Die sogenannte Syphilisfrage ist von Beginn an ein Thema der Nietzscheforschung. Das vorliegende Buch versucht diese Frage zu beantworten, indem es sich auf eine aufwändige Spurensuche bis zurück zur Syphilis der Renaissance-Päpste begibt. Wie war in verschiedenen Zeiten der Umgang mit der Krankheit und der fortwährenden Furcht, infiziert zu sein? Mit welchen Subtexten bringen Dichter und Denker zur Zeit Nietzsches das Thema zur Sprache? Und wie gab Nietzsche selbst in seinen Werken und Briefen davon Kunde? Das Buch betrachtet Nietzsche (...) im europäischen Kontext des 19. Jahrhunderts, in dem die Angst vor der Lustseuche allgegenwärtig war. Christian Niemeyers Nietzsche-Lektüre im Zeichen der Syphilis eröffnet überraschende Deutungsmöglichkeiten im Werk Friedrich Nietzsches. (shrink)

The outbreak of syphilis in Europe elicited a variety of responses concerning the disease's origins and cure. In this essay, I examine the theory of the origins of syphilis advanced by the 16th-century Italian surgeon Leonardo Fioravanti. According to Fioravanti, syphilis was not new but had always existed, although it was unknown to the ancients. The syphilis epidemic, he argued, was caused by cannibalism among the French and Italian armies during the siege of Naples in 1494. (...) Fioravanti's strange and novel theory is connected with his view of disease as corruption of the body caused by eating improper foods. His theory of bodily pollution, a metaphor for the corruption of society, coincided with Counter-Reformation concepts about sin and the social order. (shrink)

The rapid changes that syphilis underwent after the first major outbreak that occurred in Naples in the mid-1490s are believed to constitute the first well-documented example of a human disease. The new plague was of exceptional virulence, highly contagious and causing severe ulceration at the site of infection. According to medical and other historical sources, the ‘genius epidemics’ changed some years after this onset, and a slower-progressing form of syphilis seems to have replaced the initial severe form, as (...) do many virulent epidemic infectious diseases that appear in devastating forms in a previously uninfected population. But what exactly were the features of the disease at the moment of its appearance in Europe at the end of the fifteenth century? How many years did it take for the early, virulent form to be replaced and become endemic? What was the pace of these changes through the decades following the onset of the epidemic? In this essay, I review these issues through an analysis of a large number of chronologically-ordered primary historical sources. (shrink)

The Search for the Legacy of the USPHS Syphilis Study at Tuskegee is a collection of essays from experts in a variety of fields seeking to redefine the legacy of the infamous Tuskegee Syphilis Study. The essayists place the legacy of the study within the evolution of racial and ethnic relations in the United States. Contributors include two leading historians on the study, two former United States Surgeons General, and other prominent scholars from a wide range of fields.

Public health aims to provide universal safety and progressive opportunities to populations to realise their highest level of health through prevention of disease, its progression or transmission. Screening asymptomatic individuals to detect early unapparent conditions is an important public health intervention strategy. It may be designed to be compulsory or voluntary depending on the epidemiological characteristics of the disease. Integrated screening, including for both syphilis and cancer of the cervix, is a core component of the national reproductive health program (...) in Kenya. Screening for syphilis is compulsory while it is voluntary for cervical cancer. Participants’ perspectives of either form of screening approach provide the necessary contextual information that clarifies mundane community concerns. (shrink)

The Tuskegee Syphilis Experiment (TSE) has shaped African Americans’ views of the American health care system, contributing to a reluctance to participate in biomedical research and a suspicion of the medical system. This essay examines public discourses surrounding President Clinton’s attempt to restore African Americans’ trust by apologizing for the TSE. Through a narrative reading, we illustrate the failure of this text as an attempt to reconcile the United States Public Health Service and the African American public. We conclude (...) by noting the limitations of rhetoric when equal prominence is not given to policy proposals in national apologies. (shrink)

There are established ethical principles to protect human participants in biomedical research from undue exploitation by researchers. However, in the “Tuskegee Study” in the US, these principles were grossly violated. The task of this paper is to critically examine the ethical implications of that study on future practices in biomedical research, and to suggest ways of ensuring that such practices comply with appropriate ethical values.

