This paper focuses on the role of regulation in the shaping new scientific facts. Fleck chose to study the origins of a diagnostic test for a disease seen as a major public health problem, that is, a ‘scientific fact’ that had a direct and immediate influence outside the closed universe of fundamental scientific research. In 1935, when Fleck wrote his book, Genesis and development of a scientific fact, he believed that the tumultuous early history of the Wassermann reaction had come (...) to an end, and that this reaction was successfully stabilized through the standardization of laboratory practices and thanks to the rise of a specific professional segment—the serologists. He could not have predicted that in the 15 years that followed the publication of his book, regulatory measures—barely metioned in his historical narrative—would play a key role in the destabilization of the original meaning of this reaction. The introduction of mass screening for syphilis—mainly via legislation that introduced obligatory premarital tests and promoted the testing of pregnant women—weakened in fine the link between Wassermann serology and infection by the etiological agent of syphilis, the bacterium Treponema pallidum. Fleck elected to study the Wassermann reaction because of its novelty, its complexity, and because it became the focus of a controversy regarding its origins. However, the Wassermann reaction was also one the first examples of a medical technology regulated by the state and incorporated into legal dispositions. It may therefore be seen as an exemplary case of the close intertwining of scientific investigations, their practical applications and regulatory practices. (shrink)

Berichte zur Wissenschaftsgeschichte, Volume 45, Issue 3, Page 487-498, September 2022.

Berichte zur Wissenschaftsgeschichte, Volume 45, Issue 3, Page 487-498, September 2022.

In 1910, Charles Richet suggested that studying individual variations in anaphylactic responses might both open a way to experimental investigation of the biological basis of individuality and help unify the immunological and physiological approaches to biological phenomena. The very opposite would happen however. In the next two decades, physiologists and immunologists interested in anaphylaxis and allergy experienced more and more difficulties in communicating. This divergence between the physiopathological and immunological approaches derived from discrepancies between the experimental systems used by each (...) of these scientific communities. Trying to develop a point of view that took into account all bodily reactions to stimuli, physiologists thought that individual variations between the laboratory animals they used (mainly dogs and cats) constituted important experimental data. Seeking to develop reproducible studies of infection, immunity and 'sensitisation', bacteriologists and immunologists considered that individual variations between the laboratory animals they used (mainly small rodents) constituted 'noise' and not a 'signal'. Each group's loyalty to the experimental models used in their discipline widened the gap between immunological and physiological explanations of allergies and led to the abandonment of studies on the biological basis of individuality. (shrink)

Tests for hereditary predispositions to breast and ovarian cancer have figured among the first medical applications of the new knowledge gleaned from the Human Genome Project. These applications have set off heated debates on general issues such as intellectual property rights. The genetic diagnosis of breast cancer risks, and the management of women “at risk” has nevertheless developed following highly localized paths. There are major differences in the organization of testing, uses of genetic tests, and the follow up of patients. (...) This article studies testing practices and ways of managing breast cancer risk in France and compares them with those in the United States and United Kingdom. It shows how the complex interaction between global and local factors shapes the multiple meanings assumed by the phrase cancer risk. (shrink)

Although Ludwik Fleck is today recognized as one of the pioneers of the historical sociology of science, his historical and epistemological writings, most of them dating from the 1930s, long remained practically unknown. They were rediscovered following the mention of Fleck's principal work, the monographGenesis and Development of a Scientific Fact(1935) in the preface of Kuhn'sThe Structure of Scientific Revolutions(1962), and thanks to the efforts of W. Baldamus (1977) and his student T. Schnelle (1982) and of the editors of the (...) English translation of Fleck's book, R. K. Merton and T. J. Trenn. Fleck's work was studied by several scholars and was the subject of two meetings: “Colloquium Ludwik Fleck” (Hamburg, 1981) organized by L. Schaffer and T. Schnelle, and a symposium organized by R. S. Cohen (Berlin, 1984). Some of the papers presented at these meetings were published in Cohen and Schnelle 1986. Today, more than fifty years after the publication of his principal study, Fleck is on his way to becoming a “classic” of the sociology of science and of epistemology. (shrink)

Ludwik Fleck’s article, “On medical experiments on human beings” was published in 1948 in the main Polish medical journal; it was destined for general practitioners. Fleck was prisoner in the concentration camp Buchenwald, where he witnessed Nazi murderous “experiments” on the camp’s imamates; he testified about these experiments in the Nuremberg Trial of Nazi doctors. This article, and Tadeusz Kielanowski’s comment on Fleck text, stress, however, that an exclusive focus on the – hopefully rare – criminal activities of doctors may (...) be misleading. It is important to prevent the numerous ethical transgressions of ‘normal’ medical science and routine clinical practice. (shrink)

