"To many scientists just as to many historians and philosophers of science facts are things that simply are the case: they are discovered through properly passive observation of natural reality. To such views Fleck replies that facts are invented, not discovered. Moreover, the appearance of scientific facts as discovered things is itself a social construction, a made thing. A work of transparent brilliance, one of the most significant contributions toward a thoroughly sociological account of scientific knowledge."—Steven Shapin, Science
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Genesis and Development of a Scientific Fact
By Ludwik Fleck, Thaddeus J. Trenn, Robert K. Merton, Fred Bradley
The University of Chicago PressCopyright © 1979 The University of Chicago
All rights reserved.
How the Modern Concept of Syphilis Originated
The historical sources of syphilology can be traced back, without a break, to the end of the fifteenth century. They contain descriptions of a more or less differentiated specific disease (in modern terms a so-called disease entity) which historically corresponds to our concept of syphilis, although the bounds and nomenclature have undergone considerable modification. The symptomatology of the disease also underwent a similar transformation. Toward the end of the fifteenth century the line of development in the diagnosis of syphilis disappears from our view into an undifferentiated and confused mass of information about chronic diseases characterized by skin symptoms frequently localized in the genitals—diseases that sometimes assumed epidemic proportions.
Within this primitive jumble of the most diverse diseases, which crystallized during the following centuries into various entities, we can detect in addition to syphilis what we now call leprosy; scabies; tuberculosis of the skin, bone, and glands; small pox (variola); mycoses of the skin; gonorrhea, soft chancre, probably also lymphogranuloma inguinale, and many skin diseases still regarded as nonspecific today, as well as general constitutional illnesses such as gout.
The confused political conditions prevailing in Europe at the close of the fifteenth century with wars, famine and natural disasters, such as extreme heat and floods affecting many localities, resulted in a dreadful accumulation of divers epidemics and diseases. These occurred with such frequency and brought such fearful misery that the attention of research workers was increased, initiating the development of syphilological thought.
One particular circumstance above all others, namely the astrological constellation, if not father to this thought at least sired one of its constituents. "Most authors assume that the conjunction of Saturn and Jupiter under the sign of Scorpio and the House of Mars on 25. XL 1484 was the cause of the carnal scourge [Lustseuche]. Benign Jupiter was vanquished by the evil planets Saturn and Mars. The sign of Scorpio, which rules the genitals, explains why the genitals were the first place to be attacked by the new disease."
Astrology played a dominant role at the time, which readily explains why the astrological interpretation of the origin of syphilis had such a persuasive effect upon then-current research. One also finds that almost all the authors of that period hint at the sidereal origin of syphilis as the first and most important cause of the epidemic. "Furthermore, the condition here mostly affects the genitals initially, spreading from there to the whole body, and no other disease is found that starts in this way. But I guess that this is brought about by some affinity between the genitals and this disease. This may derive from some celestial effect, as the astrologers claim, arising from the conjuction of Saturn and Jupiter in the third aspect of Scorpio in the 23d degree in 1484 as well as from a simultaneous configuration of other fixed stars which just happened to occur then. Over long stretches of time many diseases were seen to arise, as well as old ones to die out, as we shall clearly show later. Not only is the origin of this disease traced to the position of the stars, but the disease is fomented again and again especially by the sign of Scorpio, which rules the genitals."
The explanation given to any relation can survive and develop within a given society only if this explanation is stylized in conformity with the prevailing thought style. Astrology thus contributed its share to the firm establishment of the venereal character of syphilis as its first "specific difference." Religious teachings, claiming that the disease is a punishment for sinful lust and that sexual intercourse has special ethical significance, finally established this cornerstone of syphilology, ascribing to it a pronounced ethical character. "Some refer the cause of the disease to God, Who has sent it because He wants Mankind to shun the sin of fornication."
