A4 LAYOUT ANTHROPOLOGIA

The Contest of Memory (CommunistTahnedcopntoesstt-oCf moemmomryu(nCiosmt mMuoninstuamndepnotsst-icnomBmuulngisat rmioan)uments in Bulgaria)
Fig 7. The Monument “1300 Years of Bulgaria”, Sofia, built
in 1981, present view

Monument of the First Bulgarian State in Shumen, no competion announced, completed in 1980,
sculptor Krum Damjanov, architect A. Brajnov. (Fig.8)

Fig 8. Monument of the First Bulgarian State in Shumen (detail)

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Fig 9. Monument of the First Bulgarian State in Shumen (overview)

 Post-Communist Period:
Monument of the Victims of the Communism in Bulgaria – chapel, commemorative walls with the
names of the victims, ritual stone cross (anonymous donation), Sofia. Competition announced in 1991
(25 projects submitted), started in 1993, completed in 1996. Sponsored by a Citizen’s Foundation,
chair Stoyan Groujchev and 18 other members. Half of the funds provided by the political immigrant
in the USA Ilja Iliev. Architects D. Krastev (head of the Bulgarian Architects’ Union) and I. Todorov,
artist I. Smolenov. (Fig. 10)

Fig 10. Monument of the Victims of the
Communism in Bulgaria

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Monument of the Victims of the People’s Tribunal, Sofia Cemetery, sponsored by donations mostly
from political immigrants from abroad, started in 1995, completed in 1997, the campaign was
initiated and organized by K. Lipovanski. Author of the project artist G. Lipovanski. (Fig.11)

Fig.11 Monument of the Victims of the People’s Tribunal,
Sofia Central Cemetery

Monument of Sacho Sladoura in Plovdiv, sculptor D. Dankov, sponsored by the private Foundation
“Dr. Lazarov”, completed in 2002 (Fig.12)

Fig.12. Monument of Sacho Sladoura in Plovdiv

Monument of the Town Fool in Plovdiv, sculptor D. Dankov, sponsored by the private Foundation
“Dr. Lazarov”, completed in 2003. (Fig.13).

Fig.13. Monument of the town fool in Plovdiv

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The origins

The most notorious, significant and influential and still untouched lieux de memoire (realms of
memory) to quote Pierre Nora’s term in Bulgaria were created during the first “Stalinist” period of the
Communist regime in Bulgaria. They still dominate the major Bulgarian cities. In order to
comprehend the issue of comparing communist and post-communist realms of memory in Bulgaria
one should take account of the several founding principles in communist ideology: mutilation of the
past and abuse of history, and the socio-esthetic dimensions of the totalitarian art. This is why we
should examine the leading political propaganda principles of the time.

The destruction of history

Appropriation of historical time is a common feature of all totalitarian cultures. Selective usage of the
past for the utilitarian purposes of the totalitarian ideology leaves its mark on the understanding of
history and modern times in terms of panculture, as well as on the fine arts and architecture in a
totalitarian society.

The foundation of the totalitarian communist practice is the complete control of history and a variety
of techniques for manipulating the past. (Simonov 1990). From the Bolshevik Revolution, History
departments of Russian universities closed down, and in high schools teachers gave lessons in the
new discipline of “Social Studies” which replaced History. “We must write history from the point of
view of the Party”, says Stalin in 1931, and in 1936 Stalin, Zhdanov and Kirov gave instructions on
how history should be taught in the USSR. The technology of ideologies makes history a legitimacy
factor. Hitler also believed one learns history not in order to discover what happened in the past, but
to acquire certain behavior necessary for the future struggle for survival of one’s people. (Geller and
Neckrich 1994).

In Bulgaria, the government organized a wholesale “tribunal against the historians” in which the most
prominent professors and scholars are discarded physically, socially and intellectually from their
profession in order to clear up space for rewriting communist history. (Moutafchieva, 1992). After
1944, the so called ‘People’s power’ begins constructing the new historical memory of the nation by
means of total propaganda, educational programs, by bogus obligatory commemorative “ritualism,”
by visual and literary realms of memory. An idiosyncratic type of social engineering aims at
disconnecting the natural historical and cultural memory of the Bulgarian nation and at imposing on it
the artificial models of a foreign ideology. The government creates the myth of the antifascist
struggle, the Red Army ‘Liberator’, and the new heroes building socialism. Cities, mountains, streets
and institutions are being renamed. The name of Stalin adorns the biggest Bulgarian seaport and the
highest peak on the Balkan Peninsula. National history is practically obliterated as bourgeoisie
anachronism.

The destruction of “historical time” (after the phrasing of M. Eliade) leads to regression towards
mythological thinking with the consequence of creation of an entire new pantheon of mystified heroes
and their materialized monumental forms.

Creation of the totalitarian space – synthesis of the arts

The reshaping of urban spaces first in the capital and later in the bigger and smaller towns and
villages is one of the largest enterprises during the communist regime in Bulgaria. It was
indispensable throughout the period between 1944 and 1989.

In no other art movement of the 20th century did the questions of synthesis and monumental arts
receive as much attention and had as large a comparative ratio as in totalitarian art. The synthesis of
the arts in a totalitarian society is sought in its totality, in its all-encompassing effect of architecture
and the fine arts, as well as in reproducing the artistically organic unity of the classical examples of
the Antiquity and the Middle Ages. (Golomstock, 1990)

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Lenin himself introduces the term “synthesis of the arts” in his plan for wholesale propaganda. This
synthesis is the most evident and most powerful representation of the ideology that targets the
collective spectator. In the USSR - as well in the other satellite communist countries after 1994 - a
complete program for synthesis of the arts is in action, with architecture taking the leading role based
on the traditional order system. (Popov, 2002).
In Bulgaria, the Lenin’s and Stalin’s examples of total propaganda were well adopted. The capital city
of Sofia followed in the creation of a new central axis from east to west. It was initiated with the
building of the memorial called the “Mound of Brotherhood” on a hill at the East end of the largest
Freedom Park. The axis continues through the Soviet Army monument in downtown Sofia, next to
the Sofia University and ends at the pentagram at the top of the Headquarters of the Bulgarian
Communist Party tower (an overall distance of approximately 3 km). After the destruction of the
main trade thoroughfare in the capital, the new political and administrative center of the city develops
along this axis, comprised by gigantic Moscow-type stone buildings designed in the USSR and in
accordance with all safety measurements – wall thickness, distance between windows, bomb shelter,
underground passages, secret exits, etc.
In the 1960s and 1970s a new stage of re-urbanization began, this time of regional towns. They turned
into replicas of the metropolises, resembling in a distorted way the Roman practice – a central square-
forum, surrounded by the Party House, local administration and a theater or museum. During more
recent times, a peculiar “palace nostalgia” surfaced and from it sprang the Palaces of Culture and
Sport – in Sofia, Varna and other cities, as well as a series of super-luxurious residences of the ruling
elite, which, however, remained closed for the common people. Thus, the dictatorship of the “third
class” (to quote M. Djilas) broke completely its demagogic connection with the people.

Fig.14.. The Monument of the Soviet Army, Sofia, built in 1954, present view

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Fig.15. Fragment of the Monument of the Soviet Army, Sofia, Graffiti protesting against the annexation of Crimea by Russia
in February 2014

Ideology turns into mythology through art

The official monuments, sponsored lavishly by the state, are the signs of the historical memory, the
ideology visualized, the power made legitimate, the “semiosis” of the socialist identity. Bulgaria is
ridden with such memorials and monuments, and only some of them were dismantled after the
changes, primarily in the big towns. For about forty years the leading artists, among them some
famous and talented Bulgarian architects, sculptors, and painters were “mobilized” and lavishly paid
by the state to design and execute various memorials.

It is noted that as an aesthetic phenomenon, totalitarian art remains eclectic, although most akin to the
academic-classical model. It seems to be a diversion from the common path of historical and aesthetic
processes. Because totalitarian art is the language of power, its discourse is the discourse of power –
thereby it does not have neither aesthetic nor artistic nature. A popular Bulgarian joke went “socialist
realism is eulogy for those in power done in a way easy to grasp by them.” The joke intended to send
the message of the inseparable aspect of apotheosis in this art, as well as the presumption that the
ruling communist elite has low culture and lacks aesthetic taste.

The examples of communist memorials and monuments in Bulgaria are a direct illustration of the
above argument. The creation of the new realms of memory not only refigured and abused history;
they constructed the new "socialist consciousness" through their uncontested powerful visual and
symbolic presence at the center of the socialist landscape. Bulgaria is literally flooded with stone and
bronze busts and statues of male and female partisans, gigantic monuments of the Soviet Liberation
Army (an oxymoron in itself), museums of the revolutionary struggle against fascism (the later never
in power in Bulgaria) and capitalism, and of the “building of socialism”, which is also perceived as a
struggle. To this day, in the village of Bania, in the region of Razlog, Southwestern Bulgaria, a
monument of Lenin and Georgi Dimitrov in a fraternal embrace sticks up. The fact that they have
never met is of no importance. The mythology has been created.

Survival technique – the mimicry of ideology and art style

In the 70s, a new period of constructing the historical and cultural memory begins. I call it socialist
nationalism and it is based on two principles. The first, ideological, was the rediscovery of national

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history. Let us rephrase the notorious saying that nationalism is the last refuge of a scoundrel. The
irreversible erosion of the so-called developed socialist society imposed the change of the model of
realms of memory as well. Second principle, aesthetic, was an attempt to change the style of
representation. In order to achieve this, the ruling elite allowed the modernists to join in and the artists
to have a relative freedom, and they also revoked the tacit veto over abstract art in Bulgaria.

Liudmila Zhivkova, the daughter of the communist leader Todor Zhivkov, became the Minister of
Culture and launched the ambitious and inadequate program “1300 years of Bulgaria.” (Rothschild
1999) In honor of the anticipated mega-celebration, the 20-meters “modern” abstract monument
called “1300 Years Bulgaria” was erected in front of the Palace of Culture in Sofia, (the latter itself
being another ambitious project of the Minister of Culture). This new intended-to be realm of
memory became soon a subject of ridicule in dozens of popular jokes, along with the aesthetic
criticism against the artistic value of the monument itself. Furthermore, it became an epitome for the
megalomaniac cultural policy of Zhivkov’s daughter, popularly called “The Princess”.

