Siegel, Schaudinn, Fleck and the Etiology of Syphilis

Pergamon

Stud. Hist. Phil. Biol. & Biomed. Sci., Vol. 32, No. 3, pp. 435–455, 2001  2001 Elsevier Science Ltd. All rights reserved. Printed in Great Britain 1369-8486/01 $ - see front matter

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Siegel, Schaudinn, Fleck and the Etiology of Syphilis Jean Lindenmann* In 1905 two different etiologic agents for syphilis were proposed in Berlin, one, the Cytorrhyctes luis, by John Siegel, the other, Spirochaete pallida, by Fritz Schaudinn. Both scientists were pupils of Franz Eilhard Schulze, and were outsiders to the Berlin medical establishment. Both belonged to the same thought collective, used the same thought style, and started from the same supposition that the etiologic agent of syphilis must be a protist. Both used the same morphological approach, the same microscopes and the same stains. Both presented their findings in the same societies, used the same rhetoric, published in the same journals, used the same arguments to criticise each other’s shortcomings. Both were backed by powerful institutions and enlisted the support of prestigious patrons. Within half a year, the scientific community at large had in its overwhelming majority accepted Schaudinn’s results and rejected those of Siegel. Social forces thus cannot be shown to have played any role in deciding the issue. Ludwik Fleck’s suggestion that ‘appropriate influence’ and a ‘proper measure of publicity throughout the thought collective’ would have been sufficient for Siegel’s ideas to win the day is untenable.  2001 Elsevier Science Ltd. All rights reserved. Keywords: Treponema pallidum; Cytorrhyctes luis; Berlin 1905; Epistemology.

The lessons to be learned from excavations of the scientific literature, besides giving due historical tribute, include a series of clinical case studies in the pathology of scientific development. (Lederberg, 1992, p. 261)

1. Introduction Thomas S. Kuhn (1922–1996), in the preface to the first (1962) edition of his The Structure of Scientific Revolutions, writes: ‘[through] random exploration . . . I have encountered Ludwik Fleck’s almost unknown monograph, Entstehung und Entwicklung einer wissenschaftlichen Tatsache (Basel, 1935), an essay that antici-

* Obere Geerenstrasse 34, CH-8044, Gockhausen, Switzerland (e-mail: [email protected]) Received 26 June 2000; in revised form 26 November 2000.

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pates many of my own ideas’ (Kuhn, 1970 [1962], pp. vi–vii). This led to an intense preoccupation with Fleck’s work, particularly after the original had been translated into English (Fleck, 1979; Fleck, 1994 [1935]). Fleck is now widely regarded as one of the founders of the sociology of science. His fame is such that one ignores him at one’s peril.1 The purpose of the present essay is not to analyse Fleck’s impact on general aspects of the history, philosophy or sociology of science; others have done this before (McCullough, 1981; Cohen and Schnelle, 1986; Harwood, 1986; Freudenthal and Lo¨ wy, 1988). Rather, I shall focus on one concrete example Fleck offers, bearing in mind that Fleck himself urges us to check our epistemic views on historical evidence, since otherwise ‘epistemology without historical and comparative investigations is no more than an empty play on words or an epistemology of the imagination’ (Fleck, 1979, p. 21). 2. Fleck and Syphilis Ludwik Fleck 2 was born in 1896 in Lwow (Lemberg), at the eastern limit of the Austro-Hungarian empire. His native language was Polish, and he spoke and wrote German fluently. He started medical studies in 1914. After the First World War Lwow became part of Poland. Fleck specialised in microbiology and immunology and became head of a hospital laboratory. From 1935 on he worked in his own private bacteriological laboratory, never ceasing to publish scientific papers, both in German and in Polish. At the beginning of World War Two Lwow came under Soviet rule, and Fleck obtained a university position. Following the German occupation of Lwow in 1941 Fleck was confined to the Jewish ghetto. There he tried, under atrocious circumstances, to develop a typhus vaccine from the urine of typhus victims. In 1943 he was deported to Auschwitz, and later to Buchenwald, where he was supposed to produce typhus vaccines for the SS. Fleck survived the war and testified in 1948 as a witness at the Nu¨ rnberg trials. In postwar Poland he occupied important academic positions. Health problems precipitated his decision to settle in Israel in 1957, where he died in 1961, shortly before his contribution to the sociology of science was rediscovered by Thomas Kuhn. Much of Fleck’s Genesis and Development of a Scientific Fact is concerned with syphilis, and especially with the way in which the Wassermann reaction, after various re-adjustments and fine tunings, became a useful diagnostic tool. This aspect of Fleck’s book has been thoroughly reviewed.3 The Wassermann and related serologic tests are complicated matters, as anybody who has tried to teach them will appreciate. At the time Fleck wrote his monograph, in 1935, the status 1 In a review of a book by Jennifer Trusted, Lynn Margulis writes: ‘Trusted’s naive approach completely ignores Ludwik Fleck’s penetrating recognition of the stages of acceptance of biologic “facts” by contemporary society’ (Margulis, 1997). 2 For biographical notes on Fleck, see Fleck (1983), Plonka-Syroka (1993), Fleck ((1994) [1935]). 3 In her penetrating analysis of Fleck’s book, Ilana Lo¨ wy writes: ‘The history of the Wassermann reaction illustrates the complicated interaction between “scientific facts” and “social facts”, and the mutual shaping of both’ (Lo¨ wy, 1995, p. 28).

