In chapters one and two of Genesis and Development of a Scientific Fact, Ludwik Fleck dissects one of the most established medical facts – the Wassermann reaction and its relation to syphilis – and investigates its origin and epistemology. As Fleck notes, the history of syphilology can be traced back to the fifteenth century, undergoing both conceptual and symptomatic modification (1). In the first chapter, Fleck discusses five ideas that have played a role in the development of our current concept of syphilis. The second chapter follows this discussion with four ideas regarding the establishment of the concept of syphilis within this historical framework.
Towards the end of the fifteenth century, astrology maintained its dominance in the ideas and concepts of the time. To put it frankly, if the stars aligned, a subject could be attacked by syphilis. Those with the sun sign Scorpio were often sensitive to the disease, Scorpio having been thought to dominate one’s genitalia (2). Along with this idea was the notion provided by religious teachings that syphilis was punishment for lust and fornication. This rooted an ethical aspect to its conceptualization, leading to an ethical stigma which has sustained even in the present day. Fleck explains that one problem with this early conception of syphilis is that it was far too broad, including other venereal diseases in its definition (3).
EMPIRICAL-THERAPEUTIC CONCEPT (MERCURY)
A second idea regarding syphilis “…evolved from medical practitioners using pharmaceutical resources” (3). Practitioners founds that a certain skin conditions reacted favorably when treated with a mercury ointment. Thus, syphilis could be distinguished from other skin ailments. This lead some to believe that the use of mercury bore the origin of the concept of syphilis. Even though mercury as a therapeutic method should not be underrated, Fleck notes that considering mercury as its conceptual origin is problematic for the following three reasons: 1) early treatises on syphilis do not mention mercury, 2) mercury was used to treat many other skin conditions, and 3) if mercury alone were decisive, other venereal diseases would not have been linked to syphilis since they are unaffected by its use (4).
A divide emerged between those who wanted to group gonorrhea, syphilis, and soft chancre and those who wanted to dichotomize them into separate disease entities. This lead to a series of experiments by three different factions. The unitarians separated gonorrhea from syphilis while unifying hard and soft chancre. The dualists unified syphilis with gonorrhea and separated hard from soft chancre. The new dualists separated all three concepts (7-8). As Fleck notes, “…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…” (8).
PATHOGENETIC DISEASE ENTITY
Fleck states that pathological ideas about syphilis appear in early treatises of the disease, based on the theory of dyscrasia: the noxious mixture of the humors. Fleck notes one aspect of dyscrasia, i.e. foul blood. The blood has gone from a good state to a bad one (11), and a cleansing or sweetening of the blood was considered the remedy (12). Although attempts were made to confirm the theory that syphilis involved the blood, it was the Wassermann reaction that achieved success and developed the science of serology (14-15).
SPECIAL ETIOLOGICAL ENTITY
After the aforementioned success, the discovery of the causative agent was in demand. In the early twentieth century, it was finally confirmed that Spirochaeta pallida is the causative agent for syphilis, and “the connection with the sex act was translated from the mystical-ethical domain into straightforward physical terms” (17).
Even though scientists have come a long way in their understanding and conceptualization of syphilis, Fleck argues that our definition is still incomplete. For example, he says that “…the “causative agent” [i.e. the special etiological entity] is but one symptom, and not even the most important, among several indicative of the disease; its presence alone is insufficient ad because of the ubiquity of many microbes it occurs automatically when other conditions exist” (18). Fleck states that new problems have arisen as the concept of syphilis has changed, thus “…nothing here was really completed” (19).
Fleck states that we can never sever the links to the past when considering scientific concepts. We cannot understand syphilis without understanding its history, even if parts of it were found to be incorrect. He argues that regarding the concept of any disease, “…the current concept does not constitute the logically or essentially only possible solution” (22). Fleck does not think that the goal of epistemology is to examine consistent concepts. If we are to understand the concept of syphilis, we must consider the socio-historical connections it stems from (23).
PROTO-IDEAS AS GUIDELINES FOR DEVELOPMENT
Many scientific facts begin from hazy or pre-ideas – in fact, the Wassermann reaction and its relation to syphilis is an example of this (23). These pre-ideas, of course, existed before any scientific proof could be attained. As such, some were discarded and some were accidentally realized. However, there are proto-ideas that originated from socio-cognitive foundations. The hazy ideas about syphilis aided its current formation, so we ought not discount pre-ideas as merely pseudoscience. Concepts may begin too broad, but they develop from these general terms to specific ones (26-7).
THE TENACITY OF SYSTEMS OF OPINION
“Once a structurally complete and closed system of opinions consisting of many details and relations has been formed, it offers constant resistance to anything that contradicts it” (27). Fleck illustrates his thought using the stigmatized notion of carnal scourge. He makes the following important point about comparative epistemology: it is an important task to discover how hazy ideas are passed down through different thought styles, how they become pre-ideas, and how they become enduring rigid structures.
We actively deny new terms even in the face of good reason for the following reasons: Firstly, it is unthinkable to contradict our current system when a term has deeply penetrated the collective thought. Secondly, an idea is unseen if it does not fit into our current system. Self-contained systems of opinions are tenacious in the operation of cognition. Fleck says that only classical theories that are rooted in a given era, are limited, and are stylistically relevant will ever be sturdy enough to advance. Thirdly, if noticed, a new idea is kept secret. Fourthly, exceptions in terms are made in order to maintain the current system. The aim is for logical conformity at any cost. The idea is to stay as true and close to a particular style or system as possible. Lastly, new ideas are abandoned for the corroboration of old ones (27-33).
Fleck thinks that if we attempt to legitimize a particular approach as the correct one, it will always be influenced by a cultural collective thought (35). More than this, stereotyped opinions that have been passed down for many years are more trusted and considered safer and more legitimate (36): “once a statement is published it constitutes part of the social forces which form concepts and create habits of thought” (37). Society internalizes, enforces, and habituates ideas, and it is difficult to penetrate such a robust fixation.
For Fleck, cognition is a social activity, so comparative epistemology requires more than a dual relationship (38). The idea of a thought collective provides the relational aspect that is missing in dualistic accounts of epistemology. Cognition, Fleck states, is to ascertain the results that must follow within a framework of preconditions that are relevant to a particular collective. As such, the three factors of cognition are the individual, the collective, and objective reality (39-40). Examples of thought collective related concepts are discernible from discussions above, one being the notion of syphilis within the religious or astrological framework (41). The evolution of an idea can be explained by its collective acceptance and subsequent adoption, leading to its eventual endurance over time and inevitable transformation in light of changing dynamics within a community. And of course, the transformative property of concepts over time can have negative effects on its value (44). Fleck importantly notes that it is possible for an extremely audacious individual to belong to several thought collectives at once; in other words, we many not be so intimately tied to our social collective imagination that we cannot ever factor ourselves out of it (45).
Fleck concludes that empirical facts are relative. We ought to consider them on a rolling basis, and only in this continual movement can we find truth (51).