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)

A new multi-stage deterministic model for the transmission dynamics of syphilis, which incorporates disease transmission by individuals in the early latent stage of syphilis infection and the reversions of early latent syphilis to the primary and secondary stages, is formulated and rigorously analysed. The model is used to assess the population-level impact of preventive and therapeutic measures against the spread of the disease in a community. It is shown that the disease-free equilibrium of the model is globally-asymptotically (...) stable whenever the associated control reproduction number is less than unity. A special case of the model is shown to have a unique and globally-asymptotically stable endemic equilibrium whenever the associated reproduction number exceeds unity. Uncertainty and sensitivity analysis of the model, using parameter values and ranges relevant to syphilis transmission dynamics in Nigeria, show that the top three parameters that drive the syphilis infection are the disease transmission rate, compliance in condom use and efficacy of condom. Numerical simulations of the model show that the targeted treatment of secondary syphilis cases is more effective than the targeted treatment of individuals in the primary or early latent stage of syphilis infection. (shrink)

The Tuskegee Syphilis Study is often cited as a major reason for low research participation rates among racial/ethnic minorities. We use data from a random-digit-dial telephone survey of 510 African Americans and 253 Latinos drawn from low income Los Angeles neighborhoods to investigate associations between knowledge of the study and endorsement of HIV/aids conspiracy theories. Results indicate African Americans were significantly more likely than Latinos to endorse HIV/aids conspiracy theories and were more aware of the study. Nevertheless, few Americans (...) and Latinos had ever heard of Syphilis Study suggesting that awareness is not a major factor in low participation rates. (shrink)

Syphilis is a bacterial sexually transmitted disease (STD), whose main route of infection is through sexual contact. In order to diagnose syphilis, Treponema pallidum must be detected in the material sampled from a lesion and a blood test must be performed in order to detect serological response to syphilis. Since 1946, a statutory obligation to report all cases of syphilis has been in force in Poland, which is why data concerning the incidence is available. The aim (...) of this paper is to analyse trends in syphilis incidence in the years 1950–2017 using Joinpoint Regression and to present the impact of prophylaxis and education of society on syphilis prevention. The Joinpoint Regression method indicated the splitting time points of the trend corresponding to real changes in incidence, which corroborates the purpose of using the method in question in epidemiological studies. (shrink)

The Tuskegee Syphilis Study is surrounded by illuminating misconceptions—myths that cannot be blithely dismissed because they actually provide some insight into the significance of the study. One of those is that the men were deliberately infected with syphilis; another is that they obtained no treatment for the disease. Some other errors are alleged in two recent articles about the study, but these articles themselves create their own fictions.

In this article, I address some infectious diseases that never really “ended,” even though their morbidity, their social impact, and their public visibility have faded away: AIDS, syphilis, and measles. I will use data from different projects I have conducted on each of those epidemics: HIV/AIDS at the doctoral training level in the 1990s, with a geographical focus on Brazil and the United States; syphilis in the context of a 2010 project on the social history of health in (...) Lisbon in the late 19th and early 20th centuries; and measles as part of my current project on labor migration in the 19th century, with a focus on epidemic outbreaks in migrant ships from Madeira to Hawaii. (shrink)

This essay is a reflection on how ethical violations continue to have an impact across generations within families of vulnerable populations that have experienced significant breaches in biomedical research. The focus is on the surviving family members of the United States Public Health Service Syphilis Study at Tuskegee (USPHS). Emphasis will be on responsible ethical practices in research and the use of an unique approach narrative storytelling to address the needs of family descendents who have been impacted by the (...) USPHS Syphilis Study. (shrink)

In 1905 two different microbes were proposed to fill the vacant role of etiologic agent for syphilis, one, the Cytorrhyctes luis, by John Siegel, the other, Spirochaeta pallida, by Fritz Schaudinn. After gathering and reviewing the evidence the majority of medical scientists decided in favor of Schaudinn's candidate. In a previous issue Jean Lindenmann challenged Ludwik Fleck's suggestion that under suitable social conditions Siegel's candidate could just as well have won acceptance by the scientific community (). To refute this (...) counterfactual thesis, Lindenmann presented an asymmetric account of the dispute over the etiology of syphilis. He adopted the view of the proponents that Schaudinn's spirochete had already been there in syphilitic lesions for centuries, only awaiting the discovery of an appropriate staining technique to be revealed. Here a more symmetric analysis of the episode will be attempted, paying serious attention to the arguments put forward by the spirochete's opponents, who expatiated on the many possibilities of inadvertently creating artifacts through microscopic preparation and staining. The symmetric account that is presented in this rejoinder thus aims to trace the simultaneous construction of facts and artifacts. It will not, however, resurrect Fleck's counterfactual thesis. (shrink)