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of the Wassermann reaction was muddled—it was not clear what kind of antigens were involved, nor whether what was detected in serum could properly be called ‘antibody’; many preferred the non-committal term ‘reagin’. It is therefore difficult to follow Fleck’s reasoning in singling out the Wassermann reaction as something central in the development of a scientific ‘fact’. Concerning syphilis, what comes closest to a scientific fact as generally understood is its etiology, what is to be regarded as the necessary cause of the disease. On this issue, the scientific community had, by the time Fleck wrote, maintained a consensus for 30 years: syphilis was an infectious disease caused by a spiral bacterium, Treponema pallidum. It is in this connection that Fleck makes a surprisingly concrete statement: Siegel also recognized, in his own way, protozoa-like structures as the causative agent of syphilis. If his findings had had the appropriate influence and received a proper measure of publicity throughout the thought collective, the concept of syphilis would be different today . . . Ultimately we would still have reached a harmonious system of knowledge even along this line, but it would differ radically from the current one. (Fleck, 1979, p. 39)

Most readers of Fleck seem to have accepted this passage without giving it too much thought. Nevertheless, it is a rather startling remark. When analysing the influence social factors exert on the evolution of scientific concepts, comparisons are often made between different cultural backgrounds, either at the same time (for instance, the concept of AIDS within western versus voodoo medicine), or at different times (for instance, the concept of tuberculosis within western medicine in the first half of the nineteenth century versus that in the twentieth century). Such comparisons always concern a multiplicity of differing social factors, any or all of which can be involved in the conceptual alternatives observed. If, however, Fleck were right, this would offer a unique opportunity for isolating the decisive factors, because he pinpoints a single instant in time, within a single cultural background. He seems to put his finger on a switch that would have allowed the scientific enterprise to follow a different path from the one we have come to view as given. It might therefore be worthwhile to see how far we can follow Fleck. So who was Siegel, and what were his ‘protozoa-like structures’ (his ‘Gebilde’), that might have opened up a view on syphilis radically different from the one we have been talked into, given an ‘appropriate influence’ (‘suggestive Wirkung’) and sufficient ‘publicity throughout the thought collective’ (‘denkkollektive Verbreitung’)? 3. John Siegel (1861–1941) 4

John Siegel was born in 1861 in Stade (Lower Saxony) and studied medicine in Freiburg and later in Bonn, where he joined a student fraternity to which his 4 For details on Siegel’s life, I am indebted to the Stadtarchiv Stade, the Stadtarchiv Freiburg i. Br., the Stadtarchiv Konstanz, and to Ina John-Siegel, one of the daughters of John Siegel, who graciously shared memories of her father with me.

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later boss and supporter, F. E. Schulze, also belonged (Hesse and Hohmann, 1995, p. 150).5 His first scientific publication was his M.D. thesis (Siegel, 1887). He settled as a general practitioner in Britz, a proletarian suburb of Berlin, in 1889. Here he seems to have set up a private laboratory, much as Robert Koch had done 15 years earlier (Brock, 1988). Between 1889 and 1891 he had the opportunity to observe an epidemic from which almost one third of a population of 9000 suffered. It is very difficult to recognize, from his description, the disease concerned. He himself likened it to scurvy (at that time thought to be an infectious disease), and he mentioned that it could be mistaken for influenza (in 1889/90 an influenza pandemic was rampant in Europe) or for typhoid fever (Britz had no hygienically acceptable water supply). He was most impressed by blisters and shallow ulcers that developed in the mouths of victims. He was told by veterinarians that an epizootic of foot-and-mouth disease among cattle was raging in the vicinity. From this he conceived the idea that the disease he had observed in humans and foot-and-mouth disease in cattle were closely related. He envisioned the relationship of the human disease to the animal disease as similar to that of smallpox to cowpox (Siegel 1891, 1894; Bussenius and Siegel, 1897). Siegel wanted to identify the etiologic agent, and very rapidly convinced himself that he had cultivated a short bacterium, apparently a coliform, from typical human cases. He immediately attempted animal inoculations. Whereas the usual small laboratory animals (rabbits, guinea-pigs, rats, dogs, cats) proved refractory, he was successful with calves, pigs and pigeons (Siegel, 1891). Encouraged by this success6 and convinced that foot-and-mouth disease must be related to cowpox or vaccinia, Siegel searched for a microorganism in vaccinia similar to the one he had just described, and promptly claimed positive results. He had inoculated eight calves and six goats intraperitoneally with vaccine lymph and had recovered his bacterium at autopsy. With cultures of this bacterium he vaccinated eight adults and three babies (within the first year of life), and challenged them with active vaccinial lymph to check whether they had become immune. The adults showed some evidence of immunity (they had been vaccinated before), whereas the children proved fully susceptible (Siegel, 1893). He then extended his work to genuine cases of foot-and-mouth disease and found the same organism in these. Now foot-and-mouth disease had a long history of failed attempts to identify its etiologic agent, so that veterinarians were skeptical. Siegel was finally convinced of the irreality (‘Haltlosigkeit’) of his claims by Carl Fraenkel (Fraenkel, 1897a,b) and by the work of the special commission on foot-

5 The student ‘Corps’ or ‘Burschenschaften’ played an important role in German academic life. The alumni (‘Altherren’) felt an obligation of loyalty towards the active student members and promoted their careers. 6 A British professor, Miller, had visited his lab and had taken a sample of his bacterial cultures which he demonstrated at a meeting in London (Siegel, 1891).

