'Experimental rage': The development of medical ethics and the Genesis of Scientific Facts

Social History of Medicine

Volumn 15, Issue 2, 2002, Pages 187-207

  Bonah, Christian ^a  

^a UNIVERSITÉ DE STRASBOURG   (France)

Author keywords

1930s; Bacteriology; BCG vaccination; Human experimentation; Julius Moses; L beck; Ludwik Fleck; Medical ethics; Scientific knowledge; Scientific tacts

Indexed keywords

BCG VACCINE;

ARTICLE; BACTERIOLOGY; BIOMEDICAL AND BEHAVIORAL RESEARCH; GERMANY; HEALTH CARE AND PUBLIC HEALTH; HISTORY; HUMAN EXPERIMENT; IMMUNOLOGY; JURISPRUDENCE; MEDICAL ETHICS; METHODOLOGY; PUBLIC HEALTH; SCIENCE;

BIOMEDICAL AND BEHAVIORAL RESEARCH; HEALTH CARE AND PUBLIC HEALTH;

ALLERGY AND IMMUNOLOGY; BACTERIOLOGY; BCG VACCINE; ETHICS, MEDICAL; GERMANY; HISTORY, 20TH CENTURY; HUMAN EXPERIMENTATION; JURISPRUDENCE; PUBLIC HEALTH; SCIENCE;

EID: 0036706904     PISSN: 0951631X     EISSN: None     Source Type: Journal    
DOI: 10.1093/shm/15.2.187     Document Type: Review

References (131)