In 1905 two different microbes were proposed to fill the vacant role of etiologic agent for syphilis, one, the Cytorrhyctes luis, by John Siegel, the other, Spirochaeta pallida, by Fritz Schaudinn. After gathering and reviewing the evidence the majority of medical scientists decided in favor of Schaudinn’s candidate. In a previous issue Jean Lindenmann challenged Ludwik Fleck’s suggestion that under suitable social conditions Siegel’s candidate could just as well have won acceptance by the scientific community . To refute this (...) counterfactual thesis, Lindenmann presented an asymmetric account of the dispute over the etiology of syphilis. He adopted the view of the proponents that Schaudinn’s spirochete had already been there in syphilitic lesions for centuries, only awaiting the discovery of an appropriate staining technique to be revealed. Here a more symmetric analysis of the episode will be attempted, paying serious attention to the arguments put forward by the spirochete’s opponents, who expatiated on the many possibilities of inadvertently creating artifacts through microscopic preparation and staining. The symmetric account that is presented in this rejoinder thus aims to trace the simultaneous construction of facts and artifacts. It will not, however, resurrect Fleck’s counterfactual thesis. (shrink)

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. (shrink)

The ability to effectively prevent smallpox was the greatest medical accomplishment of the first half of the 19th century. From 1838 to 1840, half a century after vaccination was introduced but before it became mandatory in England, data about the general population of England and Wales recorded 70 deaths per million from smallpox; only 180, 900 vaccinations were recorded. In London alone from 1848 to 1852, there were 4, 858 youthful deaths from smallpox, 67% of which occurred during the first (...) five years of life (Simon 1857).In a report to the House of Commons in 1802, Edward Jenner (1749-1823) stated that person-to-person vaccination was a basic principle of his procedure. He gained confidence in it from the case .. (shrink)

The Search for the Legacy of the USPHS Syphilis Study at Tuskegee is a collection of essays from experts in a variety of fields seeking to redefine the legacy of the infamous Tuskegee Syphilis Study. The essayists place the legacy of the study within the evolution of racial and ethnic relations in the United States. Contributors include two leading historians on the study, two former United States Surgeons General, and other prominent scholars from a wide range of fields.

The Search for the Legacy of the USPHS Syphilis Study at Tuskegee is a collection of essays from experts in a variety of fields seeking to redefine the legacy of the infamous Tuskegee Syphilis Study. The essayists place the legacy of the study within the evolution of racial and ethnic relations in the United States. Contributors include two leading historians on the study, two former United States Surgeons General, and other prominent scholars from a wide range of fields.

This special issue addresses the legacy of the U.S. Public Health Service Syphilis Study on health reform, particularly the Affordable Care Act. This article offers readers a guide to the themes that emerge in this issue. These themes include individual consent interrelated to consequences in populations issues, need for better government oversight in research and health care, and the need for overhauling our bioethics training to develop a population-level, culturally driven approach to research bioethics. We hope the guidance offered (...) in this issue will help shape a new framework to bioethics that can be integrated into the foundation of health care reform. (shrink)

In 1997 President Clinton apologized to the survivors of the U.S. Public Health Service Syphilis Study. Since then, two of his recommendations have received little attention. First, he emphasized the need to remember the shameful past so we can build a better future for racial'ethnic minority populations. Second, he directed the creation in partnership with higher education to prepare training materials that would instruct biomedical researchers on the application of ethical principles to research with racial/ethnic minority populations. This article (...) proposes the inclusion of these issues in the implementation of the Affordable Care Act. It asks, What is the right or good thing to do? What are our obligations to one another? Two challenges are examined: (a) Conducting research with African Americans without knowledge of bioethics specific to this population, and (b) the ethical dilemma of conducting research that does not adequately take into account the diversity within the Black population that is a contributing factor in health disparities. Training and policy recommendations responsive to President Clinton's Apology are presented. (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)

This article is guided by principles and practices of bioethics and public health ethics focused on health care reform within the context of promoting Optimal Health. The Tuskegee University National Center for Bioethics in Research and Health Care is moving beyond the traditions of bioethics to incorporate public health ethics and Optimal Health. It is imperative to remember the legacy of the ill-fated research entitled Tuskegee Study of Untreated Syphilis in the Negro Male. Human participant research and health care (...) must be connected to principles of bioethics and public health ethics if the Affordable Care Act is expected to positively impact on the health of people living in the United States. Optimal Health describes a strategy to achieve individual and population health. Health care reform offers an opportunity to shift from the traditional pathology focus of managing diseases to target disease prevention and health promotion with a new set of tools. Transformational change is possible if the lessons learned from the U.S. Public Health Service Syphilis Study at Tuskegee are considered and strategies in bioethics and public heath ethics are employed. (shrink)