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and-mouth disease, which established the filterability of the causative agent (Loeffler and Frosch, 1898). Fraenkel does not seem to have been prejudiced against Siegel, with whom he had been in contact. He praised his thorough survey of the literature: ‘The entire relevant literature has been assembled in the paper by Bussenius and Siegel in exemplary fashion’ (Fraenkel, 1897a; my translation). Indeed, the references appended to that paper stand out from the usually sloppy citation habits of the time. A rather friendly cooperation between Fraenkel and Siegel is also suggested by the fact that Siegel spent the summer of 1897 at Fraenkel’s institute and there published a paper in which he withdrew the claims concerning his bacillus (Siegel, 1897). In the following year, supported by the Chamber of Agriculture of Saxony, Siegel studied possibilities of vaccinating cattle against foot-and-mouth disease, and came to the conclusion that this was not practically feasible (Siegel, 1898). 4. Protists as Possible Etiologic Agents In 1892 Guarnieri had published an important paper describing a method by which intracellular inclusions of vaccinia, seen before in histological preparations but always obscured by infiltrating inflammatory cells, could be clearly visualised: inoculation of the rabbit cornea (Guarnieri, 1892).7 He interpreted these inclusions as intracellular parasites and named them Citoryctes vaccinae. This must have impressed Siegel, who, after his failure with a bacterium, had come to the conclusion that the etiologic agent of both foot-and-mouth disease and vaccinia was most likely a protist, perhaps a trypanosome (after the description of malaria plasmodia, protists were becoming fashionable). In unstained preparations of vaccine lymph he saw three kinds of structures that might be stages in the life cycle of a protist; however, he did not name them (Siegel, 1900a,b). Eventually Siegel realized that his training in parasitology was insufficient. He contacted the Institute of Zoology of the University of Berlin, whose head, Prof. Franz Eilhard Schulze (1840–1921) (Jahn, 1998, p. 951) accepted him as a collaborator for several years between 1899 and 1908. It is not clear exactly what position Siegel occupied; he had there a laboratory, equipped with the best available Zeiss microscopes (the only expensive piece of equipment at that time), where he and his collaborators could work (Jancke, 1905). He spent some time at the GermanoAustrian marine biology laboratory in Rovigno on the Adriatic coast. His mentor there was Fritz Schaudinn (1871–1906), who was himself a pupil of Schulze and had left the Berlin Zoological Institute for Rovigno in 1901 (Kuhn, 1949). Siegel’s newly acquired parasitological expertise soon resulted in a paper on an obscure parasite of an obscure leech (Siegel, 1903). This was published in Schaudinn’s

7

For a recent review on inclusion bodies, see Diosi (1998).

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recently launched Archiv fu¨ r Protistenkunde. He also studied—successfully, he later claimed—malaria of turtles (Siegel, 1905f). But Siegel had loftier ambitions. In the first months of 1905, he presented the world with a series of papers, in which he proposed etiologic agents for four diseases that, until then, had resisted all efforts at clarification: variola/vaccinia, footand-mouth disease, scarlet fever and syphilis. These papers, placed by F. E. Schulze in the Physikalische Abhandlungen der Ko¨ niglich Preussischen Akademie der Wissenschaften, were submitted on December 8th, 1904, and on January 12th and February 2nd, 1905; they appeared in print on January 9th, February 6th and February 25th, 1905—an example of the fantastic speed at which scientific publications were issued (Siegel, 1905a,b,c). In them, Siegel proposed that a group of pathogenic protists were the causative agents of variola and vaccinia (Cytorrhyctes variolae), of foot-and-mouth disease (Cytorrhyctes aphtharum), of scarlet fever (Cytorrhyctes scarlatinae), and of syphilis (Cytorrhyctes luis). These last organisms (the ‘Gebilde’ referred to by Fleck) were microscopic objects seen in syphilitic lesions, in the blood of patients with syphilis, and in the blood and kidneys of rabbits inoculated with syphilitic material. Except for their name, they had nothing in common with the intracytoplasmic inclusions described by Guarnieri, which had thus become, at the hands of Siegel, the founding member of a group of pathogenic protists called ‘Cytorrhyctes’.8 Because Schulze was a figure of great authority,9 Siegel’s claims could not be dismissed lightly. Syphilis was a sufficiently urgent public health concern (Weindling, 1994) for the Imperial Health Office (the ‘Kaiserliche Gesundheitsamt’) to need confirmation of findings that might have far-reaching consequences. Karl Ko¨ hler (1847–1912), the director of the Imperial Health Office (Brocke, 1991, p. 617), set Fritz Schaudinn, who had been recalled from Rovigno and nominated head of the newly created parasitology laboratory in 1904, to this task. 5. Fritz Schaudinn (1871–1906) Fritz Schaudinn10 was born in 1871 in Ro¨ seningken (East Prussia) of Lithuanian and German stock. He was a zoologist who had trained under the same Franz Eilhard Schulze who was now Siegel’s main supporter. Schaudinn was well known among zoologists mainly for his pioneering work in parasitology. In 1902 he

8 In English and French this was usually written ‘Cytoryctes’ (Calkins, 1904; Brinckerhoff and Tyzzer, 1906; Galli-Valerio, 1912). 9 According to Goldschmidt, Schulze was ‘an excellent zoologist’ but also ‘the prototype of what I have described as a Bonze’. Goldschmidt’s delightful recollections are not reliable when it comes to factual details (Goldschmidt, 1956). 10 For biographical notes on Schaudinn, see Prowacek (1906), Winter (1906), Hartmann and Prowazek (1906/1907), Langeron (1907), Kuhn (1949), Lelis (1971, 1972), Reber (1971), Risse (1975) and Hesse and Hohmann (1995).

