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A Dark Age for Medicine?

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ON THE ORIGINS OF THE MODERN CONCEPT OF SYPHILIS EIGHTEENTH CENTURY DEBATE, LUDWIK FLECK, AND THE ENLIGHTENMENT A thesis submitted in fulfilment of the requirements for the Degree of Master of Arts in History and Philosophy of Science Teneille Humphris University of Canterbury 2013 Abstract The enlightenment period is often considered a dark age within the history of medicine. Contrary to this sentiment, I argue that the enlightenment spirit of inquiry regarding venereal disease was vibrant, dynamic, and profoundly influenced how syphilis was understood in the subsequent century. Historiography frequently minimises advances of medical knowledge made in the eighteenth century by focusing on the inefficacy of treatments, rather than on developments in medical theories and concepts. This thesis attends to this gap by examining a case study within venereology to demonstrate that physicians engaging in public debate significantly advanced knowledge of syphilis. In doing so, this counters a historiographical trend that claims that French physician Philippe Ricord (1800-1889) was the first to distinguish syphilis from gonorrhoea in the nineteenth century. It uses historical evidence to show that the nature of syphilis was debated throughout the preceding centuries and that this distinction was clearly established in 1793 by Scottish surgeon, Benjamin Bell (1749-1806). This thesis uses the epistemic concepts devised by Ludwik Fleck in his Genesis and Development of a Scientific Fact (1979 [1935]) to illustrate how enlightenment ways of thinking substantially contributed to the development of modern medicine. This thesis therefore invites a reconsideration of the era, not as a dark age, but as a rich period of scientific endeavour. ii Contents Abstract ................................................................................................................................................................................................... ii Contents ................................................................................................................................................................................................ iii Acknowledgements ............................................................................................................................................................................ v 1. Introduction ........................................................................................................................................ 1 1.1 The nineteenth century: the dawn of modern medicine? ............................................................................... 1 1.2 The unenlightened eighteenth century? ................................................................................................................. 3 1.3 Problem statement .......................................................................................................................................................... 5 1.4 Argument ............................................................................................................................................................................. 6 1.5 Significance of this study ............................................................................................................................................... 7 1.6 The enlightenment ........................................................................................................................................................... 8 1.7 Theoretical framework ................................................................................................................................................ 11 1.8 Parameters ........................................................................................................................................................................ 11 1.9 Terminology ..................................................................................................................................................................... 12 1.10 Conclusion ...................................................................................................................................................................... 13 2. The current scientific understAnding of syphilis ................................................................ 14 2.1 Biology ................................................................................................................................................................................ 15 2.2 Syndrome identification .............................................................................................................................................. 16 2.3 Related diseases .............................................................................................................................................................. 19 2.4 Paleopathology ................................................................................................................................................................ 20 2.5 Conclusion ......................................................................................................................................................................... 21 3. Prominent themes in the history of syphilis ........................................................................ 22 3.1 The origins of the first outbreak in Europe ......................................................................................................... 22 3.2 Associations with morality ......................................................................................................................................... 29 3.3 Treatment .......................................................................................................................................................................... 31 3.4 Identifying syphilis ........................................................................................................................................................ 32 3.5 Conclusion ......................................................................................................................................................................... 35 4. On the nature of syphilis: historiography, Bell, and Ricord ............................................ 37 4.1 The debate ......................................................................................................................................................................... 38 4.2 Historiography: Ricord as a pioneer ...................................................................................................................... 39 4.3 Philippe Ricord ................................................................................................................................................................ 43 4.4 Nineteenth century recognition of eighteenth century debate ................................................................... 45 4.5 Benjamin Bell and knowledge of syphilis in the eighteenth century ........................................................ 48 4.6 Discussion.......................................................................................................................................................................... 54 4.7 Conclusion ......................................................................................................................................................................... 56 5. Ludwik Fleck’s central epistemic concepts........................................................................... 58 iii 5.1 Fleck’s life experience .................................................................................................................................................. 58 5.2 Genesis and Development of a Scientific Fact .................................................................................................... 60 5.3 Central concepts ............................................................................................................................................................. 64 5.4 Discussion and research questions ......................................................................................................................... 70 5.5 Conclusion ......................................................................................................................................................................... 72 6. Proto-ideas and enlightenment thinking .............................................................................. 73 6.1 Proto-ideas ........................................................................................................................................................................ 74 6.2 A harmony of illusions: ingenious methods of resisting Bell's theory ..................................................... 76 6.3 Bell’s theory and the tenacity of systems of opinions ..................................................................................... 78 6.4 The significance of enlightenment thinking about syphilis .......................................................................... 81 6.5 Evaluation of proto-ideas for historical analyses ............................................................................................. 83 6.6 Conclusion ........................................................................................................................................................................
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