1. L. Fleck, Entstehung und Entwicklung einer Wissenschaftlichen Tatsache. Einführung in die Lehre vom Denkstil und Denkkollektiv (Basel, 1935). For a detailed account of the reception of the writings by Ludwik Fleck,
2. see R. S. Cohen and T. Schnelle (eds), Cognition and Fact. Materials on Ludwik Fleck (Dordrecht, 1986);
3. Schäfer and T. Schnelle, 'Einleitung. Ludwik Flecks Begründung des Soziologischen Betrachtungsweise in der Wissenschaftstheorie', in L. Fleck, Entstehung und Entwicklung einer Wissenschaftlichen Tatsache. Einführung in die Lehre vom Denkstil und Denkkollektiv (Frankfurt, 1980), vii-xlix. For the history of the rediscovery of Gregor Mendel's work in plant genetics,
4. see J. M. Drouin, 'Mendel, Côté Jardin', in M. Serres (ed.), Elements d'Histoire des Sciences (Paris, 1989), 407-21;
5. R. Olby, 'Mendel No Mendelian?', History of Science, 17 (1979), 53-72;
6. A. Brannigan, Le Fondement Social des Découvertes Scientifiques (Paris, 1996).
7. L. Fleck, Genesis and Development of a Scientific Fact (Chicago, 1979), ed. T. J. Trenn and R. K. Merton, trans. F. Bradeley and T. J. Trenn, Foreword by T. S. Kuhn.
8. L. Fleck, Entstehung und Entwicklung einer Wissenschaftlichen Tatsache, Einführung in die Lehre vom Denkstil und Denkkollektiv (Frankfurt, 1980), ed. L. Schäfer and T. Schnelle.
9. I. Löwy, The Polish School of Philosophy of Medicine. From Tytus Chalubinski (1820-89) to Ludwik Fleck (1896-1961) (Dordrecht, 1990), pp. 5-8.
10. Cohen and Schnelle, Cognition and Fact;
11. T. Schnelle, Ludwik Fleck: Leben und Denken (Freiburg, 1982);
12. L. Fleck, Erfahrung und Tatsache. Gesammelte Aufsätze. Mit einer Einleitung herausgegeben von L. Schäfer und T. Schnelle (Frankfurt, 1983);
13. J. Harwood, 'Ludwik Fleck and the Sociology of Knowledge', Social Studies of Science, 16 (1986), 173-87;
14. I. Löwy, 'The Scientific Roots of Constructivist Epistemologies: Hélène Metzger and Ludwik Fleck', in G. Freuderithal (ed.), Etudes sur Hélène Metzger (Paris, 1988), 219-35;
15. J. Golinski, 'The Theory of Practice and the Practice of Theory: Sociological Approaches in the History of Science', Isis, 81 (1990), 492-505.
16. In an historical perspective, the notion of the social body is obviously linked to the idea of public health. See D. Porter, 'Public Health', in W. F. Bynum and R. Porter (eds), Companion Encyclopedia of the History of Medicine (London, 1993), 1231-61. For a study of the German situation,
17. see P. Weindling, Health, Race and German Politics between National Unification and Nazism, 1870-1947 (Oxford, 1989).
18. N. Bosanquet, 'Health Economics: Finance, Budgeting, and Insurance', in Bynum and Porter (eds), Companion Encyclopedia, pp. 1373-90. For the German system of national health insurance,
19. see U. Frevert, Krankheit als Politisches Problem 1770-1880 (Göttingen, 1984).
20. For a recent contribution to the social history of hospitals in this transformation in Germany, see A. Labisch and R. Spree, 'Einem jeden Kranken in einem Hospitale sein eigenes Bett'. Zur Sozialgeschichte des Allgemeinen Krankenhauses in Deutschland im 19. Jahrhundert (Frankfurt, 1996).
21. C. Huerkamp, Der Aufstieg der Ärzte im 19. Jahrhundert Vom Gelehrten Stand zum Professionellen Experten: das Beispiel Preussens (Göttingen, 1985).
22. A. Harrington, Reenchanted Science, Holism in German Culture from Wilhelm II to Hitler (Princeton, NJ, 1996);
23. E. M. Klasen, 'Die Diskussion über eine "Krise" der Medizin in Deutschland zwischen 1925 und 1935' (unpublished MD thesis, University of Mainz, 1984). For earlier criticism,
24. see M. Dinges (ed.), Medizinkritische Bewegungen im Deutschen Reich (Stuttgart, 1997).
25. L. Fleck, 'Zur Krise der "Wirklichkeit"', Die Naturwissenschaften, 17 (1929), 425-30.
26. J. Moses, 'Die Krise der Medizin', Biologische Heilkunst, 10 (1929), 804-5, 832-3.
27. For a general presentation, see S. Hahn, '"Der Lübecker Totentanz". Zur Rechtlichen und Ethischen Problematik der Katastrophe bei der Erprobung der Tuberkuloseimpfung 1930 in Deutschland", Medizinhistorisches Journal, 30 (1995), 61-79;