If the epidemic provided the subject matter for an investigation, the resulting emergency stimulated it. Astrology was the dominant science, and religion created a mystical frame of mind. Together these produced that sociopsychological prevailing attitude which for centuries favored the isolation and consistent fixation upon the emotive venereal character of this newly determined disease entity. The stigma of fatefulness and sinfulness was imprinted upon syphilis—a stigma which it still carries within large sectors of the public.
This rudimentary idea in syphilology, involving a theory of the venereal nature of syphilis, or syphilis construed simply as the carnal scourge, seems far too broadly based. It comprises not only what we today call syphilis but also the other venereal diseases, which have so far been successively distinguished as gonorrhea, soft chancre, and lymphogranuloma inguinale. However, the sociopsychological and historical foundation was so strong that it took four centuries before scientific advances in other fields were important enough to establish a definitive distinction among these various diseases. Such entrenchment of thought proves that it was not so-called empirical observations that led to the construction and fixation of the idea. Instead, special factors of deep psychological and traditional significance greatly contributed to it.
This first feature in the emergent science of syphilology began to establish itself toward the end of the fifteenth and during the course of the sixteenth century. But it did not remain the only one. Three other ideas, originating in other social strata and during other eras, interacted with it. Only through this interaction, the cooperation and opposition among these ideas, has the definition of syphilis as a disease entity been advanced to its present level.
The second idea evolved from medical practitioners using pharmaceutical resources. Sudhoff comments: "As a result of decades of practice, certainly spanning several generations, it became possible to distinguish and isolate from the host of chronic skin conditions a particular group which, when treated with mercury ointment, reacted favorably, indeed was completely cured.... This therapeutic finding was also taken up by the internal specialists. During the middle of the fourteenth century we encounter for the first time a comprehensive designation of those chronic skin diseases that can be cured by treatment with this general mercurial embrocation. These were distinguished from the many variants of scabies, namely chronic eczema and related skin diseases such as scabies grossa."
Sudhoff regards the use of mercury, which is rooted in very ancient metallotherapy, as the true and only origin of the syphilis concept. But this theory seems to me to be incorrect. Some early treatises on the subject consider syphilis a disease entity but do not even mention mercury. Second, mercury was a popular remedy for many other diseases of the skin such as scabies and leprosy. Third, if the curative effect of mercury were alone decisive, other venereal diseases such as gonorrhea and soft chancre should not have become related to syphilis at all, since these remain unaffected by mercury. The curative effect of Hg seems therefore to be only a secondary factor in the establishment of the concept of syphilis.
Its importance must nevertheless not be underrated, for the use of mercury in the treatment of syphilis was very widespread. It is said, for instance, that "metallic remedies are mainly mercury" or that a particular "substance is combined with these metals, mostly with mercury, although I use cinnabar more than sublimate." Remarkably, even the flow of toxic saliva during mercury treatment was considered to be a therapeutic effect involving the "evacuation" of the syphilis toxin. Such an evacuation occurs "mainly through the sputum, and nothing is more efficacious than mercury in promoting it."
The use of mercury in treating syphilis has been traditionally regarded as natural. Although it presented the risk of poisoning, it was nevertheless felt that "mercury is noble, useful in many fields, and necessary." As time went on, the effect of Hg became increasingly recognized and mercury was also used as a diagnostic aid.
But even as late as the nineteenth century it was still not possible to settle upon a satisfactory concept of syphilis on the basis of Hg alone. In accordance with the idea of carnal scourge, syphilis was thought to include other venereal diseases such as gonorrhea and soft chancre and their complications. These, as well as local diseases of the genitals, such as balanitis, which are regarded as nonspecific even today, were later differentiated on the basis of pathogenesis and etiology. These latter conditions, however, remain unaffected by mercury. So to combine both points of view, that of mercury and that of carnal scourge, it was observed that "sometimes mercury does not cure the carnal scourge but makes it even worse." This neatly resolved the dilemma. The mercury idea really concerned the diagnosis only of so-called constitutional syphilis, that is, the stage of the generalized disease. The primary stage, properly venereal because it is localized in the genitals, remained untouched by that idea and was characterized by the idea of the carnal scourge.