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founded the Archiv fu¨ r Protistenkunde, where the already mentioned parasitological paper of Siegel was to appear. He had earlier ventured into human parasitology and had published a paper on a mysterious organism, Leydenia gemmipara, present in human ascitic fluid (Leyden and Schaudinn, 1896). This was dismissed within the same year as probably an amoeboid host cell (Pfeiffer, 1896). Thus, whereas Schaudinn’s standing among zoologists was secure, the medical establishment had no reason to hold him in particular esteem. In German encyclopedias he is credited with having coined the term ‘Mikrobiologie’; this ignores the fact that Emile Duclaux, Pasteur’s successor, had published a Traite´ de Microbiologie in 1887, when Schaudinn was 16 (Duclaux, 1898, p. ii). Neither by himself nor within the organization of the Imperial Health Office could Schaudinn ever come near reliable clinical material. A collaboration was therefore launched between the Dermatological Clinic of the Charite´ Hospital under Professor Edmund Lesser (1852–1918) and Schaudinn’s group. Lesser delegated his first assistant, Erich Hoffmann (1868–1959).11 Schaudinn was assisted by Fred Neufeld and R. Gonder. Schaudinn contacted Siegel, who showed him his preparations. At the beginning of March 1905, Schaudinn and Hoffmann started investigations on material from syphilitic patients at the Charite´ Hospital (Hoffmann 1925, 1930; Neufeld, 1930; Schuberg and Schlossberger, 1930). Very soon Schaudinn saw—first in unstained, later in Giemsa-stained preparations—slender, tightly wound spiral organisms he could clearly differentiate from other spirochaetes. Schaudinn and Hoffmann’s first communications refrained from claiming an etiologic role for the organism they named ‘Spirochaete pallida’;12 they simply stated that it was regularly present in syphilitic lesions, and only there (Schaudinn and Hoffmann, 1905a,b,c). It could also be seen in preserved preparations from lymph node biopsies made four years earlier. On March 20, 1905, a confrontation between Siegel and Schaudinn was arranged before the Reichsgesundheitsrat (Siegel, 1905d). 6. Conflict Between Siegel and Schaudinn The demonstrations of Schaudinn and Hoffmann in the Berlin Medical Society on May 17 with discussions on May 24, 1905, met with overt hostility (Berliner medizinische Gesellschaft, 1905). The prestigious surgeon von Bergmann (1863– 1907), who presided over both meetings, said in an introduction to the discussion of May 24: ‘You know from the pages of the Berliner klinische Wochenschrift how warmly the director of our Zoological Institute, professor Schulze, has sup11 Goldschmidt in his Portraits from Memory (Goldschmidt, 1956) minimizes the role of Hoffmann. Although Hoffmann emerges from his autobiography as a rather obnoxious fellow (Hoffmann 1948, 1949), there is no doubt that without his excellent clinical samples Schaudinn could never have identified Treponema pallidum. 12 Schaudinn consistently wrote Spirochaete, until he renamed the organism Treponema pallidum (Schaudinn, 1905b). Others frequently wrote Spirochaeta.

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ported Siegel’s work’ (my translation). He was referring to a short paper by Schulze, written on May 15, which had appeared in the issue of May 22 of the Berliner klinische Wochenschrift (Schulze, 1905). Rather than confronting Siegel’s views with those of Schaudinn, von Bergmann had decided to limit the discussion to the latter’s presentation, since dealing with one supposed syphilis agent at a time was enough. Oskar Lassar (1849–1907),13 who had wanted to discuss Siegel’s agent, had to limit himself to the sarcastic remark that over the past 25 years exactly 25 purported agents of syphilis had been described. One of Siegel’s supporters, Curt Thesing, suggested that the spirochaetes might originate from the Giemsa stain used, and that the evidence for their being protists rather than bacteria (an important issue, since both Siegel and Schaudinn thought it most likely that the causative agent of syphilis must be a protist) was shaky— as indeed it was. In seeking to neutralize von Bergmann’s intervention, Hoffmann stressed the point that Thesing was no longer an official member of the Zoological Institute and thus could only speak for himself. He further deplored that two Royal (Prussian) Institutions (the Clinic for Dermatology and the Zoological Institute) were pitted against each other. This did not go well with the audience—scientific controversies ought not to be influenced by the affiliations of the researchers involved (which was, by the way, what Hoffmann had wanted to say). Von Bergmann closed the session with the words: ‘. . . until another agent responsible for syphilis engages our interest’ (Risse, 1975). 7. The Verdict of the Scientific Community Schaudinn’s spirochaete was stunningly successful. Within a few months confirmations from all parts of the world came in by the dozen. On June 7th, Carl Fraenkel, in a lecture before the Halle medical society, was possibly the first to positively assert the etiologic role of the spirochaete in public (Fraenkel, 1905). By July 18th, more than 20 scientists had already published confirmatory findings (Ploeger, 1905). Three months later, Schaudinn could report on more than 100 authors who had seen the spirochaete (Schaudinn, 1905a). In Paris, Metchnikoff and Roux had immediately confirmed the presence of the spirochaete in experimentally infected monkeys (Metchnikoff and Roux, 1905), as had Levaditi in human congenital syphilis (Levaditi, 1906). In the fall of 1905, a newly created medical journal, Medizinische Klinik, carried out a sort of poll among European professors of dermatology. Answers were obtained from Bern, Brussels, Heidelberg, Kiel, Rostock and Vienna; all were in favor of the spirochaete, although most insisted that definitive proof along the principles laid out by Koch was still lacking (Anonymous, 1905). On January 17th, 1906, Theodore Shennan read a paper before 13 There were two famous dermatologists in Berlin who in later accounts have sometimes been mixed up: Edmund Lesser (1852–1918), chief of the dermatological clinic at the Charite´ Hospital, and Oskar Lassar (1849–1907), head of a fashionable private clinic (Bloch, 1905; Munk, 1979).