The history of the memorial complex in Shumen, North-Eastern Bulgaria is nearly similar, part of the
same program “1300 Years of Bulgaria”. It is an impressive and creative complex of structures,
sculptures, mosaics build by Kroum Damianov in the center of region of the first Bulgarian medieval
state (681-996). Some foreign researchers even interpreted - incorrectly - the erection of this
monument as a deliberate provocation against the compact Turkish minority in the region, since an
argument for it could be found with the so-called Regeneration process – an attempt to denationalize
the Turkish minority in Bulgaria in 1984-85. (Biancinni 1999).

Similar is the style (and the present condition) of the memorial complex “Mound of Brotherhood” in
Plovdiv. It represents not only the so-called “anti-fascist struggle”, but all national liberation
movements of Bulgaria, thus for the first time joining the nationalistic and the communist reading of
historical memory. The expressionist sculptures of the renowned artist Liubomir Dalchev
(subsequently, he immigrated illegally to the USA) have been recently mutilated since their bronze
parts – heads, arms, legs, rifles – are stolen, despite the 24 hours security measures.

The social fate of communist monuments preservation

It is more than obvious that even now the centers of a number of Bulgarian cities are dominated by
Stalinist-era-like monuments of the Soviet army and Soviet soldiers; towns remain named after
Dimitrov and Blagoev, with giant statues of their namesakes still erect (Pernik, Dimitrovgrad,
Blagoevgrad). The so-called “Mounds of Brotherhood” or common graves are widely spread
throughout the country, in smaller towns and villages the monuments dedicated to the local partisans
are left untouched.

The most notorious examples of such monuments are the Mound of Brotherhood in Sofia, the Soviet
Army monument in Sofia, the Soviet Soldier monument in Plovdiv, popularly called “Aljosha” and
until recently the Mausoleum of Georgi Dimitrov in Sofia.

The falsification for the “soldiers’ monuments”

Long and heated debates and both serious and ridiculous projects were launched for the freeze or the
demolition of the famous monument of the Soviet soldier – by the name of Aliosha in Plovdiv (avant-
garde packing in the style of Christo, the Bulgarian born ecological artist of world fame; covering the
stone statue with gigantic metal mirrors, tearing down only the Kalashnikov and renaming the
Monument Aljocha Karamazov after the Dostoevsky’s literary character etc.). (Information about the
debates at the Municipality of Plovdiv courtesy Albena Hranova.)

All debates were over when the Russian ambassador in Bulgaria, Anatoly Sharapov threatened
Bulgarian authorities that any action taken against the monuments of the Soviet Army in Bulgarian
would be taken as a violation of military graveyards, which have long been considered revered under

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international law. (It is a fact that the memorial of the Soviet Army is still standing untouched in the
centre of Vienna. But it was part of a special clause in the peace treaty between Austria and the USSR
signed in 1949. The Red Army fought long and bloody battles on Austrian territory and therefore this
monument is rightly considered a soldiers’ memorial).

There is a claim that in 1992 President Z. Zhelev did sign a contract with President Eltzine which
provided for the preservation of all “Soviet Soldiers’ Monuments in Bulgaria. (Dimitrov 2004).

But the case in Bulgaria is completely different. Not a single Red Army soldier has fallen for the
‘liberation’ of Bulgaria from the ‘fascists’. Not even mentioning the fact, that at this time there were
no German troops in Bulgaria anymore and there was no resistance whatsoever from the side of any
Bulgarian garrison when the Red army marched into the country.

Therefore the argument for the sanctity of the monuments of the Soviet Army and its soldiers in
Bulgaria is just another falsification. Based on this falsification Bulgarian landscape and cultural
memory is still an object of a powerful ‘irradiation” from the gigantic Soviet Army monuments.

Disapearence

Katherine Verdery is right to argue that: “Tearing down and erecting statues goes on all over the
world, in the past as well as present; there is nothing specifically post socialist communist about it.
Because political order has something to do with both landscape and history, changing the political
order, no matter where, often means changing the bronzed human being who both stabilizes the
landscape and temporally freezes particular values in it. But there are two ways in which these
instances are nonetheless specific to post socialism.…First is their sheer number, reflecting the
magnitude of the changes. Even though the social orders emerging from socialism may continue to
resemble it in many respects, part of their legitimation comes from representing themselves as
discontinuous with it; statue successions are critical in this representation. Second, if statues
participate in stabilizing particular spatial and temporal orders,…., then to the extent that socialism
organized space and time differently from other kinds of society, tearing down socialist-era statues is
indeed special.” (Verdery, 1999).

After 1989, with no “unnecessary” explanation, but rather quickly and in shame, the mandatory
statues of Lenin, Dimitrov, Brezhnev and a couple of local party heroes were caused to disappear.
The ruling party, renamed overnight from BCP -- Bulgarian Communist Party into BSP – Bulgarian
Socialist Party in 1989, did not want to provoke neither a debate, nor provide explanation why it was
necessary to remove the most prominent symbols of its rule.

Postfactum, there were a lot of proposals for modification of the most significant memorials. In 1991,
the director of the Dimitrovgrad Theater Nedialko Delchev suggested – with no avail - that all
monuments be shipped to the city of Dimitrovgrad and thus turn it into a kind of a real life museum of
communist memorials. (Oral interview of the author, November, 2004) .Any attempt for the design of
a Statue Park (following the Hungarian example), or the refigure of a particular space either as a
museum, lapidarium, or a living space organized to exhibit the relics of the communist past, never
came into existence in Bulgaria.

All these proposals were in fact provoked by the spontaneous attacks on the monuments in the shape
of graffiti, parades to parody the communist-style manifestations, etc. This type of unprovoked, mass,
unorganized defacing of communist symbols was subject to criticism by the former ruling elite or
nomenclature – protest were expressed concerning the vandalized monuments, groups of war veterans
and partisans were organized to clean the graffiti off, local authorities were to post police surveillance
so that the monuments would be protected from the “love of the people”.

The graffiti was gone. Some monuments were disassembled, others – smelt or “decorated”. And there
is the unique case of the Dimitrov Mausoleum, blown up in 1999.

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Is graffiti vandalism?

“Political categories are themselves dynamic, taking on different meanings and functions as they are
embraced and deployed. Old forms and symbols are being redefined as they are mobilized for new
objectives in a new political context.” (Creed 1999). The same turned out to be true for the realms of
memory in Bulgaria.

The released social energy after the collapse of communism found its most widespread manifestation
in mass meetings, processions, night vigils, carnivals, and concerts that took place all over the
country. An original artistic group was formed in Plovdiv, consisting of a young avant-garde
sculptors and artists. They organized several extremely popular exhibitions and happenings, focused
on radical disfiguration of Communist symbols and signs. Its name was “Rub” (Edge). The irony and
sarcasm, combined with outstanding artistic creativity brought this group international recognition.
(Information courtesy of the members of the group “Rub” Dimitar Kelbechev, Koljo Karamfilov,
Roumen Zhekov, Monica Romanska and the critic Dimitar Grozdanov ).

Another potent new way to express the negative reactions to communism was the graffiti boom. It is
not random that graffiti was mostly seen in the two sacred spots for communism in the capital city –
the Soviet Army monument and the Mausoleum, both of which later became the subject of research
done by Bulgarian and foreign scholars alike. The best part of the graffiti comprises political slogans,
denouncing the Communist party and its leaders, ridiculing and caricaturing famous political figures
(including the newly elected democratic leaders), drawing parallels between fascism and communism,
condemnations against the crimes of the former regime, and calls for new elections. Those graffiti did
not only cause the appearance of even more graffiti, but provoked dialog and contradictions. The
walls of these two notable memorials in Sofia became a peculiar place for a terse and ironic
discussion between the supporters of the former Communist Party and those of the new Democratic
Party. They carried messages with more universal meanings as well – for example on the back of the
Soviet Army monument there was a graffiti saying:“I don’t want to be a soldier.”(Mihailova 1993,
Elchinova and Raicheva 1991, Kraev 1990).

In the analysis of public opinion, done on the basis of various surveys, it turns out that even though
24% of people do not pay attention to graffiti, 81% do not approve of them. They think that they are
done by ill-educated, sectarian, vengeful, neo-Nazi, vagabond young people. The accusations voiced
range from encroachment on national dignity, destruction of national pride, disregard for our own
historical past and go as far as calling graffiti blasphemy, vandalism, triteness, loathsome, obscene,
vulgar, democracy-gone-wrong, lack of culture, and hideous.

The positive opinions on graffiti, a significantly smaller percentage, define them as rebellion, denial,
social release and disregard for the symbols of social realism. And the people writing them are seen
as jokers, jolly, free people, without insecurities, people who act on their emotions, rather than
thinking things through, ardent followers of some political party, and even zealots. (Ivanova 1997).
The author of this research expresses the opinion that ultimately graffiti stand for the uneducated,
obscene, vandalized form of protest. In my opinion, it is exactly the opposite – graffiti are the result
of the outburst of energy, creativity and irony that have been suppressed for a long time. And it was
this protest that spontaneously and irreversibly turned some of the most powerful symbols of
communism into a new creative space, where the resolve of the anonymous, but active citizen was
clearly seen. In this way graffiti in fact stultified communist realms of memory and it destroyed their
inviolability, gave life to dead fictional ideological symbols, and thus became the first attempt for the
deconstruction of these realms.

P.S. Continuation of the spontaneous deconstruction

The impulsive deconstruction that began with graffiti to turn former totalitarian spaces into grotesque
“carnivals” resulted in a peaceful and spontaneous destruction of the essence of the communist realms

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of memory. That was and still is a way of taking this space “away”, using it for activities that are
completely contradictory to the forced taboo that was placed on these spaces before. Each year in
front of this monument of the Soviet Liberation Army a techno music parade, which lasts for more
than twelve hours, is held. And throughout the year skaters occupy the space around the monument.
The Sofia municipality even provided them with special facilities for skating. These teenagers,
speeding away on their skates, could not care less for the pig-iron giants of Communism surrounding
them, or for the fact that the Soviet Army has never actually liberated Bulgaria from anything, or that
the “red grannies” will hold a procession on May 9th and will lay flowers in front of the statue’s
Russian soldiers’ guns. For these teenagers the monument is invisible.

Could a denial be greater than the indifference of the new generation?

