[Contributions of the Netherlands and its colonies to the knowledge of the cause of leprosy in the 19th century]. / Bijdragen van Nederland en zijn koloniën aan de kennis over de oorzaak van lepra in de 19e eeuw.

OBJECTIVE: To determine the Dutch contributions to the formulation of the concept that leprosy is an infectious disease. DESIGN: Literature study. METHOD: A search for relevant publications was made in the Nederlands Tijdschrift voor Geneeskunde (Dutch journal of Medicine; NTvG) and the Geneeskundig Tijdschrift voor Nederlandsch-Indië (Medical Journal of the Dutch Indies; GTNI) with the aid of the search terms 'lepra [leprosy]', 'lepra Arabum [Arab leprosy]', 'melaatsheid [leprosy]' and 'elephantiasis Graecorum [Greek elephantiasis]'. In addition, on the basis of references in the publications in the NTvG and the GTNI, as well as via searches in the catalogues of the Royal Library in The Hague and the libraries of Dutch universities, an inventory was made of the Dutch medical dissertations and other monographs on leprosy, as well as the medical historical review articles, from the 19th century. RESULTS: For a long time, physicians described the aetiology of leprosy in terms of 'a substrate' to which all sorts of mixtures of infection, heredity and hygiene contributed. From the middle of the 19th century onwards, this explanatory model with multiple possible solutions gave way to a controversy between two explanatory models: heredity as an 'anti-contagious' principle versus contagiosity. These two explanatory models were mutually exclusive in their universal aspirations. The debate in the Netherlands took place in the field of tension between European concepts on the one hand and on the other hand ideas and practices resulting from the interaction between the Netherlands and its colonies. Inspired in part by the writings of the Dutch physician C L Drognat Landré, who based his contagion theory on observations in Surinam, the Norwegian G. H. A. Hansen discovered the leprosy bacillus in 1873. It was not until 1897, at the international leprosy conference in Berlin, however, that consensus was to be reached on leprosy being an infectious disease. CONCLUSION: An essential contribution to the development of the contemporary ideas as to the cause of leprosy was made from the Netherlands.

Comparison of cardiolipin and treponemal tests in the serodiagnosis of yaws.

Results of the Veneral Disease Research Laboratory (VDRL), rapid plasma reagin (RPR), Treponema pallidum haemagglutination (TPHA), T. pallidum immobilisation (TPI), and fluorescent treponemal antibody absorption (FTA-ABS) tests on sera of 661 children from a region where yaws is hypoendemic are compared. For 107 (16.2%) out of 661 sera the FTA-ABS test was the only one showing reactivity; in these instances the test was weakly reactive (intensity of fluorescence scored as +) and the children had no history and no signs or symptoms of treponemal disease. A solitary, weakly reactive FTA-ABS test result seems to have no clinical significance in these cases. The FTA-ABS test can be used as a confirmatory test for yaws instead of the TPI test, if only the results of sera showing an intensity of fluorescence scored as ++ or more are considered to be positive. There appeared to be no significant differences in the results of the VDRL, RPR, and TPHA tests as screening tests for yaws when the TPI or FTA-ABS tests were used as reference tests.

Attenuated yaws in Surinam.

Results of a pilot survey in the central, northern region of Surinam indicate that yaws is prevalent (hypoendemic) in this part of the country. No classical symptoms of yaws were seen. The observed lesions were scanty or solitary, dry papillomatous, or macular and scaly, which fits into the clinical picture of attenuated endemic treponematosis.

Attenuated yaws in Surinam

In 1976, 969 schoolchildren from the District of Saramacca in Surinam (age 4 to 16 years) were examined, especially the skin and mucous membranes. Blood samples were collected by venepuncture and skin samples were taken from individuals with lesions suggesting yaws. The diagnosis of yaws was based on a combination of epidemiological data, clinical findings, results of the VDRL test, histological evidence, and the effect of treatment with penicillin. The results showed that 212 children (22 per cent) had a reactive VDRL test, of which 29 children showed clinical lesions suggesting yaws. This indicated that yaws is prevalent (hypoendemic) in the District of Saramacca. No classical symptoms of Yaws were seen. The observed lesions were scanty or solitary, dry papillomateus, or macular and scaly, which fits into the clinical picture of attenuated endemic treponematosis

Comparison of cardiolipin and treponemal tests in the serodiagnosis of yaws

This study was carried out in 1976 and 1977 to asses the value of cardiolipin and treponemal tests in the serodiagnosis of yaws. These tests were conducted on the sera of 661 children from a region where yaws is hypo-endemic. Results of the Venereal Disease Research Laboratory (VDRL), rapid plasma reagin (RPR), Treponema pallidum haemagglutination (TPHA), T. pallidum immobilisation (TPI), and fluorescent treponemal antibody absorption (FTA-ABS) tests were compared. The FTA-ABS test showed a weak reactivity (+) for 107 (16.2 per cent) sera and these children had no history and no signs or symptoms of treponemal disease. The FTA-ABS test can be used as a confirmatory test for yaws instead of the TPI test, if only the results of sera showing an intensity of fluorescence scored as ++ or more are considered to be positive. There appeared to be no significant differences in the results of the VDRL, RPR and TPHA tests as screening tests for yaws when the TPI or FTA-ABS tests were used as reference tests