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the Edinburgh Medico-Chirurgical Society and concluded: ‘there is much to support the relationship of Spirochaeta pallida to syphilis’ (Shennan, 1906). Siegel’s friends—among them Theodor Saling, a zoologist, and Walter Schulze, an ophthalmologist, son of F. E. Schulze (Hoffmann, 1930)—fought some valiant rearguard battles, concentrating on demolishing the spirochaete, particularly when demonstrated by silver impregnation, a notoriously tricky technique (Thesing 1905, 1906; Schulze 1905a,b, 1907; Saling, 1906a,b; Schulze, 1906a,b; Saling, 1907a,b). Siegel himself countered arguments brought up against his findings (Siegel, 1906). He conceded that spirochaetes were frequently present in syphilitic material, but he assumed that they were mere passengers or saprophytic contaminants (Berliner medizinische Gesellschaft, 1911). He did many animal experiments and succeeded in cultivating his organism, which now was thought to be a coccus (Siegel, 1911a). Returning to his first love, foot-and-mouth disease (Siegel, 1912a,b,c,d), and supported by the Prussian Ministry of Agriculture (Ho¨ lzel, 1912), Siegel once more provided the Imperial Health Office with an opportunity to check his claims (Wehrle and Zwick, 1913), which kept the scientific community busy for several years (Waldmann and Trautwein, 1929). Very late in his life he published three pamphlets purporting to show that the etiologic agent of syphilis was a filterable virus (Siegel 1935, 1937, 1940). Thus, during 35 years’ work, his organism had mutated from a trypanosome-like protist to a cultivable coccus to a filterable virus. The last publication carries the hopeful subtitle ‘preliminary communication’.

8. Siegel’s End The First World War saw Siegel as a physician assigned to a field hospital. After the war, he seems, as a scientist, to have vanished: upon the death of his mentor, F. E. Schulze, in 1921, an obituary lists 53 former collaborators in Berlin, among them Schaudinn and Thesing, but not Siegel (Heider, 1922). In 1931 he settled in a quiet private practice in Freiburg, a place he had loved since his student days. His life ended there in 1941, at the age of 80, from pneumonia after a night spent in an cold air raid shelter. Prof. Stu¨ hmer recalls: In 1934 I transferred from Mu¨ nster to Freiburg to take the chair of Dermatology. On the third day a man with white hair and carrying a thick bundle of notes under his arm introduced himself as Dr. Siegel. Only after further enquiry did it dawn upon me that this must be the discoverer of the 4 Cytorrhyctes agents of scarlatina, measles (sic), smallpox and syphilis. Siegel came to ask for lab space in my clinic. He wanted to perform animal experiments in order to ‘debunk the Spirochaeta pallida and to prove the correctness of the agent he had discovered’. He gave me the impression of an unhappy human being entirely dominated by a fixed idea. (Stu¨ hmer, 1956; my translation).

Whoever has had to deal with scientific cranks will recognize the pathetic figure: a haggard King Lear betrayed by his own brainchildren.

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9. Schaudinn’s End Schaudinn disliked his work at the Imperial Health Office, which did not allow him to do research as he wanted. His most happy years had been in Rovigno, far away from the Berlin bureaucracy (Kuhn, 1949). His assignment to check on Siegel’s findings he saw as a disagreeable chore. When he was offered, in the course of 1905, a position in Hamburg he was glad to leave Berlin. He had also been deeply offended by the antagonism he had met in the Berlin medical establishment. The International Medical Congress in Lisbon (April 1906) was to be his triumph, but when he attended it, he was a terribly sick man. On his return trip to Hamburg an emergency operation was performed on board a ship, and he died in Hamburg from sepsis following a pararectal abscess on June 22, 1906, aged 35 years (Kuhn, 1949). Ironically, he, who saw himself as the quintessential protozoologist, is best remembered for his description of Treponema pallidum, a bacterium. 10.

Discussion

The enthusiam of the 1880s, during which, after the description of the tubercle bacillus, it looked as if in due course all infectious diseases would yield to a bacterial etiology, soon gave way to a certain disenchantment. Some of the most deadly scourges of mankind—smallpox, yellow fever, malaria, typhus, syphilis, measles, scarlatina—remained unexplained. This was particularly galling in the case of syphilis, one of the first diseases to have been clearly recognized as contagious, and one whose mode of transmission had been suspected from its first appearance. Protozoa and filterable viruses emerged as new candidates towards the end of the century, and great hopes were pinned on these agents as possible solutions to as yet unresolved problems. With regard to syphilis, the expectations prevailing on the eve of the dispute I have outlined above are clearly expressed by Iwan Bloch (1872–1922) in his chapter on the history of syphilis in Puschmann’s Handbuch der Geschichte der Medizin (Bloch, 1905, p. 454): ‘However, there is no doubt that sooner or later the syphilis bacillus will be discovered’ (my translation). This was in the year that saw the clash between Siegel and Schaudinn. In the spring of 1905 two groups emerged, championing two different etiologic agents for syphilis: one of these (the spirochaete) became rapidly recognized as representing reality, whereas the other (cytorrhyctes) was dismissed as irrelevant. Fleck tells us that, given modest changes in social circumstances (better ‘suggestive Wirkung’, ‘denkkollektive Verbreitung’), it might have been the other way round, and that this would have resulted in a drastically changed, but equally satisfactory scientific perception of syphilis. Why Fleck limits his analysis to Siegel’s ‘Gebilde’ and eschews the other 25 purported agents of syphilis that had been described earlier, and for which exactly the same arguments could be made, remains unexplained. Fleck must have felt that, carried to its extreme, his hypothesis led to absurd conclusions. For if dozens of different organisms could serve equally well