Destruction: natural and by force

Both are currently happening in Bulgaria.

Natural destruction is simply the disintegration of the gigantic memorials, built exclusively in the
second period of the creation of the “realms of memory” – the period of socialist nationalism. The
iron-concrete construction crumble, the tiling is falling off, the inlaid work is breaking open, the
metal is corroding, and the iron reinforcement is beginning to show. The monuments are being fenced
off so that passers-by do not get hurt. The most prominent example of this destruction is the famous
“1300 years of Bulgaria” monument. As it crumbles away piece-by-piece daily - because of its
extremely incompetent execution – it poses a real threat for anyone who happens to walk past it.
Funds for its complete destruction or restoration have not been found, nor a political decision for
either of the two has been taken. The situation with the Memorial Complex in Shumen is identical.

There is yet another, peculiar form of destruction – theft. The morning’s light found many city parks
throughout Bulgaria with empty pedestals, with missing busts and heads of the heroes of our national
pantheon. Naturally, theft of metal is widespread wherever possible, but the monuments proved to be
easy to access and rich in material. More ingenious municipalities replaced the missing statues made
of stone. In poorer regions only the empty pedestals remain.

This problem is both social and economic. But the state could have easily dealt with it by simply
refusing to buy such material as scrap metal. However none of the governments so far implemented
this simple and logical solution. The scrap metal trade is booming at the expense of the legs, arms,
and heads of the statues. It is an interesting fact that many of of the monuments subject to theft were
built before the Communist era or were dedicated to the heroes of the National Liberation movement.
The enormous memorials of the communist era are safe from theft because of their size, height and,
of course, weight. They are physically everlasting.

A special case: the demolition of the Mausoleum

In August 1999, ten years after the fall of the Berlin Wall, in the centre of Sofia the Mausoleum of
Georgi Dimitrov, the internationally known activist of the Commintern and Head of the Peoples’
Republic of Bulgaria during the period between 1946 to 1949, was torn down. The first
democratically elected president of Bulgaria, Zhelyu Zhelev, long before that had jokingly
commented that the building was the westernmost point marking the spread of the special kind of
anachronistic eastern necrophilia that extended from North Korea, Vietnam, through China and
Russia to…Bulgaria. The Mausoleum was not just a realm of memory—it was the actual centre of the
communist total public propaganda—from its tribune the party/state leaders greeted massive and
obligatory parades organized for over 40 years. And Dimitrov’s mummy was visited not only by
students and tourists, but by the foreign diplomatic and political figures visiting the country.

Precisely due to these reasons it became the centre of the spontaneous deconstruction of the realms of
memory sacred to Communism. Young people took the building over during the parades and

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carnivals; that is where, in keeping with folk tradition, piles of stones were gathered to express the
dissatisfaction with this or that politician; that is where the first political graffiti appeared and where
the opposition kept its vigils at night. The Mausoleum was deconstructed by another event as well—
due to the wish of Dimitrov’s heirs, the mummy was removed from the Mausoleum and cremated in
the presence of a close family circle. The former tomb no longer served its previous specific purpose.
Even the former communists—now socialists—held their demonstrations away from the Mausoleum.
Proposals for the fate of the empty tomb started mushrooming—the artist Ognian Funev suggested
that it became a museum of wax dolls representing Bulgaria’s most recent history, the leader of the
Bulgarian Communist Party wanted it to be a Pantheon of military glory, Oxford University professor
Richard Crampton, a renowned expert in Bulgarian history saw it as a museum dedicated to the
victims of totalitarianism, and the most radical proposal was that it was turned into a…urinal. The
building was eventually demolished, the event produced relief in some, nostalgic aggression in others,
and for a third group of people this was a reason for intellectual contemplation.

The author of the most extensive article on the Mausoleum, Maria Todorova, (Todorova, 2004) insists
that tearing something down does not transform it from a realm of memory into a realm where the
past is forgotten, and that the process of forgetting the past should be accomplished not by erasing it,
but by overlap, as argued by Umberto Ecco. She uses numerous citations from the debates on the
demolition /even though she states that there were no debates at the time/, as well as citations from
results of public opinion polls. It turns out that 64% of the 529 people from Sofia, who participated in
the poll, do not like the Mausoleum, but only 34% were in favour of its demolition. 42% wanted it
transformed into something else, and 24% wanted it left as it was. The data from another poll shows
that 42% of the participants favoured its preservation, while 27% wanted it torn down.1

The conclusion is justified by Paul Ricoeur’s system with its three approaches to the processes of
memory and forgetting:

• Forgetting and the forgotten memory on a psychopathological level

• Manipulated memory and forgetting on a practical and instrumental level
• Controlled memory and forgetting on an ethical/political level

In the last category, prohibition and forgiveness are closely related to the complexity of the past:
prohibition - to memory and loyalty to the past, and forgiveness - to guilt and the process of making
peace with the past. (Ricoeur, 2000).

Todorova uses analogy to suggest that “…persecution and destruction, even when explicitly
articulated as means towards forgetting, serve as reminders and can simultaneously /and
intentionally/ increase the level of social tension”. (Todorova, Maria. Op. cit., 393).

My reasons for not accepting this kind of reasoning come from a different point of view. I would
insist on analysis of the historic context of the otherwise limited debate on what should be done with
the Mausoleum and whether its demolishing is so dangerous to the climate of social stability in
Bulgaria. The dispute over the Mausoleum thus becomes a singular focus of intellectual interest and
of social debate. However this is actually just the top of the iceberg called the legacy of the
communist past. The problem comes from the fact that Bulgaria was intentionally deprived from the
process of analysis and self-reflection that was intended to bring about the decision regarding the fate
of the symbol that was the Mausoleum.

The issue at hand is not how harmless the Mausoleum had become after the removal of the mummy,
but why that mummy was there in the first place, and who that leader of the Bulgarian people had
been. The trouble is not whether there had been a debate about the demolishing of the building or not.
Even up until today communist history in Bulgaria has not been “demolished,” but radical discourse
in support or in opposition of its legacy was concealed. Thus a consensus taboo against the “crime

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and guilt” discourse was adopted by the major mass media. The series and varieties of crimes
committed by the regime were pushed aside to the periphery of the mass awareness — from the mass
murders of people not given the right of a fair trial, the concentration camps, the deportations, the
dismissal of workers, to the destruction of the environment, the ruin to which agriculture was brought,
the financial crisis, and the spiritual devastation. The media, the institutions producing academic
history, as well as those dedicated to public education, still keep repeating the stereotypes of
communist historiography and evaluations of the recent past. A new textbook on the history of
Communism has not been yet written.

The problem is not whether the Mausoleum should have become another museum, but that the
Bulgarian public still has neither a clear nor systematic view of what exactly should be exhibited in
this museum fifteen years after the changes. The trouble is not how many people like or dislike the
Mausoleum and the leader inside it. The problem comes from the fact that in Bulgaria nobody has
been sentenced for the murders and persecutions of the period between 1944 and 1989. Access to the
archives of the secret services is constantly being restrained, if not completely denied. The law on
access to the archives of the former State Security network was rescinded. The State Security activists
are still members of the governing circles. This is one of the indirect reasons behind the enormous
and endless proliferation of texts glorifying communism in Bulgaria and justifying the reactions of
the former elite.

Today’s realms of memory / The invisible post- communist monuments

There are few, at the periphery, built with private donations, modest, and – socially invisible. The
creation of the new realms of memory is distinctly different from the one during communism.

The first of those monuments was a simple iron cross at the place of the most sinister concentration
camp in Lovech, Northern Central Bulgaria, where during 1961-62 150 prisoners were murdered
without court procedures. A similar cross marks the place of execution of about 80 people, victims of
the communist illegal repressions in October, 1944 next to the town of Dupnitsa in Southwestern
Bulgaria. New mass graves from that time appear in various sights in Bulgaria (Dobrinishte village,
South-Western Bulgaria and in Gorna Oriahovitsa in Northern Central Bulgaria). They do not have
monuments. Most visible is the Monument of the Victims of communism in Bulgaria, built in the
same park in front of the Palace of Culture where the monument “1300 Years of Bulgaria” is falling
apart. It is a complex of a small chapel, granite slabs with the names of the victims engraved, and an
authentic stone ritual cross. The Citizens’ Association with chairman Stoyan Gruichev made the
building of the monument possible. It is a blend between traditional church architecture, the Vietnam
War Memorial in Washington and the native Bulgarian medieval legacy. None of the 23 people I
interviewed around the monument knew its dedication. Most often, they connected it with the war
monuments of the Balkan wars in 1912-1913.

The other virtually invisible monument stands at the very end of the Central Sofia cemetery, where on
February 1, 1945 the regents, the ministers and a great number of the members of the 25th National
Assembly were executed. Their names are written at the sides of the columns surrounding the
allegorical figure of a mourning woman. Only one person from the private security company of the
cemetery was able to show me the way to the monument of the biggest massive execution of the
political elite of pre-war Bulgaria, sentenced by the People’s Tribunal. The monument was built
entirely with donations, initiated and organized by Georgy Lipovanski. It is seldom visited, and then
primarily by the relatives of the perished.

The last type of new monuments of post-totalitarian times is the portraitist bronze statues that the
private foundation of Dr. Lazarov, political immigrant in Germany, built in Plovdiv. The first of these
monuments stands in the Music Conservatory yard and it represents Sasho Sladura, violinist virtuoso,

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The Contest of Memory (CommunistThaencdonpteostsot-fCmoemmomryu(CnoismtmMunoisnt uanmdepnostts-cionmmBuunligstamroianu)ments in Bulgaria)

killed during his first night at the concentration camp of Lovech. The second is of Tsanko Lavrenov,
famous Bulgarian painter, and the third is of the town fool Milio – the local character

The common feature of these monuments is that they are of real people who left a deep mark in the
cultural memory of Bulgaria, not of depersonalized and idealized mythological-ideological contrived
types of heroes, common in the communist period. And the commemoration of the local town fool is
a new type of urban self-parody – a sign for a modern anti-totalitarian self-reflection. His monument
became the most popular meeting place at the busiest spot in downtown Plovdiv.