Au cours des années 1910 et 1920, les effets conjugués des idées savantes sur la spécificité des anticorps, de la croyance profane à l’existence d’un sang syphilitique et de l’importance attribuée à la détection de la syphilis par les autorités sanitaires ont permis de transformer un test diagnostique peu efficace, la réaction de Wassermann, en «fait scientifique» incontestable. Ce fait scientifique établit l’équivalence« individu Wassermann positif= personne infectée par l’agent étiologique de la syphilis, la bactérie Treponema pallidum ». Il a (...) ainsi modifié les contours de l’entité nosologique «syphilis», les pratiques professionnelles, les représentations profanes de la syphilis et les politiques de santé. Tenu pour solide pendant une trentaine d’années, ce «fait scientifique» fut toutefois déstabilisé dans les années 1950 en raison du hiatus croissant entre les résultats accumulés grâce à la diffusion massive du test de Wassermann et les données épidémiologiques sur la prévalence de la syphilis, et de la comparaison entre les résultats de la réaction de Wassermann et ceux des nouveaux tests diagnostiques spécifiques du tréponème. Un pourcentage élevé de personnes «Wassermann positives» fut alors redéfini comme des « faux positifs biologiques », soit des individus souffrant de pathologies autres que la syphilis, mais cependant capables d’induire une réaction Wassermann positive. L’équivalence « personne Wassermann positive = individu infecté par Treponema pallidum » fut remplacée par l’équation« personne Wassermann positive = individu infecté par le tréponème ou faux positif biologique ». La nouvelle vision de la réaction de Wassermann modifia à son tour les pratiques des professionnels et les représentations que le grand public se fait de la maladie. L’histoire de la détection de la syphilis illustre les interactions complexes entre « faits scientifiques » et « faits sociaux» et l’interdépendance de leur évolution. (shrink)

In the inter-war period physicians elaborated numerous ‘biotherapies’ grounded in the complex interactions between physiology, bacteriology and immunology. The elaboration of these non-specific biological treatments was stimulated by the theory of generalized anaphylaxis that linked the violent reaction to a foreign protein to a broad array of chronic diseases, from asthma and urticaria to rheumatism or chronic colitis. Such diseases were perceived as the result of an ‘abnormal reactivity’ to a sensitisation of tissues and organs by bacteria and by foreign (...) proteins, a view that provided an effective bridge between new concepts derived from bacteriology and immunology and the long-standing pathological tradition. Accordingly, physicians attempted to treat these conditions through specific desensitisation and non-specific biological therapies: peptone treatment, protein therapy, haemotherapy, ‘antivirus’ or ‘opotherapy’. Therapies that attempted to neutralise the harmful effects of chronic infections through ‘desensitisation’ were not seen as marginal medical practices, but were promoted by leading advocates of the ‘Pasteurian sciences’, such as Richet, Widal, Vallery-Radot, Wright and Fleming. They also led to development of new products by the pharmaceutical industry. (shrink)

Ludwik Fleck is known mainly for his pioneering studies of science as a social activity. This text investigates a different aspect of Fleck’s epistemological thought—his engagement with normative aspects of medicine and public health and their political underpinnings. In his sinuous professional trajectory, Fleck navigated between two distinct thought styles: fundamental microbiological research and practice-oriented investigations of infectious diseases. Fleck’s awareness of tensions between these two approaches favored the genesis of his theoretical reflections. At the same time, his close observation (...) of medical and epidemiological practices led him to the conclusion that collectively produced scientific facts are situated and fragile. Thought collectives, Fleck explained, can err or yield to external pressures, with potentially disastrous consequences. While Fleck the reflexive experimental scientist has been creatively translated into the science studies idiom, Fleck the reflexive practical microbiologist and public health expert still awaits inspired translation. (shrink)

Le cancer est perçu aujourd’hui comme une maladie qui affecte à peu près autant d’hommes que de femmes. C’est cependant une conception relativement récente. Jusqu’au milieu du xxe siècle, le cancer était considéré comme une pathologie principalement féminine, les tumeurs malignes produisant des symptômes typiques faciles à détecter. Au xxe siècle, les cancers féminins – du sein et de l’utérus – sont les principales cibles des campagnes publiques pour la détection précoce des tumeurs malignes. Depuis les années 1950, le développement (...) de méthodes efficaces de diagnostic et l’augmentation des cancers du poumon, plus fréquents chez les hommes, met fin à l’image du cancer comme une pathologie féminine. Dans les discours publics et les medias, les cancers des organes reproducteurs féminins continuent cependant d’être plus visibles que ceux des organes reproducteurs masculins, et les femmes à risques sont plus souvent sujettes à une chirurgie de prévention mutilante. (shrink)

Le cancer est perçu aujourd’hui comme une maladie qui affecte à peu près autant d’hommes que de femmes. C’est cependant une conception relativement récente. Jusqu’au milieu du xxe siècle, le cancer était considéré comme une pathologie principalement féminine, les tumeurs malignes produisant des symptômes typiques faciles à détecter. Au xxe siècle, les cancers féminins – du sein et de l’utérus – sont les principales cibles des campagnes publiques pour la détection précoce des tumeurs malignes. Depuis les années 1950, le développement (...) de méthodes efficaces de diagnostic et l’augmentation des cancers du poumon, plus fréquents chez les hommes, met fin à l’image du cancer comme une pathologie féminine. Dans les discours publics et les medias, les cancers des organes reproducteurs féminins continuent cependant d’être plus visibles que ceux des organes reproducteurs masculins, et les femmes à risques sont plus souvent sujettes à une chirurgie de prévention mutilante. (shrink)