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as agents of syphilis, why reject other explanations, based, for instance, on masturbation, celestial punishment, or sorcery?14 This may seem an outrageous extension of Fleck’s ideas, but it has been done, probably not for syphilis, which is no longer controversial, but with respect to AIDS (Schulz, 1998). Limiting the discussion to the one concrete example Fleck mentions, the evidence at hand shows that the social circumstances of the two competing groups, Schaudinn’s and Siegel’s, were extraordinarily similar. Their work was done in 1904 and and the first 5 months of 1905. Both were in Berlin. Both group leaders were pupils of F. E. Schulze. Both had the same training, belonged to the same thought collective and used the same thought style. Both had no doubts that the causative agent of syphilis must be a microorganism, and that it might be related to a trypanosome-like protist. Both suspected that the agent could not be cultivated, so that evidence of causation would have to rest on the regular presence of the agent in syphilitic lesions and its absence from control preparations. Both used the same instruments, the best available microscopes, and the most advanced staining and microphotographic techniques. Both published their findings in journals of wide circulation, both addressed the same audience and used the same rhetoric to promote their views. Both met, at the beginning, the same level of healthy skepticism from their peers. There is no evidence that one of the groups was more impeded in making its findings known, had much weaker institutional backing or was less skilled at advertising its achievements than the other. It is true that Siegel had, on his track record, the blemish of having suggested an etiologic agent for a human malady he thought to have the same relationship with foot-and-mouth disease as had smallpox with cowpox, and that he had withdrawn this claim. However, reports on etiologic agents which later vanished into oblivion abound around the turn of the century and were not held too severely against their perpetrators. Schaudinn himself had also suffered a bad flop with his Leydennia gemmipara n.g. n.s., when he had ventured into unfamiliar terrain. Those who tried to repeat Siegel’s results on syphilis may have had their reservations from the start, but there is no evidence that any attempts were made to impede the dissemination of Siegel’s Cytorrhyctes luis. Scientific journals remained open to him until 1914, and his papers were thoroughly reviewed in the specialized abstracting services such as the ‘Referate’ section of the Centralblatt fu¨ r Bakteriologie, the Deutsche medizinische Wochenschrift, the Hygienische Rundschau, Index Medicus, and others. Those who checked his findings (Fraenkel, the commissions 14 Some sociologists of science argue that any human activity which results in people becoming convinced that they have acquired knowledge about the world, be it by experience, observation, experiment, meditation, revelation or whatever, is to be treated on equal terms (the postulate of symmetry, see, for example, Golinski, 1998, pp. 22, 190). Thus, in a culture in which our current mainstream medicine is regarded as a repository of valid facts about health and disease, people ‘know’ that syphilis can be transmitted by contagion. In cultural surroundings that accept sorcery, people ‘know’ that disease can be transmitted by casting a spell. Both forms of knowledge should be considered equivalent. There is no indication that Fleck, who drew all his examples from an observational and experimental tradition, would have endorsed this view.

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on foot-and-mouth disease in 1897 and on syphilis in 1905) were in contact with him, looked at his bacterial cultures, his microscopic preparations and his animal experiments. He seems to have been given in every respect a fair hearing. In 1907/1908, he could expose his views on a total of 74 pages with several in-text figures and 5 plates in the Centralblatt fu¨ r Bakteriologie, a leading journal (Siegel, 1907, 1908a,b). Even as late as 1912 the Kaiserliche Gesundheitsamt went to the unbelievable length of testing, with Siegel’s participation, his newest claims on the etiologic agent of foot-and-mouth disease (by then, it was a coccus, now written ‘Zytorrhykteskokken’, cultivable on ordinary bacteriological media), using a dozen heifers (some of them, at Siegel’s request, pregnant) and several pigs (Wehrle and Zwick, 1913). Siegel’s coccus did produce symptoms, but not those of foot-andmouth disease, and it failed to protect against challenge with authentic infectious material. This shows that, in spite of the bad reputation that Siegel must have accumulated by that time, he was still taken seriously. In a way, both Siegel and Schaudinn were outsiders, not belonging to the medical establishment proper—and this at a time when hierarchical boundaries were jealously guarded. Siegel was not visibly engaged in a climb up the academic ladder: He was not ‘Privatdozent’, a position only inexactly rendered by the English term ‘lecturer’. To become Privatdozent (an unpaid position), one had to submit to a faculty a bulky second thesis which had to show that the candidate was capable of independent, original research. Now F. E. Schulze, Siegel’s patron, was head of an institute of zoology, belonging to the faculty of science. Siegel, an M.D., could not pass for a full-blooded zoologist. Furthermore, Siegel had a knack for sitting between chairs: with his work on foot-and-mouth disease he was trespassing on the turf of the veterinary faculty; with his work on scarlatina he encroached on pediatrics or hygiene, with syphilis on dermatology, with vaccinia on public health. In contrast, Schaudinn was Privatdozent, but in zoology—nothing to recommend him to the medical faculty. He disliked the work assigned to him, which had an administrative touch and none of the prestige associated with a university position. He was therefore glad to leave his job in Berlin at the first opportunity. Nevertheless, the German scientific establishment was not as ossified as might appear. After all, it was not so long ago that Robert Koch had worked his way from small district physician in Wollstein to his exalted position in Berlin (Brock, 1988). And F. E. Schulze, although his whole life was devoted to zoology, had earned an M.D. in 1863 and an honorary Ph.D. in 1871 (upon becoming head of an institute for zoology and comparative anatomy in Rostock), before ascending to Berlin via Graz (Heider, 1922). Even assuming that Siegel suffered from a certain social handicap,15 this was 15 When starting this work I thought that Siegel might be a Jewish name, and this would have explained discrimination in Wilhelminian Germany. However, John Siegel was born in a Lutheran family (as was Schaudinn), and he is said by his descendants to have been an early adherent to the National Socialist party.