The visual realms of memory from the communist and post-communist periods are not comparable
neither by number, nor by theme, nor by style, nor by magnitude. They represent two different types
of culture, two different types of self-knowledge and construction of public opinion and of cultural
memory. The former is official, contrived, eclectic and lavishly state-sponsored. The latter is free,
selective, creative and voluntary. The former continues to dominate on a purely physical level all
bigger cities in Bulgaria, while the latter is still in the margins of Bulgarian cultural self-reflection.
When this changes will be determined by the change of the paradigm of attitude towards the past.

The reasons

Bulgarian society has been vetoed an objective and fair assessment of its communist past. Even today
Bulgarian society is still a subject of a major historical manipulation fostered by the revival of the
communist nostalgia. The comparative study of communist and post-communist memorials has
shown this clearly.

The conclusion is that for the last fifteen years Bulgaria lacks a real, coherent politics of creating a
(un)visible memory, or realms of memory of the recent communist past. The issue is much larger than
the issue of bare construction of monuments of the victims of communist purges and their particularly
limited “geography”. The main reason for this omission is the fact that the political elites in Bulgaria
have been refusing to clearly admit and acknowledge the historical guilt for the crimes of the
communist regime.

Back in 1996, the European People’s Party proposed to the Parliamentarian Assembly of Europe
(PASE) to pass Resolution 1096 on the condemnation of communism as a whole. The issue has been
postponed for over nine years now. Ironically enough, this was done on the grounds of “missing
sufficient information about the crimes of communist regimes in Eastern Europe". (Elenska 2004).
The reasons that made this possible are complex. On one hand, this is the “la gauche caviar” attitude
coming from West European leftist circles; on the other hand, this is because the Communist
Holocaust had never had its own Nuremberg.

The 39th National Assembly in Bulgaria adopted an Act Declaring the Criminal Nature of the
Communist Regime in Bulgaria only in May 2000. The representatives of the Bulgarian Socialist
Party did not sign it, although this declaration did not have any legal implications, but rather tended to
be more of a declarative nature.

For twenty five years of freedom, Bulgarian society was deprived from both the sources of
information revealing its recent communist past and the thorough investigation, systematization and
analysis of the crimes of the regime.2 (Hristov 1989), That is why the pseudo-nostalgic attitude is
surfacing, that is why socialists continue to stubbornly be proud of the hundred years history of their
party, even though it caused the repression of democracy and of many fundamental human rights and
values in Bulgaria. The main issue is much larger than whether the demolishing of the Mausoleum
would have put the balance of social tension at risk (which it never did), or whether the Soviet Army
monuments are or are not soldiers’ memorials. Due to the flexible policy of the post-communist
elites, Bulgarian society has been living in a paranoid asymmetry regarding its own history, and what

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Evelina Kelbecheva Evelina Kelbecheva

is even worse, regarding the current state of affairs. Because the predominant judicial doctrine in the
world is still based on the maxim -- Ex iniuria ius non oritur – "unjust acts cannot create justice".

Fig. 16 The Monument of the Town Fool Milyo, built in the 1990’s by Dr. Lazarov Foundation, Plovdiv

References

Biancinni, Stefan. 1999. The Regenerative Process in Bulgaria. Paper delivered at the Annual Convention of
the American Association for Advancement of Slavic Studies (AAASS), Boca Raton, Florida.

Bochkov, Kiril 2005. Oral interview, January 2005.
Bremmaer, Hans. 2002. La politique artistique du national –socialisme. Paris : Maspero.93,
Creed, Jerald. 1999. Deconstructing Socialism in Bulgaria. Uncertain Transition. Ed. Michael Buraway and

Katerine Verdery.Lanham : Rowman &Littlefield Publishers
Dimitrov Philip, 2004. Legal Aspect of the Condemnation of Communism. In The International Condemnation

of Communism: The Bulgarian Perspective. Excerpts from the Reports presented at the Colloquium in
Koprivschtitsa (Bulgaria), 24-26 September 2004. Sofia: Vasil Stanilov Workshop, 111-112.
.Elenska, Mariana. 2004. On Mimicry and Short Memory. In The International Condemnation of Communism:
The Bulgarian Perspective. Exerpts from the Reprts presented at the Colloquium in Koprivschtitsa
(Bulgaria), 24-26 September 2004. Sofia: Vasil Stanilov Workshop, 34-35.
Elchinova, Magdalena, and Raicheva Valentina. 1991.Grafichnite textove ot studentskata opupazionna stachka
I grada na istinata (The Graphic Texts from the Students’ Strike and the Town of Truth). Bulgarski
Folklore, 17.3 , 22-41.
Geller, Michael & Neckrich Anatoli. 1994.Utopiata na vlast (The Utopia in Power). Sofia: LIK, 8.
Gergov, G. 2000. Istinata za mavzoleja. (The Truth about the Mousoleum). Sofia : Sibia, 8.
Golomstock, Ivan. 1990. Totalitarian Art. London: Collins Harvill.198.
Groujchev, Stoyan.2004. Oral interview, December 2004
Hristov, Hristo. 2004. The Crimes During the Communist Regime and the Attempts at Their Investigation after
10 November 1989 .In The International Condemnation of Communism: The Bulgarian Perspective.
Excerpts from the Reports presented at the Colloquium in Koprivschtitsa (Bulgaria), 24-26 September
2004.Sofia.
Ivanova, Radost, 1997. Grafitite varhu pametnika na Savetskata armiia I mavzoleja (The Graffiti over the
Soviet Army Monument and the Mausoleum). In Sbogom dinozavri, dobre dochli krokodili! Etnologia
na promianata. (Farewell Dinosaurs, Welcome Crocodiles! Ethnology of the Change).Sofia: Bulgarian
Academy of Sciences Academic Press Marin Drinov, 85-107
Kraev, Georg. 1990 . Mitologiata gradskata folklor na praznichnost ili kam mitologiiata na dnechnoto (For the
Mythology of the City Folkloric Festivity or for the Mythology of the Present-day). Bulgarski Folklore,
16.3 33-41.

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Lipovanski, Georgy, 2005. Oral interview January 2005.
Mihailova, Katia.1993. Photorazkaz za novoto litse na mavzoleja (Photostory for the Face of the Mausoleum).

Bulgarski Folklore19.4. 104-110.;
Moutafchieva, Vera. 1992. Sadat nad istorizite (The Tribunal Over the Historians). Sofia : Bulgarian Academy

of Sciences Publishing Press Marin Drinov,.8-12.
Popov, Chavdar. 2002. Totalitarnoto izkustvo. Ideologia, organizazia, praktika. (Totalitarian Art. Ideology,

Organization, Practice). Sofia :St.Kliment Ohridski University Press,.215.
Ricoeur, Paul. 2000. Le memoire, l’histoire, l’oubli. Paris: Gallimard. 83-97.
Rothschild, Joseph. 1999. Return to Diversity. A Political History of East Central Eurrope Since World War II.

Oxford: Oxford University Press,215-216.
Simonov, Konstantin. 1990. Glazami heloveka moevogo pokolenija. (Though the Eyes of a Man from my

Generation). Moscow: Isskustvo, 165-166.
Todorova, Maria. 2004. Mavzoleiat na Georgi Dimitrov kato lieu de memoire (The Mausoleum of Georgi

Dimitrov as Realm of Memory). Fakel 4-5 (2004). 371- 400.
Trufechev, Nikolaj. 1968. Monumentalnite izkustva I architecturata v Bulgaria. (Monumental Arts and

Architecture in Bulgaria). Sofia : Tehnika, 178-181.
Verdery, Katherine. 1999. The Political Live of Dead Bodies. Reburial and Post socialist Change. New York:

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The IHT Online : http://www.iht.com/articles/2004/11/09/news/bulgaria.html

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ΑΝΘΡΩΠΟΛΟΓΙΑ
& IΣΤΟΡΙΑ

ANTHROPOLOGY
& HISTORY



How did malaria reach the MediterraneanH?owAdnidompaelanriqaureeascthiothne Mediterranean? An open question

How did malaria reach the Mediterranean? An open question

Katerina Gardikas

Department of History, National and Kapodistrian University of Athens

Abstract

The history of malaria may have a life of more than a century, but central questions still remain
unresolved. Furthermore, like malaria research in general, it has been affected by shifts in
scientific paradigms, which have redefined research projects and approaches to existing questions.
By highlighting the underlying assumptions of conflicting histories, which often transcend
paradigmatic shifts, this paper explores the storylines of vivax and falciparum malaria until the
arrival of the diseases in Greece.

Keywords: malaria, vivax, falciparum, history, Mediterranean, Greece

A brief survey

Among human diseases, malaria was the first to generate an interest in its historical background.
To this day, however, many central issues in the history of malaria remain unresolved. Some of
these issues define the circumstances of the arrival of malaria in the Mediterranean. This paper
explores the underlying assumptions and fundamental arguments of the conflicting narratives.

Before the early twentieth century, the medical authors of antiquity were treated as medical rather
than historical sources. Thereafter and until the 1950s the history of malaria attracted the interest
of scholars but was set exclusively in the classical lands and relied for its sources mostly on
ancient Greek and Latin works (Bruce-Chwatt and de Zulueta 1980). Conflicting views on the
chronology of malaria in the Mediterranean appeared as early as these first histories of the
disease, that is after the publication of Jones’s Malaria, a neglected factor in the history of Greece
and Rome, and the controversy to which it gave rise (Jones, Ross and Ellett 1907). W.S.H. Jones,
a classical scholar, as well as Ronald Ross, the malariologist who discovered the transmission
mechanism of malaria through the anopheles mosquito, in his introduction to the book, were both
clear about the African origin of malaria.

Soldiers, merchants, or slaves coming from Africa or Asia, the ancient homes of malaria,
introduced it. Once introduced, it must have spread from valley to valley with fearful effect upon
the inhabitants. It would probably have seized first the most low-lying and fertile valleys,
especially the cultivated outskirts of the cities, and have thence spread into the upland villages
and even into the heart of some of the cities. Everywhere the children would be attacked and
would remain infected, with pale complexions, emaciated frames, and enlarged spleens, until
puberty, when a partial (but only partial) immunity might rescue the probably stunted bodies of
the survivors from further illness. Gradually the whole rural life of the affected area would be
vitiated; the hardy peasantry and the vigorous soldiers would no longer be found; the rich would
desert their villas, and the priests the rural shrines of the gods. Still further, supposing that at the
same time numbers of Africans and Asiatics had been poured into the country as slaves, these
people, already probably inured to malaria in their tropical homes, would survive, while their
fair-haired masters and masters' children would gradually tend to be eliminated; so that, after
perhaps a century or two, the whole character of the population might gradually be changed.
(Jones, Ross and Ellett 1907).

