1940-1945.

The consequences of the uses of concepts of heredity in society and health care are not simply determined. This is demonstrated by a study of Dutch National Socialist doctors and biologists in the Second World War. During the German occupation of the Netherlands SS-biologist W.F.H. Stroër (1907-1979) and SS-doctor J.A. van der Hoeven (1912-1998) attempted to create a eugenic research and health care institute in the Netherlands. Heredity was accorded a key role in National Socialist plans for reorganization of Dutch health care. The ideas of the SS-eugenicists were closely related to those of leading geneticists and eugenicists in the Netherlands. Eugenic ideas were spread among all political ideologies. As late as November 1942 cooperation between the SS and non-Nazi geneticists was still discussed. The hardening of the political climate during the war created more explicit dividing lines between them. The SS-researchers did not believe in the existence of well-defined and separated races. They rejected a purely genetic determinism and advocated measures of social hygiene next to a positive and negative eugenics in the creation of a more healthy Germanic people and a purer race. Racial and genetic concepts were not exclusively translated into eugenic policies directed at human reproduction.

On cannabis, chloral hydrate, and career cycles of psychotropic drugs in medicine.

This article compares the careers of two psychotropic drugs in Western psychiatry, with a focus on the nineteenth century: Cannabis indica and chloral hydrate. They were used by doctors for similar indications, such as mania, delirium tremens, and what we would now call drug dependence. The two show similar career paths consisting of three phases: initial enthusiasm and therapeutic optimism; subsequent negative appraisal; and finally, limited use. These cycles, which we term "Seige cycles," are generally typical of the careers of psychotropic drugs in modern medicine. However, differences in the careers of both drugs are also established. The phases of chloral show relatively higher peaks and lower valleys than those of cannabis. Chloral is the first typically "modern" psychotropic drug; a synthetic, it was introduced in 1869 at a time of growing asylum populations, pharmaceutical interests, and high cultural expectations of scientific medicine. Cannabis indica, introduced in the 1840s, is typically a "premodern" drug steeped in the climate of cultural Romanticism. We conclude that the analytical concept of the Seige cycle is a useful tool for future research into drug careers in medicine.

Cancer health communication in the Netherlands 1910-1950: paternalistic control or popularization of knowledge?

From the First World War onwards anti-cancer organizations in Europe attempted to spread the message of "Do Not Delay": cancer is curable, if and when early diagnosed. This article reports on a systematic study of sources on cancer health education from the medical and public domains in the Netherlands between 1910 and 1950. Dutch cancer specialists were not at all enthusiastic about spreading too much knowledge about various aspects (genetic, environmental etc.) among laymen, fearing cancerophobia among the public, and preferred to channel information and guidelines through intermediate health professionals. Cancer health education campaigns, doing away with this paternalistic attitude, only started on a comparable scale to other countries in the 1950s, possibly because of the pressure of fund-raising. Before that time compliance of patients with public health policies was orchestrated by the intervention of intermediate civil bodies, such as home nursing services. Health policies in the Netherlands were characterized by indirect strategies involving different actors.

[Current thought on hereditary transmission and human genetics]. / Van degeneratie tot individuele gezondheidsopties. Het maatschappelijk gebruik van erfelijkheidsconcepten in de twintigste eeuw.

On the basis of a review of the historiography on thought about hereditary transmission and human genetics in the 20th century in Britain, the United States, Germany, Russia, Sweden, and the Netherlands, a new research perspective is formulated. Concepts of heredity and their use in society have been various and diverse. Definitions of heredity and of the influence of 'nature' and 'nurture' in shaping genetic material have significantly changed. In the new research perspective the focus is directed to the role of a broad range of concepts of heredity in framing debates and practices around health, disease, and behaviour, including but not exclusively the concepts of Mendelian genetics, neo-Lamarckism', and concepts prevalent in eugenic movements. A research programme is outlined that is directed at specific problem fields in health care (e.g. alcoholism), and uses various sources to examine the historical dynamics in medical and public spheres.