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more than offset by Schaudinn’s untimely death in 1906, at the age of 35 years. Had it been the other way round, had Siegel died immediately after publishing his Cytorrhyctes luis, one might, with some reason, argue that death had aborted the possibility of his views being widely recognized. But it was the promotor of Spirochaete pallida who died. There was one more element in favor of Siegel: He was medically qualified, and he had in addition a postdoctoral training in parasitology, which he had learned at the very hands of Schaudinn. Whereas today, for someone wanting to work at the cutting edge of medical science, a Ph.D. degree might seem more appropriate than an M.D. degree, this was not so in 1905. All the great German bacteriologists of that time—Emil von Behring, Carl Eberth, Paul Ehrlich, Carl Fraenkel (Fraenken), Georg Gaffky, Edwin Klebs, Robert Koch, Friedrich Loeffler, Albert Neisser, Richard Pfeiffer, August von Wassermann—were medically qualified.16 It was decidedly unusual for a zoologist like Schaudinn to study a uniquely human malady, syphilis. In fact, at the International Medical Congress in Lisbon (April 1906), a prize of 5000 (gold) francs, unanimously voted by the assembly, was vetoed by the Berlin Medical Society on the grounds that Schaudinn was not an M.D. and was too young to receive such a prestigious prize, which went to the 86-year-old Laveran instead (Kuhn, 1949). There is not a shred of evidence that social forces favored Schaudinn at the expense of Siegel; the opposite seems to have been the case. In Berlin, where such forces were most influential, Schaudinn met with severe criticism. Neufeld recalled that the Berlin popular press was heavily biased in favor of Siegel (Neufeld, 1930). Immediately after Schaudinn’s death, Lesser noted that his fate illustrated the saying that no one is recognized as a prophet in his own country (Lesser, 1906). The Berlin Medical Society, before whom the seminal demonstration of Schaudinn and Hoffmann had taken place barely a year earlier, refused the reading of an obituary notice by Hoffmann (Reber, 1971). As late as 1911, again at a session of the Berlin Medical Society, Siegel, in discussing a paper by Uhlenhuth and Mulzer on experimental syphilis in rabbits, reminded the audience that he had been the first to show that rabbits were receptive for syphilis (Berliner medizinische Gesellschaft, 1911). He very shrewdly criticised the argument used by his opponents, who called the experimental disease produced in rabbits syphilis because it teemed with the same spirochaetes that were contained in the inoculum. He forgot that he had used the same argument six years earlier when showing Cytorrhyctes luis in the blood of rabbits inoculated with syphilitic material. Siegel’s point of view was supported by Prof. David von Hansemann (1858–1920), a respected pupil of Virchow (Munk, 1979). This may have been a belated shot in the skirmishes between Virchow and Koch—if so, it was a shot fired in the wrong direction, for Siegel’s concepts were

16 The exception is Ferdinand Cohn, but he never worked with medically important organisms (Bulloch, 1960 [1938]).

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firmly anchored in the Koch tradition: in 1911 he insisted that he had been engaged in bacteriological work for close to 25 years, and that he resented criticism that would make a beginner blush (Siegel, 1911b). We might alternatively look at the situation in a more Latourian fashion (Latour, 1984). The physical ‘actants’ on both sides were the same: microscopes, slides, stains, samples, journals. The social institutions were similar: the Kaiserliche Gesundheitsamt, the Zoology Institute of the Ko¨ nigliche Universita¨ t Berlin, the learned societies with their meetings, the interactions between the two groups, the hospitals from where the samples were obtained. The material endowments of the two groups also seem comparable—at any rate, there is no evidence that Siegel suffered from a lack of money; he is said (Hesse and Hohmann, 1995, p. 92) to have been supported by the all-powerful Friedrich Althoff (1839–1908) of the Prussian ministry of Cultural Affairs (Brocke, 1991). By mid-1905 he had inoculated close to 50 rabbits and 13 monkeys (Siegel, 1905e); in 1906, he was able to inoculate 30 rhesus monkeys with various syphilitic products (Berliner medizinische Gesellschaft, 1906). By 1908 he had purchased the most advanced Reichert dark field apparatus and could report on the inoculation of 100 monkeys, among them many baboons (Siegel, 1908a). The human actants of course were different, but if we were now to say that one group (Schaudinn’s) was highly competent and the other (Siegel’s) a bunch of bungling jerks, this would be passing a value judgement to which we can only be led by hindsight. This would amount to the circular argument that because Siegel failed to convince, he must have been incompetent, and because he was incompetent, he failed to convince. The last actants, the spirochaete on one side and the cytorrhyctes on the other, were clearly different. The spirochaete, when it appeared wiggling and undulating on the microsope stage, had the glamour of a silent movie star, whereas the clumsy cytorrhyctes missed its cues and failed to show up altogether. But what was the reason for this crucial difference? If we accept that the social forces on both sides of the issue were roughly equal, why should the decision have fallen so rapidly and so decisively in favor of the spirochaete? What additional social forces must be invoked to make Fleck’s proposal, that Siegel’s cytorrhyctes could just as well have served our need for scientific explanations as does the spirochaete, acceptable? These would have to be mighty social forces indeed, and certainly not the public relations measures suggested by Fleck. The decision in favor of Schaudinn was reached by the scientific community at large, outside Berlin, outside Germany. This consisted of scientists who could hardly be influenced by any additional propagandistic gimmicks that might have been deployed in Berlin. These scientists were blissfully unaware of the pecking order prevailing in German academic and paraacademic circles. The fight beween Siegel and Schaudinn must, to them, have been typical of ‘querelles d’Allemands’. So they simply got hold of a good microscope and looked for themselves. To offset the (perhaps naive) idea that the spirochaete