Medico-philosophical reflections were developed in the 19th and the 20th centuries by three consecutive generations of Polish physicians, active in what was later named the Polish School of Philosophy of Medicine. The second generation of this school published its own journal, Medical Critique [Krytika Lekarska], from 1897 to 1907. Medical Critique included numerous articles on the nature of medical knowledge, the reductionism versus holism debate in biology and medicine, the importance of teleologically-oriented approaches in medicine, the influence of theories and (...) of a priori ideas on clinical observations and on ‘clinical facts’, the problem of classification of diseases, the normative and ethical dimension of medicine, and the ion relationships between philosophy, history and medicine. The existence of a journal dealing specifically with theoretical reflections on medicine undoubtedly contributed to the propagation of original work in the philosophy of medicine in Poland. (shrink)

The ArgumentPatients suffering from advanced, incurable cancer often receive from their doctors proposals to enroll in a clinical trial of an experimental therapy. Experimental therapies are increasingly perceived not as a highly problematic approach but as a near-standard way to deal with incurable cancer. There are, however, important differences in the diffusion of these therapies in Western countries. The large diffusion of experimental therapies for malignant disease in the United States contrasts with the much more restricted diffusion of these therapies (...) in the United Kingdom. The difference between the two reflects differences in the organization of health care in these countries and distinct patterns of the professionalization of medical oncology in America and in Britain. The high density and great autonomy of medical oncologists in the United States encourages there the diffusion of experimental therapies (regarded by some as expensive and inefficient); the lower density of these specialists in the United Kingdom and their task as consultants and not primary caregivers, favors the choice of more conservative (for some, too conservative) treatments. Theoretically, the decision as to whether patients suffering from advanced, incurable cancer will be steered toward an experimental therapy or toward palliative care depends on the values and beliefs of these patients and their physicians. In practice, however, such choice does not depend exclusively on the individual' cultural background and ethical values, but is also strongly affected by the — culturally conditioned — Professional and institutional structure of medicine. (shrink)

This article argues that Ludwik Fleck’s understanding of scientific observation as a social and cultural process stemmed not only from his practical experience as a bacteriologist and serologist, but also from a confrontation with ideas developed by other Polish thinkers. It discusses ideas of three such thinkers: the ophthalmologist and philosopher of medicine Zygmunt Kramsztyk, the mathematician and painter Leon Chwistek, and the playwright, painter and photographer Stanislaw Ignacy Witkiewicz. Kramsztyk was interested in the way the observer’s preconceived idea shaped (...) observations through selection of specific visual elements and the rejection of others. Chwistek developed a theory of ‘multiple realities’ which proposed several divergent and equally valid patterns of grasping reality. In his plays, photographs, drawings and paintings Witkiewicz experimented restlessly with destabilization and transformation of the notion of a stable external reality. It links, then, debates on ‘reality’ in Poland between 1900 and 1939 to intersections of ideas derived from modern physics, psychology of perception, and avant-garde art.Keywords: Ludwik Fleck; Stanislaw Ignacy Witkiewicz ; Leon Chwistek; Poland; Perception; Avant-garde art. (shrink)

This paper compares anti-hookworm campaigns conducted in the early twentieth century in France, Germany, Brazil and West India. The populations that suffer from hookworm are not identical in the North and in the South. In tropical and semi-tropical regions hookworm is mainly found among poor peasants and is related to lack of hygiene, while in temperate climates hookworm was a professional disease of miners, a highly organized professional segment. Nevertheless, major disparities in the pattern of hookworm control did not reflect (...) the North-South divide, but a difference between campaigns. These aimed at the eradication of hookworm infection (Germany and West-India) and at alleviating the effects of this infection on populations (France and Brazil). Maps that represented the prevalence of hookworm mirrored the aims of the sanitary campaign in which they were used: eradication of parasitic worms versus the reduction of the handicap induced by these worms. In public health as well, representing is intervening. And vice versa: patterns of intervention shape representations. Ce texte compare des approches développés pour lutter contre l'ankylostomiase au debout du vingtième siècle en France, Allemagne, Brésil et Indes Occidentales. Dans les pays chauds, cette pathologie se trouve avant tout parmi les paysans pauvres, tendis que dans les pays de climat tempéré, cette infection est avant tout une maladie professionnelle des mineurs, un secteur professionnel bien structuré et doté d'un taux de syndicalisation élevé. Cependant, les différences les plus importantes ne furent pas celles entre les pays du Nord et du Sud, mais entre les campagnes qui ont eu comme but l'éradication de l'infestation (celles en Allemagne et en Indes Occidentales) et celles qui ont visé avant tout d'atténuation des ses effets sur les populations infectées (celles de France et de Brésil). Les cartes de diffusion de l'ankylostomiase furent façonnées par les buts des chercheurs: cartes utilisés dans une campagne contre le parasite ne furent pas identiques à celles utilisés dans un effort de limiter un handicap induit par une maladie. En santé publique aussi, représenter c'est intervenir. Et inversement: les modalités d'intervention façonnent des représentations. (shrink)