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Katerina Gardikas Katerina Gardikas

Ross speculated in 1907 that malaria took hold of Greece after the classical era. Regarding Italy,
though, Jones postulated that malaria was present there only after the second century BCE (Jones,
Ross and Ellett 1907). Likewise, Angelo Celli, in his history, which was published posthumously,
dated the introduction of malaria also from Africa to Italy to the aftermath of the second Punic
war around 200 BCE (Celli 1925).

Other early-twentieth century histories debated the origins of malaria in the Greek lands by
associating their interpretation of Greek legends with the Hippocratic medical corpus, whose
accurate account of malarial fevers introduced a definitive ante quem, at least for the presence of
vivax malaria in classical Greece. It was safe therefore to speak of malaria, or periodic fevers of
varying periodicity, before the fifth century BCE. Authors who favoured an earlier emergence of
malaria focused on traditions that had survived into the literate world from a non-literate, oral
legacy and argued that mythical creatures such as the Hydra of Lerna, for instance, represented
the lethal effects of malaria on humanity (Kardamatis 1907). However, if vivax and quartan
malaria were already established in the Greek lands by the fifth century BCE, when Hippocrates
described their symptoms with great accuracy, could the same be true of falciparum malaria?
Despite the absence of textual evidence, the survival of the Hydra myth would suggest that both
the benign and the malignant form of the disease coexisted. The answer largely depended on the
interpretation of the descriptive terms in the Hippocratic texts and, specifically, on the meaning
attributed to the term “ημιτριταίος”. If the term referred to the irregular fever outbreaks of
malignant tertian, or falciparum malaria, then the Hippocratic corpus could be seen to include a
description of falciparum malaria, which would have coexisted with vivax and quartan malaria
making Greece an area of mixed infections already in the fifth century. Otherwise, the argument
ran, falciparum malaria must have established itself in the Greek lands centuries later.

The scope of malaria history received a significant transformation after the Second World War,
when some malariologists moved beyond textual evidence and turned their attention to evidence
from the hard sciences, namely climatological data and entomology and the effect of climate
changes on the evolutionary success of anopheles mosquitoes, the vectors without which no
plasmodium species could ever establish itself (Zulueta 1973). A fresh controversy over the same
question arose in the new scientific context.

At the same time, anthropological evidence from archaeological excavations brought fresh insight
to malaria research in combination with a new explanatory tool, the malaria hypothesis put
forward by the British geneticist J.B.S. Haldane in 1948. This hypothesis associated the frequency
in a population of certain haemoglobinopathies, such as thalassaemias and the sickle-cell
mutation, with the evolutionary advantage against dying from malaria conferred by these
mutations. Thus, evidence of the spatial distribution of these haematological disorders and their
dating became relevant to a region’s malarial past. This line of research pushed the chronology of
malaria even further back in time, while evolutionary thinking became an intrinsic component of
the history of the disease (Angel 1972).

More recently, arguments based on research in molecular biology and evolutionary ecology
further enriched the field. The search, moreover, for the origins of the plasmodium parasites
revealed their very ancient ancestry. Thus, although the first narratives began in the
Mediterranean, when sources came to encompass the hard sciences, the history of the origins of
malaria moved away from Europe to Africa and Asia and initially focused on all human malaria
diseases (Webb, J. L., Jr. 2009). Thereafter, however, research centred mostly on dating
falciparum malaria and the selective pressures it placed on humans. Despite the extent of its
worldwide prevalence only recently has research also turned to the story of vivax. Different
assumptions, approaches and interpretations have produced widely dissenting narratives among
scientific communities that do not always communicate with one another. The history of the
evolutionary trajectories of each species also determines our understanding of when it may have
invaded the Mediterranean world and by which route.

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How did malaria reach the MediterraneaHno?wAdind mopaleanriaqrueaecshtitohenMediterranean? An open question

The infection was introduced to new areas by human migrants to locations of suitable altitude,
temperature and ecology populated also by potentially susceptible Anopheles vectors. Critical for
the establishment of a malarial species was its capacity to survive long enough in its host by
sustaining continued infection, therefore by adapting to host density. As it spread to new areas,
malaria initially was epidemic, unstable in nature and therefore seriously life-degrading, before
becoming endemic. Thus, before the arrival of agriculture, sparse and mobile Eurasian
populations could most likely sustain unstable infections only of vivax and malariae malaria.
Moreover, as infected Africans entered the Eurasian landmass, they encountered new, non-
African, species of mosquitoes among which some were, or eventually became, capable of
hosting and transmitting human malaria (Webb, J. L., Jr. 2009).

The history of malaria may be broken down into several partial narratives, namely that of each
plasmodium species as well as that of each capable vector, that is some thirty to forty species of
anopheles mosquitoes, and the physical and social environments that support them. It furthermore
hinges on research breakthroughs in an array of scientific disciplines. Assembling these partial
narratives has resulted in complex and rarely straightforward or uncontroversial malaria histories.
Moreover, the geographical distribution of malaria is linked to a variety of environmental and
man-made factors. The early history of the disease may therefore be reconstructed by taking into
the account changes in the interaction of the plasmodia with these factors.

Vivax malaria

Owing to its capacity to lie dormant for years in the liver of infected humans, it is generally
agreed that vivax malaria did not require dense human populations to survive and sustain an
infection. In this respect it differs from modern P. falciparum. As for its origin, one widely held
view stated that its cause, P. vivax, evolved in west Africa, where the population became immune
to the disease thanks to the spread of Duffy negativity, a condition of the red blood cell that
prevents the plasmodium from adhering to its surface. It is found in approximately ninety percent
of the west Africans and provides total protection from the disease to homozygous carriers. The
progression of this condition eastward at declining rates demonstrated that P. vivax originated in
west Africa and spread to east Africa with migration (Webb, J. L., Jr. 2009). One author has
indeed suggested that on the basis of available evidence, human refractoriness to vivax malaria
as a result of Duffy negativity appears to be the very earliest known chapter in human beings'
genetic adaptation to vector-borne infectious disease and, indeed, the very earliest known chapter
in humanity's long struggle with parasitic disease. (Webb, J. 2005).

Another view regarding the site of origin of vivax malaria held that it may have originated from
macaque monkeys in southeast Asia and spread to humans before the end of the last Ice Age and
before the arrival there of African strains (Webb, J. L., Jr. 2009). According to yet another
hypothesis, vivax malaria may have spread into Asia out of Africa with Homo erectus migrants
one or two million years ago (Sallares 2002).

In recent research, however, an international group of scientists uncovered evidence in the faeces
of gorillas and chimpanzees in the wild in a large number of locations in central Africa, infected
with a close relative of P. vivax. They tried to reconcile the existence of vivax-type infections in
chimpanzees and gorillas in the wild with the virtual absence of human vivax malaria thanks
Duffy-negativity in the region. To this end, they thus performed mitochondrial DNA analysis and
proved that human vivax malaria developed from the quite diverse species of ape vivax malaria
and spread to the rest of the world in a single plasmodium lineage after African human
populations had developed immunity to the disease (Liu, et al. 2014, accessed April 21, 2014). In
the words of Paul Sharp, one of the leading researchers in the team, an ancestral P. vivax stock
was able to infect humans, gorillas and chimpanzees in Africa until the Duffy negative mutation
started to spread -- around 30,000 years ago -- and eliminated P. vivax from humans there.
Under this scenario, extant human-infecting P. vivax represents a parasite lineage that survived

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Katerina Gardikas Katerina Gardikas

after spreading out of Africa. (http://www.sanger.ac.uk/about/press/2014/140221.html, accessed
21-4-14).

In other words, according to this latest research work, human vivax malaria emerged from a
common ancestral P. vivax that infected apes and humans, when Africans became immune to the
disease. Its arrival in the Mediterranean would depend on its encounter with capable mosquitoes
and suitable climatic conditions but not necessarily on dense human populations.

If, therefore, it emerged around 30,000 years ago and then spread out of Africa into the Eurasian
continent in the blood and the liver cells of migrant human groups, it could establish a foothold
wherever climatic conditions were suitable for populations of capable anopheles mosquitoes. As
climatic conditions fluctuated, so would the spread or contraction of the range of vivax malaria. In
fact, as Carter and Mendis have pointed out, vivax malaria is far less responsive to adverse
environmental circumstances than falciparum malaria and proves the hardest to eradicate (Carter
and Mendis 2002). It is therefore likely that vivax malaria may have existed among the sparse
hunter-gatherer populations of southern Europe, before the rise of agriculture and would have
been unstable and severely life-degrading (Carter and Mendis 2002; Mueller, et al. 2009).

This dating is consistent with theories of an early arrival of vivax malaria in Greece, not however
before temperatures permitted vectors to move from the warmer Middle Eastern interior to the
cooler northern Mediterranean shores, that is, according to Julian de Zulueta, not before around
4000 BCE (Zulueta 1973), or not before the Mesolithic period, around 7000 BCE, in Greece,
which presented moderately malariogenic climatic conditions suitable for the establishment of
vivax malaria, according to Antonia Morgan-Foster’s recent dissertation (Morgan-Forster 2010).

Falciparum malaria

Falciparum malaria is quite a different story. Owing to its virulence and case mortality it has
received a great deal of attention from researchers. One of the assumptions that divides the two
main lines of dissension consists of the premise that P. falciparum was able to sustain a continued
line of infection among the sparse populations of hunter-gatherers, that is before the emergence of
agriculture and settled village life.

This view that implies an early emergence of the disease dates the origin of P. falciparum to
around 100,000 years ago. The hypothesis has the parasite coevolve with humans, when, on the
one hand, the ancestors of humans and chimpanzees, and, on the other, the ancestors of P.
falciparum and P. reichenowi diverged from their respective common ancestor some five million
years ago. The 100,000-year-old human parasite is assumed to have been capable of tolerating the
cooler temperatures of the Pleistocene among small social groups of hunter-gatherers, but that the
spread of agriculture greatly contributed to the its expansion within the last 10,000 years (Joy, et
al. 2006). The work of Robert Sallares and Sir David Weatherall subscribe to this historical
account of falciparum malaria (Sallares, Bouwman and Anderung 2004; Weatherall, D. 2010).