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had an equivalent in reality, that it had already been there in syphilitic lesions for centuries, that it had simply awaited being revealed for all to see by a reliable description based on an appropriate technique, whereas the cytorrhyctes was born of delusion, ambition and incompetence, would have required social forces immensely more powerful than what Fleck proposes. Such social forces are conceivable. They were at work when Lysenkoism was forced down the throat of Soviet geneticists (Medvedev, 1969). But this is certainly not what Fleck had in mind. Fleck expected the alternative course that science could have taken to be self-sustaining once the choice at the switching point had been made, something which brute force cannot achieve. Thus, in the other example Fleck mentions, that of the wretched community of typhus workers at Buchenwald, who under enormous pressure had to get results and who mistook stain precipitates for Rickettsiae (Fleck, 1946), their whole previous work collapsed the moment they were shown authentic Rickettsiae. To this Fleck adds the revealing comment: ‘the social mechanism leading to error is the same as that leading to true knowledge’ (my translation). Hence social mechanisms cannot decide an issue.

11. Conclusions How is one then to come to terms with an incomprehensible proposal by a man whose work has unquestionable merit? To be sure, Fleck does not tell us that we have been wrong all the time and that we should belatedly rehabilitate Siegel as the ‘true’ discoverer of the etiologic agent of syphilis. Fleck says: given the path which science has taken, we inevitably and legitimately regard Treponema pallidum as a reasonable way of explaining syphilis. But: had the scientific enterprise taken another turn, we would with equal certainty and justification believe in Cytorrhyctes luis. Fleck does not say: had our society evolved since antiquity along a different path than that leading to the technical civilisation as we see it, we might be quite happy with other systems of acquiring knowledge. This would be so diffuse a statement that nobody would care to challenge it. By naming John Siegel, Fleck indicates a stage in the evolution of science where the features which distinguish it from other human endeavours were well established. If we take Fleck at his word (and how better could one pay homage to a man than by taking him at his word?), his suggestion is quite unequivocal: in the year 1905, within the community of medical scientists who followed the models elaborated by Pasteur’s and Koch’s schools of etiologic attributions (or thought style, to use Fleck’s terminology), two different etiologic agents for syphilis were presented. Fleck wants us to believe that social factors tipped the balance in favor of the spirochaete. To tip the balance to the other side, he does not propose some cataclysmic paradigm shift, but merely better ‘suggestive Wirkung’ and ‘denkkollektive Verbreitung’. I have shown above that social forces, because they were so evenly balanced between the two compet-

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ing groups, cannot be held responsible for the decision in favour of one view at the expense of the other.17 Perhaps Fleck was not at all interested in the way consensus was reached within a given thought collective, but was primarily concerned with the conceptual opposition between different thought collectives. Here again, mentioning Siegel is entirely gratuitous and leads us nowhere. Siegel belonged to exactly the same thought collective as did Schaudinn, otherwise the term ‘collective’ becomes meaningless. Syphilis was an ill-chosen object on which to base Fleck’s theoretical considerations. If these indeed are anticipations of modern thoughts in the sociology of science, Fleck could be said to have been right for the wrong reasons. Siegel, ‘in his own way’ (to paraphrase Fleck, as does the English translation18), is also a fascinating figure. Does he represent an element in what has been called ‘pathological science’ (Langmuir, 1989)? Did he suffer a devastating flash of insight when he realized that, with his microscope, his stains and his samples he could have been the first to see the spirochaete? That he had missed entering the pantheon of great scientists by a treponema’s breadth? He did have some merit in triggering the investigation leading to the spirochaete, a microorganism which otherwise might have taken much longer to be detected. He was one of the first to use rabbits, although his technique was appalling (Siegel, 1905f) and his animals died miserably before being ever able to show clinical signs of syphilis. Nevertheless, rabbits soon became the standard experimental animals for the study of syphilis. So Siegel could also be said to have been right for the wrong reasons. His stubborn resistance to an accumulating body of evidence is not unique in the annals of science. A recent example concerns the acquired immunodeficiency syndrome, AIDS, and the refusal of some scientists to acknowledge the human immunodeficiency virus, HIV, as its necessary cause (Duesberg and Rasnick, 1998). To these, HIV is just a passenger, as was the spirochaete to Siegel. This could lead to another ‘clinical case study’ (Lederberg, 1992) for future historians to ponder. Acknowledgements—I am indebted to Johannes Eckert, Otto Haller, Theodor Hiepe, Janusz Jeljaszewicz, Ina John-Siegel, Jonas Lelis, Ilana Lo¨ wy, Margaret Rossiter, Lutz Sauerteig, Heidi Seger, Eduard Seidler, Johanna Siegel, Ru¨ diger Wehner, the staff of the German town archives of Freiburg, Konstanz and Stade, and to several anonymous referees for advice, help and criticism.

References Anonymous (1905) ‘Umfrage u¨ ber die a¨ tiologische Bedeutung der Spirochaeta pallida und des Cytoryctes luis fu¨ r die Syphilis’, Medizinische Klinik 1(52), 1342–1345. Berliner medizinische Gesellschaft (1905) ‘Offizielles Protokoll, Sitzungen vom 17. 5. und 24. 5. 1905’, Berliner klinische Wochenschrift 42(22,23), 694, 699, 731–734. Berliner medizinische Gesellschaft (1906) ‘Offizielles Protokoll, Sitzung vom 10. 1. 1906’, Berliner klinische Wochenschrift 43(4), 110–111. 17 18

This of course does not imply that social forces have no influence on the evolution of science. ‘gema¨ ss seinem Wissen’ is translated as ‘in his own way’ (Fleck, 1979, p. 39).

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