28. P. Menut, 'The Lübeck Catastrophe and its Consequences for Anti-tuberculosis BCG Vaccination', in A. M. Moulin and A. Cambrosio (eds), Singular Selves. Historical Issues and Contemporary Debates in Immunology (Amsterdam, 2001), 202-10.
29. For material on medical experimentation on human subjects between 1900 and 1930, see R. Steinmann, 'Die Debatte über Medizinische Versuche am Menschen in der Weimarer Zeit' (unpublished MD thesis, University of Tübingen, 1975);
30. B. Elkeles, Der Moralische Exkurs über das Medizinische Menschenexperiment im 19. Jahrhundert (Stuttgart, 1996);
31. E. Tashiro, Die Waage der Venus. Venerologische Versuche am Menschen am Menschen in der Zeit von 1885 und 1914 (Husum, 1991). For a general perspective,
32. see S. E. Lederer, Subjected to Science: Human Experimentation in America Before the Second World War (Baltimore, 1995).
33. H. M. Sass, 'Reichsrundschreiben 1931', Journal of Medicine and Philosophy, 8 (1983), 99-111. For the historical genesis of the Richtlinien,
34. see C. Bonah, 'Ethique et Recherche Biomédicale en Allemagne. Le Procès de Lübeck et les Richtlinien de 1931', Journal International de Bioéthique, 12 (2001), 23-39.
35. D. S. Nadav Julius Moses (1868-1942) und die Politik der Sozialhygiene in Deutschland (Gedingen, 1985);
36. D. S. Nadav, Volksgesundheit als Aufgabe der Politik: der Gesundheitspolitiker Julius Moses und die Sozialhygieniker (Bremen, 1983);
37. K. Nemitz, 'Julius Moses - Nachkss und Bibliographie', Internationale Wissenschaftliche Korrespondenz zur Geschichte der deutschen Arbeiterbewegung, 10 (1974), 219-41.
38. J. Moses, Der Totentanz von Lübeck (Radebeul/Dresden, 1930).
39. For a historical presentation of bioethics, see B. Elkeles, 'Medizinische Menschenversuche gegen Ende des 19. Jahrhunderts und der Fall Neisser. Rechtfertigung und Kritik einer Wissenschaftlichen Methode', Medizinhistorisches Journal, 20 (1985), 135-48;
40. H. T. Engelhardt and S. Spicker (eds), The Use of Human Beings in Research (Dordrecht, 1983);
41. H. Helmchen and R. Winau (eds), Versuche mit Menschen in Medizin, Humanwissenschaften und Politik (New York, 1986);
42. D. Rothman, Strangers at the Bedside (New York, 1992);
43. W. T. Reich (ed.), Encyclopedia of Bioethics, 5 vols (New York, 1995);
44. C. Wiesemann and A. Frewer (eds), Medizin und Ethik im Zeichen von Auschwitz. 50 Jahre Nümberger Ärzteprozeß (Erlangen, 1996);
45. U. Tröhler and S. Reiter-Theil (eds), Ethics Codes in Medicine: Foundations and Achievements of Codification since 1947 (Aldershot, 1998).
46. For a contemporary summary of the issues of medical ethics in Germany in the 1920s, see A. Moll, Ärztliche Ethik. Die Pflichten des Arztes in allen Beziehungen seiner Thätigkeit (Stuttgart, 1902). For a general presentation,
47. see R. Baker, 'The History of Medical Ethics', in Bynum and Porter (eds), Companion Encyclopedia, pp. 852-87.
48. Fleck, Genesis and Development, p. 77.
49. The subsequent biographical information is based on Cohen and Schnelle, Cognition and Fact;
50. T. Schnelle, Ludwik Fleck: Leben und Denken;
51. L. Fleck, Genesis and Development;
52. L. Fleck, Erfahrung und Tatsache.
53. For a recent analysis of the confusing accounts of this period, see P. Weindling, Epidemics and Genocide in Eastern Europe 1890-1945 (Oxford, 2000), pp. 333-52, 363-7.
54. L. Fleck and L. Füllenbaum, 'Experimentelle Beiträge zur Ätiologie des Lupus Erythematodes', Dermatologische Wochenschrift, 84 (1927), 485-7;
55. L. Fleck and L. Füllenbaum, 'Clinical and Experimental Contribution on Etiology of Lupus Erythematosus', Urologie and Cutaneous Review, 35 (1931), 358-61.
56. L. Fleck, 'Über die Exanthin-Reaktion bei Meerschweinchen und Kaninchen', Krankheitsforschung, 8 (1930), 404-6;
57. L. Fleck, 'Versuche über eine Lokale Hautreaktion mit Proteus X-19 Extrakten (Die Exanthinreaktion), Zeitschrift für Immunitätsforschung und experimentelle Therapie, 72 (1931), 282-300;
58. L. Fleck and J. Hescheles, 'Über eine Fleckfieber-Hautreaktion (die Exanthinreaktion) und ihre Ähnlichkeit mit dem Dicktest', Klinische Wochenschrift, 10 (1931), 1075-6;
59. L. Fleck and J. Hescheles, 'Über die Eigentümlichkeit der Exanthin- (Fleckfieberhaut-) Reaktion beim Menschen', Zeitschrift für Immunitätsforschimg und experimentelle Therapie, 79 (1933), 514-20;