Most scientists today, however, agree that falciparum malaria requires a dense population and
anthropophilic anopheles species to sustain an infection and that it originated in Africa; they
disagree, however, as to the chronology of its trajectory.

Earlier hypotheses on the descent of P. falciparum argued that although it coevolved with
humans, a bottleneck episode eliminated the earlier branches and left modern P. falciparum as the
only survivor approximately five to ten thousand years ago (Rich and Ayala 2000; Carter and
Mendis 2002). In the same vein, Mario Coluzzi first suggested that modern falciparum malaria
first established itself in the rural villages of Africa when, thanks to the emergence of village
settlements and higher population densities, social conditions selected for the mosquito’s
endophilic/anthropophilic habits, around 6,000 years ago. Indeed, around that time A. gambiae
contributed to the spread of P. falciparum in tropical Africa (Coluzzi 1999). Thus, although the

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How did malaria reach the Mediterranean? An open question

How did malaria reach the Mediterranean? An open question

Neolithic revolution originated in Asia, the presence in Africa of A. gambiae promoted the
emergence of epidemic and, later, endemic P. falciparum in Neolithic tropical Africa. In contrast,
social and ecological conditions in Asia rendered vivax malaria an unstable infection and the most
prevalent form of malaria in that continent (Sallares, Bouwman and Anderung 2004; Webb, J. L.,
Jr. 2009). James Webb made an interesting point on the epidemiological differences between
Africa and Asia, when he observed: Rather than the African pattern of heavy endemic falciparum
infection, in tropical Asia patterns of malarial infections are generally more unstable and have
remained so to the present day. This may be due, in part, to the fact that the anopheline vectors
there had more opportunities to take their blood meals from domesticated animals. At all events,
there was considerable regional variation in the stability of malarial pressure (Webb, J. L., Jr.
2009).

Recent evidence from DNA analyses of infected chimpanzees and gorillas in the wild in tropical
Africa has led geneticists to suggest that, in fact, the two related plasmodia, that is P. reichenowi
found in chimpanzees and human P. falciparum have not evolved from a common ancestor but
that rather the latter has originated from the former and then adapted to the ecological and social
conditions of the agricultural era (Rich, et al. 2009).

As falciparum malaria became endemic in Africa a number of human genetic adaptations
developed in response to selective pressures exerted by the disease that protect their heterozygous
carriers from the severe effects of falciparum malaria and death. Thus sickle-cell anaemia, which
originated only in that continent, could not have developed before falciparum malaria became
endemic, that is before the spread of agriculture, perhaps, as James Webb argues, during the first
millennium BCE or in the early first millennium CE (Webb, J. L., Jr. 2009). Likewise, G6PD
deficiency is also associated with selective pressures from falciparum malaria. Carter and Mendis,
however, include vivax malaria as a source of selective pressure and estimate the emergence of
this condition in Africa at around twelve to four thousand years ago (Carter and Mendis 2002).
These disorders seem to have emerged in Africa and spread out of the continent. Thalassaemias,
by contrast, evolved independently under local selective pressures within each population at a
time that David Weatherall has defined as “fairly recent.” Weatherall dates the development of
haemoglobin disorders to the spread of agriculture between five and ten thousand years ago
(Weatherall, D. J., et al. 2002; Weatherall, D. 2010; Piel, et al. 2010).

So how and when did falciparum malaria appear in Greece and the Mediterranean?
Entomological, climatological and haematological evidence have contributed to the reconstruction
of the history of the disease, again, however, without contributing towards a consensus. Thus, J.L.
Angel in the 1960s associated lesions in osteological finds from archaeological excavations with
thalassaemia and the sickle-cell trait and, consequently, falciparum malaria. The earliest of these
finds dated to the Mesolithic period leading Angel to conclude that this disease was endemic in
the Greek lands around 7000 BCE. Few scientists and scholars agreed with such an early dating of
falciparum prevalence (Angel 1972). In fact, Antonia Morgan-Forster recently revisited his data
on the basis of new climatological and environmental evidence and estimated that the warmer
Neolithic climatic in parallel with the social environment were more conducive to falciparum
malaria and the presence of A. Superpictus and A. sacharovi, the capable anopheles species that
transmitted the disease, than the earlier period and, moreover, than the cooler Bronze age.
However, human activity in the Bronze age and trade relations with Egypt, where evidence from
mummies suggests falciparum malaria prevalence, may have created a suitable environment for
the reintroduction of the disease (Morgan-Forster 2010; Nerlich, et al. 2008). Thus Morgan-
Forster’s interpretation for an early dating of falciparum malaria prevalence in the Greek land and
her accounts of the relevant ecosystems are consistent with the evidence of P. falciparum found in
Egyptian mummies.

Evidence, however, brought to bear on the question by malariologist Julian de Zulueta in his
seminal article published in 1973 and titled “Malaria and Mediterranean History”, examined
climatological in association with entomological data and precluded any extensive, endemic

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Katerina Gardikas Katerina Gardikas

malaria until temperatures got warmer, around 4000 BCE (Zulueta 1973; Zulueta 1994). As for
falciparum malaria, he argued that, if there was any falciparum malaria in fifth-century Greece, it
must have been sporadic cases introduced from north Africa (Zulueta 1973; Zulueta 1994; Bruce-
Chwatt and de Zulueta 1980). Vector distribution was central to his argument. The key vector, A.
sacharovi, an anthropophilic mosquito of Asian origin, could only have moved to southern
Europe once temperatures rose in the Neolithic period but then would have required centuries, he
estimated, to overcome its refractoriness to African P. falciparum until the intense trading
activities and ecological pressures of the Hellenistic and Roman times, when intense falciparum
epidemics must have occurred (Zulueta 1973; Zulueta 1994). De Zulueta furthermore looked at
the Greek landscapes as he knew it and commented: The author of this article has had the
opportunity to visit as a malariologist and as a student of history many of the battlefields of
antiquity in Greece and other Mediterranean lands and has often been confronted with the
difficulty of how to explain the campaigns of the past with malaria conditions of the present
(Zulueta 1973).

With regard to the presence of falciparum malaria in Greece and subsequently in Italy, Robert
Sallares and his co-authors argue in favour of an earlier chronology on the basis of haematological
and climatological evidence. Falciparum malaria prevalence must have been preceded by the
arrival of its principal mosquito vectors, that is of A. sacharovi from western Asia, in the case of
Greece, and A. labranchiae from north Africa, in the case of Italy. The disease must then have
been followed by the hereditary haematological disorders it selected for. Thus, falciparum malaria
must have been endemic in Greece when the Greeks began colonising Italy in the eighth century
BCE introducing their type of thalassaemia beta to their new country. If, as climatological data
and fourth-millennium evidence from Egyptian mummies suggest, suitable conditions had existed
for the presence of both P. falciparum and A. sacharovi in Greece already in the Neolithic period,
the vector would have had ample time to overcome the refractoriness to the parasite noted by de
Zulueta (Sallares 2002; Sallares, Bouwman and Anderung 2004).

Conclusion

The history of malaria has its own past of more than a century. It has been affected by the
emergence of new research projects and scientific paradigms, which have overturned old
certainties and opened up new approaches to existing questions. The purpose of this paper was to
highlight the underlying assumptions of the storylines and disagreements, which transcend
paradigmatic shifts.

References Cited

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Bruce-Chwatt, Leonard Jan, and Julian de Zulueta. 1980. The Rise and Fall of Malaria in Europe: A

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Carter, Richard, and Kamini N. Mendis. 2002. Evolutionary and Historical Aspects of the Burden of
Malaria. Clinical Microbiology Reviews 15(4 October):564–594.
Celli, Angelo. 1925. Storia della malaria nell’agro Romano. Città di Castello.
Coluzzi, M. 1999. The Clay Feet of the Malaria Giant and Its African Roots: Hypotheses and Inferences
About Origin, Spread and Control of Plasmodium Falciparum. Parassitologia 41:277–283.
Jones, W.H.S., Ronald Ross, introd by, G.G. Ellett. 1907. Malaria, a Neglected Factor in the History of
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Joy, D.A., Jianbing Mu, Hongying Jiang, and Xinzhuan Su. 2006. Genetic Diversity and Population History
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Plasmodium Falciparum in Ancient Egypt. Emerging Infectious Diseases 14(8):1317–1319.
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Europe in Antiquity: New Approaches to Old Problems. Medical History 48:311–328.
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American Society of Hematology 1:35–57.
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Webb, James L.A., Jr. 2009. Humanity’s Burden: A Global History of Malaria. Studies in environment and

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Webb, James 2005.Malaria and the Peopling of Early Tropical Africa. Journal of World History 16(3

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August):7–15.

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Magdolna Szente A brief history of epilepsy and its research and therapy

A brief history of epilepsy and its research and therapy

Magdolna Szente

University of Szeged, Department of Physiology, Anatomy and Neuroscience

Abstract

Epilepsy is a chronic neurological disorder, one of the first recorded medical conditions of humankind
that affects people of all ages, races and social classes. The general judgment of epilepsy in the
different cultures is characterized by a permanent variations and antagonism between irrational and
rational explanations. Epilepsy has begun to be understood only in the last hundred years, due to
intensive clinical and experimental research work. The main goals of epilepsy research are to explore
changes in structure and function of neurons and glial cells and in their networks, that lead to hyper
excitability and epileptogenesis, and to develop more efficient therapies to prevent epilepsy and
epileptic seizures with less side effects. Animal models of epilepsy help to avoid the practical and
ethical issues associated with human studies, and provide valuable possibility both for studying the
pathophysiological mechanisms of epilepsy and for developing treatments. Epilepsy research in the
past half century has been dominated by cellular and synaptic physiology and by neuropharmacology,
and a large amount of knowledge regarding the cellular and molecular basis of epileptogenesis has
been learned. The revolution in molecular genetics in the past two decades oriented the focus of
research on the genetics of the epilepsies. While the ultimate goal of curing epilepsy has not yet been
achieved, today epilepsy can often be treated quite successfully, and a range of new antiepileptic
drugs and other treatments are now being tested in clinical studies.

