The debate about acclimatization in the Dutch East Indies (1840-1860).

Around the middle of the nineteenth century, conflicting views were put forward on the influence of climate on health and disease in the Dutch East Indies. In this part of the world, old Hippocratic ideas influenced views on the cause of disease much longer than in the Netherlands. Moreover, Brunonian theories--which had been discarded in the Netherlands--fitted the discussion about the effect of temperature on the body. Additionally, scientific medicine was introduced. Scientific methods, such as the collection of meteorological and statistical data, were promoted by a small group of military health officers. However, the use of scientific data did not guarantee a clear-cut opinion on the causes of disease. Numbers proved as disputable as other, less objective, medical observations. Mortality statistics and numbers of patients especially were used as arguments in various discussions. The example of Bosch, who changed his views on the dangers of tropical climate, demonstrates that statistics could be used for different purposes. At first, in his position as General Inspector, he used them as an argument to provide better care for the military personnel; later, when retired and a civilian, he used them as justification for colonization in relation to an intended improvement of the living conditions of the natives. The dangers of tropical climate for the health of Europeans were played down as soon as other--primarily economic--motives for living in the tropics became strong enough.

[Nutrition science and disease in the medical history of the 20th century]. / Voedingsleer en ziekte in de medische geschiedenis van de afgelopen eeuw.

In the twentieth century Dutch physicians provided major contributions to the development of the science of nutrition. Before the Second World War research was centred around vitamins and infant food, while at the same time the people's nutrition became a topic. Shortage of foodstuffs and nutrients had characterized the Dutch diet in the beginning of the century, but in the fifties the balance shifted towards an abundance of choice, nutrients and energy intake. Improvement of the optimum nutrient concentration pro energy unit became the main scientific challenge in order to prevent chronic degenerative diseases. Today, an unbalanced nutrition pattern is once more an issue as a relative nutrient shortage occurs in case of low energy intake and a limited variation of foodstuffs leading to chronic degenerative diseases. In addition, the difference between food components and medical drugs is decreasing by the advent of 'nutriceuticals'. Considering the variety of nutrition-related diseases the science of nutrition needs a more prominent place in medical academic education.

[The history of healing; beriberi: 'kind of paralysis']. / Geschiedenis van het genezen; beriberi: 'een zeker soort verlamming'.

Beriberi began to attract increasing attention in the second half of the 19th century, mostly due to the large numbers of victims among Dutch military personnel in the Netherlands East Indies. A study, carried out in Atjeh in 1886 by the Japanese Sugenoya and F. J. Cornelissen, led to the conclusion that there existed a beriberi bacillus which they could make visible in stained microscopical preparations. An extensive disinfection campaign in all barracks followed, but its benefits were a matter of debate. Inadequate nutrition in the investigators' eyes was only a predisposing factor. A.G. Vorderman (1844-1902) assumed a connection between rice feeding and beriberi in prisoners; he reported that the disease coincided with a diet of polished white rice. Beriberi could be prevented by providing the prisoners with 'red rice' (unpolished rice). However, red rice was regarded as inferior and status-lowering so that substitution of red for white rice in the rations was impossible. The concept of a 'lacking substance' (thiamine, vitamin B1) was hesitatingly accepted in the Netherlands. C. Winkler and C. Eijkman, for instance, refused until the early twenties of this century to exclude the possibility of a bacterial infection as the cause. As known, Eijkman in 1929 was awarded the Nobel prize for his contribution to vitamin research.

Historical study: Cornelia C. de Lange (1871-1950)--a pioneer in clinical genetics.

The life and work in the field of clinical genetics of one of the most outstanding Dutch pediatricians of the first half of the twentieth century, Cornelia C. de Lange (1871-1950), is described against the background of the development of pediatrics, anthropogenetics, and clinical genetics in the Netherlands. Cornelia de Lange specialized in and worked on all aspects of the broad field of pediatrics. During her 50 years of practice she collected an immense series of observations on pediatric disorders. As theories on human genetics developed during the 1920s and 1930s, her interest in congential disorders and heredity increased as she saw the implications for the pediatric clinic. She benefitted from her vast experience and her knowledge of the national and international literature when she recognised and described new entities, one of which is named after her: the Brachmann-De Lange syndrome.

[Development of the medical care for schoolchildren in the Netherlands 1796-1904]. / Ontwikkeling van de schoolgeneeskunde in Nederland (1796-1904).

The foundations of the school medical service can be found at the end of the eighteenth century. In conformity with the ideas of the Enlightenment the middle class wanted their thoughts on virtue, education, health and social welfare put into practice. During the nineteenth century several laws on primary education were enacted that have been of importance to the medical and hygienical care of the schoolchild and its environment. In 1806 an Act on primary education was accepted that was operative until 1857. The most important change, however, was imposed by the Act of 1900 that introduced compulsory primary education. Improvement of the environment in which children were educated, was the main aim of nineteenth century physicians. They devoted themselves to the improvement of the school climate, light, air, ventilation, heat and school-desks and for the schoolchild more bodily exercise and gymnastics in combination with a reduction of lessons and homework. They argued for lessons in hygiene for pupils as well as for teachers, but got few results on these subjects. In the twentieth century the school physician made his entry into the school. From 1904 on physicians were appointed in an increasing number of municipalities. Their work became part of the municipal health services that were founded during these years.