60. L. Fleck, 'Über Hautreaktion mit Exanthin. Bemerkungen zu der Arbeit von Nemschilov', Klinische Wochenschrift, 13 (1934), 303-4.
61. L. Fleck, 'Ein Fall von Pseudosyphiloma Anorectale Mykotischer Ätiologie (Kladiosis)', Dermatologische Wochenschrift, 90 (1930), 379-82.
62. L. Fleck and E. O. Ludwik, 'Zur Variabilität der Streptokokken', Zentralblatt für Bakteriologie, 125 (1932), 180-200.
63. Löwy, The Polish School of Philosophy of Mediane, p. 217.
64. Most of Fleck's publications that were not in Polish were published in German language journals such as Klinische Wochenschrift, Dermatologische Wochenschrift, Zentralblatt für Bakteriologie, Naturwissenschaften, or the Zeitschrift für Immunitätsforschung und experimentelle Therapie.
65. Harwood, Ludwik Fleck and the Sociology of Knowledge, pp. 177-8.
66. Fleck, Genesis and Development, p. 45.
67. The term 'German-speaking' refers in this context to the system of medical faculties and medical education that Joseph BenDavid has called a 'medical market place'. One of the key elements of that system was not the national boundary but rather the existence of a common language. The German-speaking system of medical education thus includes Germany, Austria, part of Switzerland, part of Poland, and by extension some of the Eastern countries whose educational systems were closely tied to this German language community. J. BenDavid and A. Zloczower, 'The Idea of the University and the Academic Market-Place', Archives Européennes de Sociologie, 2 (1961), 303-14;
68. J. BenDavid and A. Zloczower, 'Universities and Academic Systems in Modern Society', European Journal of Sociology, 3 (1962), 45-84.
69. A. Calmette, Die Schutzimpfung gegen Tuberkulose mit BCG (Leipzig, 1928), trans. Kalbfleisch;
70. P. Menut, 'Ethique et Ethos de la Recherche Bio-médicale en France. Le Cas de l'Introduction de la Vaccination par le BCG: 1900-1930', in C. Bonah and E. Lepicard (eds), Les Procès Médicaux: Lieux de Références, Révélateurs et Régulateurs d'Ethique comme d'Ethos (Rapport Final au Ministère de l'Emploi et de la Solidarité et Ministère de la Justice, Strasbourg, 2000), 58-80.
71. Landesarchiv Schleswig-Holstein (LASH), Abt. 352, Nr. 297, Urteil der II. Grossen Strafkammer des Landgerichts der freien Hansestadt Lübeck, 6 February 1931, pp. 156-216.
72. Moses, Der Totentanz von Lübeck, p. 7.
73. The subsequent biographical information is based on Nadav, Julius Moses (1868-1942) und die Politik der Sozialhygiene, pp. 120-36, 258-92;
74. Nadav, Volksgesundheit als Aufgabe der Politik;
75. K. Nemitz, 'Julius Moses - Nachkss und Bibliographie', pp. 219-41.
76. K. Nemitz, 'Julius Moses und die Gebärstreik-Debatte 1913', Jahrbuch des Instituts für Deutsche Geschichte, 2 (1978), 321-35.
77. J. Moses, '100 Ratten und 20 Kinder', Der Kassenarzt, 5 (10 March 1928), 1-2;
78. J. Moses, 'Arzt und Experiment', Der Kassenarzt, 5 (21 April 1928), 1-2;
79. J. Moses, 'Der Kampf gegen das Menschenexperiment', Biologische Heilkunst, 9 (1928), 687-9.
80. Weindling, Health, Race and German Politics, pp. 485-6.
81. Fleck, Genesis and Development, p. 100, italics as in the original.
82. The publication is the Ärztliche Vereinsblatt, which became in 1930 the Deutsche Ärzteblatt. According to Waigand, 90% of the German physicians were members of that corporative organization. B. Waigand, 'Antisemitismus auf Abruf. Die Geschichte des "Deutschen Aerzteblattes" und die Jüdischen Mediziner 1918-1933' (unpublished MD thesis, University of Freiburg, 2000).
83. The Reichsärzteordnung was finally obtained on 13 December 1935. M. Rüther, 'Ärztliches Standeswesen im Nationalsozialismus 1933-1945', in R. Jütte (ed.), Geschichte der Deutschen Ärzteschaft: Organisierte Berufs- und Gesundheitspolitik im 19. und 20, Jahrhundert (Köln, 1997), 142-93, in particular pp. 173-5.
84. Moses, 'Die Krise der Medizin', pp. 804-5, 832-3.
85. Moses, Der Totentanz von Lübeck, pp. 8-9.
86. W. Kröner, Unsere Kinder = Versuchskaninchen? Die Sachverständigenkomödie von Lübeck (Berlin, 1930).
87. Fleck, Genesis ana Development, pp. 86-94.
88. Löwy, The Polish School of Philosophy, pp. 69-120, 171-213.
89. Ibid., pp. 4-5.