Key words: history, epilepsy, seizure, research, treatment

A brief history of epilepsy

Epilepsy (or seizure disorder) is a chronic neurological disorder, characterized by spontaneous
recurrent seizures, triggered by abnormal electrical activity in the cortex (Dichter 1994). Unlike many
diseases, epilepsy doesn't have a single specific origin, it can be caused by a number of factors
ranging from lesions in the brain, stroke, an abnormality in brain wiring, an imbalance of nerve
signaling chemicals called neurotransmitters, metabolic abnormalities, genetic inheritance or
infections of the central nervous system, or some combination of these factors (Shorvon et al. 2009,
Engel et al. 2007). Epilepsy is one of the first recorded medical conditions of humankind that affects
people of all ages, races and social classes. There are about 50 million people living with epilepsy in
the world, this is around 1 in 100 people.
The word ‘epilepsy’ has a Greek origin, derived from the “epilepsia” which means to seize, to take
hold of or to attack. The word ‘seizure’ originates from the Latin word ‘sacire’, meaning to claim.
Since the first description in the history (can be traced back as far as at least 3000-4000 BC) epilepsy
has generally been identified by its most noticeable and dramatic manifestations, specifically by the
mysterious brief repeated attacks. The general judgment of epilepsy in the different cultures is
characterized by a permanent variations and antagonism between irrational (superstitious) and
rational (scientific, natural) explanations. In history epilepsy was long misunderstood, feared and
neglected.

Due to a general lack of knowledge over hundreds and thousands of years mankind was unable to find
a natural explanation for the frequently dramatic symptoms and strange behavior accompanying
epileptic seizures, as it has been unable to find its cause (Coutsoukis 2008, Eadieand Baldin 2001,
Engel et al. 2007). Seizures as strange behavior have been contributed through the ages to

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supernatural power, resulting of an invasion of the body by a particular spirit or god – usually evil or
demon. People with epilepsy were not allowed to marry nor have children in Nazi Germany and in
America even in the 1920’s. Still today, people with epilepsy often have to face with discrimination
in the society, family, marriage, employment, law and education.

The human brain is an amazingly complex system consisting of about 100 billion neurons and even
more non-neuronal brain cells called glia. In order to understand epilepsy, basic knowledge is
required about how the brain actually works. Epilepsy has begun to be understood only in the last
hundred years or so, due to intensive clinical and experimental research work (Engel et al. 2007).

The history of epilepsy and its treatment dates back to the ancient civilization at the Middle East
(Scott 1992). The oldest detailed account of epilepsy is in a Babylonian text written in the Sumerian
language on a Babylonian clay tablet (ca. 3000- 2000 BC). The tablet is one of 40 ones in the British
Museum in London, comprising a “textbook” of medicine. Although the Babylonians accurately
described many of the different seizure types recognized today, they had no understanding of
pathology of brain function therefore they emphasized the supernatural nature of epilepsy (Reynolds
et al. 2008). They supposed that epileptic seizures were a form of attack by demons or spirits that had
invaded a person’s body. These early superstitions were challenged by ancient physicians of India and
then later by Greek physician/philosopher Hippocrates (Magiorkinis 2011). According to the ancient
Indian medicine, described in Ayurvedic literature the harmony among the body doshas (humors)
constitutes health, and their disharmony constitutes disease (Manyam 1992). Charaka Samhita (about
400 BC) describes epilepsy as ‘apasmara’ which means ‘loss of consciousness’, a chronic and
difficult to treat.

Four major types of epilepsy were distinguished based on the disturbance of doshas. Consequently the
treatment of illness, including epilepsy requires restore the harmony of the doshes by changing life
style, dietary regimen and treatment with herbo-mineral formulas.

In early Greece, before Hippocrates epilepsy was called the ‘Sacred Disease’ because, it was
believed, that the visions experienced by persons with epilepsy were sent by gods (Eadie and Bladin
2001). Epilepsies were also called ‘lunatic’ by the Greeks and Latins, since it was a common thought
that people with epilepsy were affected by the moon goddess Selene, and that “the moon governs the
periods of epileptic diseases”. As in the early Greco-Roman period (332-392 AD), and in the ancient
pre-Christianity cultures, like Egyptians, the Hindus, Aztecs and the Incas in Central America, people
also connected the supernatural powers responsible for invading epileptic persons to their different
gods (Eadie and Bladin 2001).

Consequently treatment of epilepsy in these historical times focused mainly on different spiritually
based methods. It was believed that relief from epilepsy was only possible by appeal to help of the
god. Romans used an extremely pervasive treatment for epilepsy, using the blood of a murdered
person, mostly blood of a gladiator. Hippocrates (460-377), was the first person, who recognized that
epilepsy was not sacred, neither divine nor demonic but rather a disorder of the brain (Magiorkinis
2011). Although he correctly identified the brain as site of the problems, he suggested incorrect
causes, specifically a superfluity of phlegm in the brain. This concept of epilepsy as due to excess
phlegm in the brain was also supposed by Galen, another Greek, 2nd Century AD (Eadie and Bladin
2001). For cure epilepsy, Hippocrates recommended treatment with drugs and diet, bloodletting,
based on his unscientific theories of the balance between hot and cold. Although, Hippocrates’s view
of epilepsy as a brain disorder was a revolutionary view, unfortunately it remained neglected for
many centuries. Christianity continued to link epilepsy to god. The Bible include many references to
epilepsy, some describe Jesus healing epilepsy by driving out an evil from the unfortunate human
having a seizure. Priests attempted to cure people with epilepsy by casting the demons out of them

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with magic and prayers. In the medieval times (14-15. century) the general ways of thinking as well
as observations on epilepsy were mainly dominated by the Catholic Church (Diamantis et al. 2010).
Epilepsy (was called as ‘falling sickness’) were no longer considered to have natural causes. Epileptic
seizures were declared to be associated with devil, evil spirits and demons (‘morbus daemonicus’),
the results of witchcraft or a punishment from god (Tempkin 1971, Hunt et al. 2007). Hysteria and
epilepsy were frequently confused with witchcraft or demonic possession; especially if seizures were
manifested in tremors, convulsions or of loss of consciousness (Diamantis et al. 2010). Therefore, it
was believed that epileptic seizures can only be cured with different divine aids, like fasting,
sacrifices, pilgrimages, treatment with plants, a blessed ring or exorcisms. Many women who suffered
from hysteria and/or epilepsy were judged and condemned to die at the stake (Engel et al. 2007).
People often prayed to several saints for their help or to intercede with god on their behalf. St
Valentine (martyred by the Romans on February 14, 273) was the predominantly important patron of
people with epilepsy.

Since 14 February 2011 the second Monday of February (a day close to Valentine’s Day) is dedicated
by the Bureau for Epilepsy and the International League Against Epilepsy as the European Epilepsy
Day, what aims to increase the public seizure awareness and to explode the myths and remove the
stigma associated to epilepsy (Shorvon et al. 2009).

During the Renaissance (from around 1500) new facts about anatomy of the nervous system were
discovered, therefore physicians and priests begun to questioning the belief the demonic possession as
an etiology for epilepsy (Adams et al. 2012, Diamantis et al. 2010). The most common concepts in
this time were that generalized seizures have natural causes, while absence and partial seizures were
caused by demonic possession or hysteria. Around 1600 it was accepted, that epilepsy can be the
result of head injury or diseases like syphilis. The Swiss physician Paracelsus (1493-1541) has made
the first tentative steps towards practicing natural ‘scientific’ medicine (Crone 2004). He interpreted
epilepsy as a sudden dynamic, physic-chemical event, an abnormal boiling of vital spirits in the brain,
and suggested that the process originates in the spleen, what is potentially curable by chemical means
(Latrochemistry or chemical medicine). Paracelsus also stated that epilepsy could be inherited.
Unfortunately, Paracelsian’s thoughts were purged by his less creative professional opponents during
the following century, or rather longer.

Today it is quite generally accepted that he introduced a new era in chemical activity by turning away
the attention of chemists from the worthless medieval alchemy to the application of chemistry in
medicine. Over the following century, during Enlightenment (from the late 1600’s on) the way
epilepsy was looked at began to change, due to advances in anatomy and pathology as well as the
development of chemistry, pharmacology and physiology (Diamantis et al. 2010). The belief that
epilepsy is caused by demons or god faded, rather epilepsy was widely accepted as a disease of
natural origin. However, as a consequence of the incomplete knowledge about basics mechanisms of
the brain functions, epilepsy was still misunderstood in this time. Epilepsy was thought to be a form
of insanity and contagious diseases, therefore people with the disorder were separated away from
other patients. Even in the In the Salpetriere Hospital in France, the birthplace of modern neurology,
epileptic persons were kept side-by-side with mentally handicapped, those with chronic syphilis and
the criminally insane.

In the second half of the 19th century, as neurology emerged as a new discipline different from
psychiatry, the concept of epilepsy as a disorder of the nerves became more generally accepted. The
great English neurologist, John Hughlings Jackson revolutionized the theories of pathophysiology of
epilepsy (1873) describing epilepsy as an ‘occasional, sudden, rapid and excessive disorderly
discharge’ in part of the cerebral cortex that can affect consciousness, sensation and behavior (Eadie
MJ 1995, Hogan and Kaiboriboon 2003, Reynolds 1989). Through the description of the “dreamy

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state” (1876), he accurately characterized and localized medial temporal epilepsy (Hogan and
Kaiboriboon 2003). As the concept of Jackson about epilepsy as a disorder of the brain began to be
acknowledged, after centuries of ineffective medical measures physicians started to believe, that
effective treatment for the chronic neurological condition is possible (Eadie and Baldin 2001).

Medical treatment of epilepsy began in 1857 when Charles Locock, Queen Victoria's physician by
serendipity first noticed the anticonvulsant properties of potassium bromide (Eadie 2012, Scott 1992).
Unfortunately peoples with epileptic seizure often were given such high doses of potassium bromide
that their personalities changed to irritable and moody, giving the doctors somewhat legitimate excuse
to keep them in the institutions. Potassium bromide continued to be used as a sedative and
anticonvulsant for human patients for at least 100 years. Today it is generally acknowledged that
epilepsy is not contagious, not a mental illness, not a symptom of intellectual decline, but
neurological disorder, no more mysterious than other physical illnesses, and certainly not a reason for
shame or family embarrassment. Many people with epilepsy have normal or above-average
intelligence. Epilepsy can often be treated quite successfully.