Thus two points of view developed side by side, together, often at odds with each other: (1) an ethical-mystical disease entity of "carnal scourge," and (2) an empirical-therapeutic disease entity. Neither of these points of view was adhered to consistently. Although mutually contradictory, they eventually became amalgamated. Theoretical and practical elements, the a priori and the purely empirical, mingled with one another according to the rules not of logic but of psychology. Empiricism was largely displaced by an emotive apriority. Some physicians even doubted the existence of syphilis altogether. In a sixteenth-century treatise it is claimed that "quite a few therefore state that there is no such thing as the French pox, except in the imagination of some of our contemporaries. For they say that what we call the French pox constitutes a variety of conditions."
There were those who doubted it even as late as the end of the nineteenth century. Dr. Josef Hermann, for many years (1858–88) physician-in-chief and head of the department of syphilis at the Imperial and Royal Hospital of Wieden in Vienna, published a pamphlet about 1890 entitled Constitutional Syphilis Does Not Exist. In his view syphilis is a "simple, local disease which never spreads to the human blood, is completely curable, never leaves permanent effects, and is never propagated by procreation and heredity." It manifests itself through chancre or gonorrhea "and by all the direct sequelae of these two primitive conditions." On the other hand, there is a "veritable host of disease manifestations which profoundly affect the social life of humanity and even the entire generation. But all these general symptoms do not constitute syphilis at all. They are exclusively produced either by the mercury treatment itself or by other bad concoctions." To Hermann, syphilis still meant the original carnal scourge [Lustseuche], construed as only a localized disease without general symptoms. A general syphilitic condition would have the presence of syphilis in the blood as a "first premise," but "the existence of syphilitic blood is only a dogmatic precept without the slightest evidence to support it." Hermann declared that "no pathognomonic indication of syphilis will ever be found in the blood of those suffering from this disease."
Although his views appear to have been fossilized as measured even by the standards of his time, this outsider is of particular importance in our investigation for the following reason. He attested to just how strongly syphilis and Hg had become associated with one another, and also emphasized the quandary in which the physicians found themselves because of the pleomorphism of the syphilis symptoms. This in turn produced a general and urgent "demand for blood tests" as the means to identify this disease entity with precision.
The concept of syphilis, then, was still vague and incomplete. The two approaches to it contradicted each other. The clash was felt all the more clearly to the extent that the primitive ethical-mystical idea lost its fascination owing to changes in the general thought style and as more details of the relevant phenomena were brought to light. But the concept still remained too variable, and not sufficiently entwined or interwoven within the fabric of contemporary knowledge to be considered finally established with a firmly based, objective existence, and thus to appear as an undoubtedly "real fact."
The intellectual clarity of the issue, in particular, was clouded because several important factors were disregarded. No attempt was made to differentiate between venereal diseases with general symptoms and those either lacking them altogether or, like gonorrhea, rarely exhibiting them. Hereditary syphilis and the inferior quality of the offspring of syphilitic parents were also problems; as were the unsolved puzzle of latent syphilis, the reappearance of the disease, and also its variously suspected relation to many other diseases such as tabes and progressive paralysis, lupus, and scrophulosis. In general, the era of experiments and wide-ranging knowledge developed in detail had already begun. History records an abundance of experiments and observations about inoculations, reinoculations, and immunity relations. But it would be wrong to think that experiments, no matter how clearly conceived, always produced the "correct" results. Although important as starting points for new methods, these were worthless as evidence.