90. Similarly, Fleck did not mention his ties with the Polish School of Philosophy of Medicine although they have been considered as essential to his thought and writings; ibid., pp. 5-6.
91. Fleck, Genesis and Development, p. 105.
92. For Fleck's feeling of a dawning revolution in bacteriology, see the paper by I. Löwy, 'The Epistemology of the Science of an Epistemologist of the Sciences: Ludwik Fleck's Professional Outlook and its Relationships to his Philosophical Works', in Cohen and Schnelle (eds), Cognition and Fact, 421-42.
93. LASH, Abt. 352, Nr. 297, Urteil der II. Grossen Strafkammer, pp. 13-36.
94. Ibid., pp. 23-38.
95. W. Kröner and V. Noack, Anti-Calmette (Berlin, 1931), pp. 34-5.
96. Fleck, Genesis and Development, Prologue, p. xxvii.
97. Ibid., p. 114.
98. Ibid., pp. 38-9.
99. Ibid., p. 41.
100. Ibid., pp. 85-7.
101. LASH, Abt. 352, Nr. 297, Urteil der II. Grossen Strafkammer, pp. 122-56.
102. Moses, Der Totentanz von Lübeck, p. 4.
103. LASH, Abt. 352, Nr. 297, Urteil der II. Grossen Strafkammer, pp. 92-121.
104. Hahn, 'Der Lübecker Totentanz', p. 63;
105. Bonah, 'Ethique et Recherche Biomédicale', pp. 33-6.
106. LASH, Abt. 352, Nr. 297, Urteil der II. Grossen Strafkammer, pp. 122-52.
107. Moses, Der Totentanz von Lübeck, p. 7.
108. For the comparison with the legal use of the concept of fact, see S. Toulmin, 'Ludwik Fleck and the Historical Interpretation of Science', in Cohen and Schnelle (eds), Cognition and Fact, 267-85, p. 278.
109. Fleck, Genesis and Development, pp. 28-9.
110. Moses, Der Totentanz von Lübeck, p. 77.
111. Fleck, Genesis and Development, pp. 28-9.
112. Ibid., p. 18. 'A few important points remain to be made concerning the idea of the causative agent. . . . A good example is the "infection inapparente" (Nicolle) which progresses without clinical illness. . . . Another probably related is that of the completely harmless germ carrier who harbours certain bacteria far more often than the associated disease. Consequently the idea of the causative agent has lost the overriding importance it enjoyed during the classical period of bacteriology.'
113. Ibid., pp. 29-30.
114. Ibid., p. 61. 'Now continuous biological changes, within any complex biological individual, . . . can be divided into several categories. . . . Or they are cyclic changes of which some are genotypically conditioned and others are the result of reciprocal action within the complex life unit. These include the life cycle of organisms (ageing), generational change, and some of the dissociation phenomena of bacteria. Both serogenesis and immunogenesis must be listed here, as well as the virulence as a life phase of bacteria and even some infectious diseases.' On bacterial variation, see further pp. 87-93.
115. Ibid., pp. 18-19. 'Theoretical bacteriology has further inherent difficulties. The biological character of Spirochaeta pallida is closely related or similar to that of S. cuniculi, S. pallidula, S. dentium, and others. It can be distinguished only by means of tests on animals. S. pallida should therefore be defined by syphilis, instead of the other way around. (Syphilis defined by S. pallidum). An additional factor is the extreme degree of variation in bacteria, which in some families is so great that, for the time being, classification of such species is out of the question. Unpredictable fluctuations in virulence, such as transformations of the saprophytes into parasites and vice versa, altogether destroy the relation which initially appeared so simple between a given type of bacterium and its associated disease.'
116. Ibid., p. 107.
117. Moses, Der Totentanz von. Lübeck, p. 7.
118. Ibid., p. 7.
119. Ibid., pp. 76-7.
120. Fleck, Genesis and Development, p. 114.
121. Ibid., pp. 92-3.
122. LASH, Abt. 352, Nr. 297, Urteil der II. Grossen Strafkammer, pp. 91-2.
123. Fleck, Genesis and Development, pp. 114-15. (The translation here has been slightly revised.)
124. Ibid., pp. 113-15.
125. Ibid., p. 113.
126. Ibid., p. 104.
127. Ibid., pp. 105-6.
128. Ibid., p. 106.
129. A. Frewer, Medizin und Moral in Weimarer Republik und Nationalsozialismus, Die Zeitschrift "Ethik" unter Emil Abderhalden (Frankfurt a.M., 2000).
130. Fleck, Genesis and Development, p. 64.
131. Ibid., p. 116