An argument developed between those who believed in the identity of gonorrhea, syphilis, and soft chancre (the "theory of identity") and the physicians who wanted to divide the great pox into several disease entities. "Several physicians, especially Andree and Swediauer, attempted to establish the identity of the infective material of the two diseases on the basis of the gonorrheic mucus and the chancre pus. After a few experiments conducted with these substances it was claimed that the gonorrheic toxin could sometimes produce chancre and vice versa—a view which was widely adopted. Fritze thought that the two conditions differed specifically but not generically," since with some organisms the pathogenic substance "was too weak to produce chancre, although still strong enough to produce gonorrhea." Hunter inoculated the skin of a healthy person's genitals with gonorrheic pus and obtained an ulcer followed by typical syphilis. Although he maintained the identity of gonorrhea with syphilis, he differentiated between soft and hard (indurated) chancre; the latter alone was supposed to be part of the syphilis complex (the "theory of duality"). A theory of pseudosyphilis grew out of the distinction. This involved a disease resembling syphilis, although it was in fact fundamentally different and not preceded by hard chancre.
Another school differentiated the gonorrheic toxin from that of syphilis, but regarded gonorrhea as the primary stage of a general constitutional disease designated the "gonorrhea disease." This indicates the influence of the theory of syphilis. The "unitarians" (Ricord), yet another school at the time, completely separated gonorrhea from syphilis. They insisted, however, that both hard and soft chancre were identical and spoke of a special predisposition to general syphilitic afflictions, necessary for the general stage to succeed chancre. Finally, the "new theory of duality" clearly differentiated both gonorrhea and soft chancre from syphilis.
All these observations refer only to the question how to distinguish among various venereal diseases. By no means does it concern the whole complex of problems regarding the syphilis concept—f or instance, its relation to tabes or to progressive paralysis. These latter problems were not tackled until pathogenesis and etiology had become sufficiently developed during the second half of the nineteenth and the early twentieth century.
If we consider purely theoretically the viewpoint held during the eighteenth and the first half of the nineteenth century, we must make the following observations.
Excerpted from Genesis and Development of a Scientific Fact by Ludwik Fleck, Thaddeus J. Trenn, Robert K. Merton, Fred Bradley. Copyright © 1979 The University of Chicago. Excerpted by permission of The University of Chicago Press.
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Table of ContentsForeword
Genesis and Development of a Scientific Fact
Overview of Contents
How the Modern Concept of Syphilis Originated
Epistemological Conclusions from the Established History of a Concept
Established History of a Concept
The Wassermann Reaction and Its Discovery
Epistemological Considerations Concerning the History of the Wassermann Reaction
Commentary and Annotation
Most Helpful Customer Reviews
An absolutely essential book in the philosophy and sociology of science. Originally published in 1935, this truly remarkable book seems to anticipate major arguments and concepts from some of the most prominent figures in the philosophy and sociology of science since the 1970s. Fleck's concepts of thought style and thought collective is suggestive of Kuhn's notion of a paradign and Foucault's episteme; his distinction between vade mecum science and experimental practice seems to anticipate Latour's distinction between ready-made science and science in action. Perhaps most importantly, Fleck defty and persuasively explains that his radical contextualization of knowledge does not amount to relativism. He is much better than more recent philosophers and sociologists of science at showing that, although facts are not plucked whole from nature like ripe fruit but created and developed by scientists so that what might be a fact in one historical context need not be in another, facts are nonetheless very substantial and real. Most interestingly and uniquely, Fleck gives makes clear and persuasive an idea that as a historian has always seemed doubtful to me: that an idea could be ahead of (or behind) its time. Surely this is a book that was ahead of its time when it was published in 1935. Rather, it seemed to capture perfectly the key ideas and spirit of science studies as they have developed since the 1970s.
Fleck's understanding of the workings of science was a half-century ahead of his time. Unlike most science studies scholars, Fleck was brilliantly practiced as a scientist before he wrote about its system of producing knowledge. And he had both the sensitivity and sensibility to understand the human condition which is no different in science than out. Kuhn's perception was good--Fleck's was great.