History of advances in epilepsy research

The main goals of epilepsy research are: (1) to understand the underlying mechanisms by which
epilepsy develops, specifically to explore changes in structure and function of neurons and glial cells
and in their networks, that lead to hyper excitability and epileptogenesis, (2) to work out new means
to prevent epilepsy in individuals at risk, and (3) to develop more efficient therapies to prevent
seizures with less side effects (Engel et al. 2007, Pitkänen, Santos 2000). In order to be able to
prevent, treat and cure epilepsy, researchers first must find out how it develops in the brain. The
process by which neural circuits are converted from normal excitability to abnormal hyper
excitability, or links brain injury or other predisposing factors to chronic condition in which seizures
occur spontaneously and repeatedly, is termed epileptogenesis (Pitkänen and Lukasiuk, 2001, Santos
et al. 2000).

The general international effort to explore the fundamental neuronal mechanisms of epileptogenesis
and of recurrent seizures as well as treatment of epilepsy resulted in the development of clinical
human and experimental animal research on epilepsy (Engel et al. 2007, Jefferys 1994, Kupferberg
2001, Perucca E 2005). Animal models of epilepsy help to avoid the practical and ethical issues
associated with human studies by allowing the reproducible induction of epilepsy, and provide
valuable possibility both for studying the pathophysiological mechanisms of epilepsy and for
developing treatments. (White 2002). An appropriate animal model should share characteristics with
human epilepsy, including similar pathology, a latent period following initial insult, chronic hyper
excitability and spontaneous seizures (White 2002). Although the majority of basic research is mostly
carried out with experimental animal models of seizures and epilepsy, much information was gained
by observing patients with epilepsy in the early years of neuroscience.

In recent years it has become increasingly possible to carry out basic research directly with patients as
a result of the growth of epilepsy surgery programs and the development of non-invasive functional
neuroimaging technology (Engel et al. 2009). The modern area of epilepsy research started in 1929
when the German psychiatrist Hans Berger first reported the existence of electric potentials (voltage
fluctuations) in the human brain (Haas LF 2003). He demonstrated that electrical activity of the brain
could be recorded (electroencephalogram, EEG) by electrodes placed on the scalp and connected to
a biological amplifier (electroencephalograph). This new method was a milestone for the
advancement of neuroscience, helped to locate the site of seizure discharges and expanded the
possibilities of neurosurgical treatments. The abnormal interictal and ictal epileptiform EEG patterns
were first identified in the 1930s by Fred and Erna Gibbs, William Lennox, and Herbert Jasper

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Magdolna Szente A brief history of epilepsy and its research and therapy

(Bromfield 2012, Engel et al. 2007). Interictal background electrical activity could be recognized as
spontaneous spikes (indication of abnormal, rapid, synchronous electrical activity of the neurons
situated below the recording electrode), or sometimes as spike and wave complexes (Ayala 1973).
The ictal EEG paroxysms are characterized by a sudden onset of burst of rhythmic repetitive sharp
waves. These discharges may either be focal or generalized, manifesting both halves of brain.
Although today the importance of electroencephalography is not as great as it was before, the recent
EEG data collection systems combined with other functional imaging methods like MEG
(MagnetoEncephaloGraphy), PET/SPECT (Positron Emission Tomography/Single Positron Emission
Computed Tomography) and modern structural neuroimaging techniques like CT (Computed
Tomography), fMRI (functional Magnetic Resonance Imaging), and DTI (Diffusion Tensor Imaging)
are still essential methods making of neurologic diagnosis and neurosurgical planning (Engel et al.
2007). Since the discovery of the brain’s electrical activity scientists applied more and more advanced
cellular and molecular electrophysiological techniques to discover the real nature and meaning of
the electrical activity of nerve cells (Ayala 1973, Dichter MA 1994, Engel et al. 2009, 2009) .

Experimental epilepsy research in the past half century has been dominated by cellular and synaptic
physiology and by neuropharmacology. A large amount of knowledge regarding the cellular and
molecular basis of epileptogenesis has been learned (White 2002). At the beginning experimental
epilepsy research investigations were carried out in in vivo on the brain of living animals. In the
eighties, scientists began to perform in vitro studies by using samples of mouse, guinea pig and rat
brains or cultures of their neurons. Today human tissue is increasingly used for basic science,
obtained, for example, during operations to remove epileptic focus or during other brain surgery.

Recent studies demonstrate the possible successful use of a simple model system, the amoeba
Dictyostelium in epilepsy research in order to replacing, refining, and reducing animal usage at least
partially. This non-sentient model might be useful in epilepsy drug development and to understand
the basis for the drug action (Walker 2013). Than a small number of lead final compounds are aimed
to be tested in refined and accepted chronic seizure animal models as well as in clinical trials.
Different kinds of manipulations (among others to produce lesions of brain-stem, cortex or corpus
callosum by localized cortical freezing, by focal or systemic chemicals, like pilocarpine, kainic acid,
GABAA receptor blocker bicuculline and penicillin, potassium channel blocker 4-aminopyridine,
elevated extracellular potassium, zero magnesium-containing solutions, or by experimentally induced
psychomotor seizures using stimulation and aluminium oxide, were introduced to produce
epileptiform activity in the animals and in slice preparations (Dichter 1994, Ransom 2007, Engel et
al. 2007, 2009, Scott 1992, Szente and Baranyi 1998).

A crucial break through occurred at the beginning of the 1960s, with the use of intracellular
recordings to demonstrate the changes in excitable properties of individual neurons located in an
epileptogenic aggregate (Kandel subsequently was awarded the Nobel Prize in Physiology). Another
important mile-stone was the development of the in vitro hippocampal slice technique in the 1970s
(Dichter 1994, Engel et al. 2007, 2009).

Due to gradually advanced techniques scientists explored the feedback synaptic excitation as a
synchronizing mechanism, the various inhibitory processes, the modulating roles of glia and other
non-synaptic factors, the neurotransmitter function (first of all the GABA-mediated inhibition and the
glutaminergic excitatory mechanisms), and discovered the structure and function of ion channels, as
well as the function and structure of gap junction cannels in the electrical synapses (Dichter 1994,
Engel et al. 2007, 2009, Szente et al. 2002, Szente 2008). It turned out, that these all can be part of the
cause of the abnormal epileptic activities at both systems and molecular level.

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The revolution in molecular genetics in the past two decades oriented the focus of research on the
genetics of the epilepsies. A large-scale, international study on the genes involved in epilepsy, using
state of the art technology has revealed genetic mutations that cause the abnormal properties of the
neurons and glia cells and their networks through which the mutations are expressed and result in
clinical epilepsy (Hildebrand et al. 2013, Kaneko et al. 2002, Williams and Battaglia 2013). The
findings could help to advance treatments for the most severe forms of epilepsy. It has become
increasingly clear that only a few rare types of epilepsy are caused by alterations in single genes.
Many forms of epilepsy seem to be caused by a complex interaction among multiple genes by
increasing a person's susceptibility to seizures that are triggered by an environmental factor. The
recognition that several monogenetic epilepsies and many inherited symptomatic epilepsies are linked
to mutations in genes encoding either voltage-gated or ligand-gated channels (“channelopathies”)
initiates a new era in understanding the molecular pathophysiology of seizure disorders (Hildebrand
et al. 2013). These findings significantly could help the direct molecular diagnosis of some
phenotypes of epilepsies as well as to advance treatments for the most severe forms of epilepsy
(Kaneko et al. 2002). Although genetic testing is not yet widely applied, the advent of new screening
technologies promises to greatly expand both knowledge and clinical utility in the epilepsies
(Hildebrand et al. 2013).

History of Treatments for Epilepsy

Epilepsy has varying causes and about half of all seizures have no known cause yet. While the
ultimate goal of curing epilepsy has not yet been achieved, researchers by better understanding how
and why epilepsy develops have made a great deal of progress to improve treatment options
(Benbadis and Tatum 2001, Dichter 1994). The main aim of treating epilepsy is to enhance the
quality of life by preventing seizures but causing minimum of side effects.

The most common way to treat epilepsy is with anti-epileptic drugs, which decrease the frequency
and/or severity of seizures in people with epilepsy (Benbadis and Tatum 2001, Scott 1992). During
the last few decades greater attention has been paid to the psychological and social needs and quality
of life issues of people with epilepsy, although progress is slow and services are still poor. Various
animal models of seizures, and occasionally of epilepsy, are commonly used to screen potential
compounds not only with antiepileptic effect, but also antiepileptogenic (Engel et al. 2009).Today
epilepsy can often be treated quite successfully, and a range of new antiepileptic drugs and other
treatments are now being tested in clinical studies.

The first effective treatment for epilepsy, the potassium bromide (Eadie 2012, Scott 1992) was
discovered serendipitously (1857), after centuries of ineffective medical approaches, and was the only
AED until phenobarbital was introducen in 1912, followed by the development of phenytoin in 1938
(Bialer 2012). The chemical structures of the subsequent AEDs (e.g., phenytoin, primidone,
ethosuximide) resemble that of phenobarbital. The empirical discovery of carbamazepine (1962) and
the serendipitous discovery of valproic acid (1967) led to subsequent AEDs having chemical
structures that are diverse and completely different from that of phenobarbital (Bialer 2012).

Since the 1960s there has been an accelerating process of drug discovery, based in part on a much
greater understanding of the electrochemical activities of the brain, especially the excitatory and
inhibitory neurotransmitters. Sixteen AEDs were introduced between 1990 and 2012. The
conventional antiepileptic drugs can be grouped according to their main mechanism of action,
although many of them have several actions and others have unknown mechanisms of action. The
main groups include sodium channel blockers, calcium current inhibitors, gamma-aminobutyric acid

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Magdolna Szente A brief history of epilepsy and its research and therapy

enhancers, glutamate blockers, carbonic anhydrase inhibitors, hormones. Several antiepileptic drugs
have multiple action or work through some unknown mechanism of action (Ochoa et al. 2011). Even
if antiepileptic drugs do not cure epilepsy, for about 70% of people with epilepsy good seizure control
can be achieved through using them.

In developed countries in recent years, several new drugs have come on to the market. Seizures can
now be controlled in approximately three-quarters of newly-diagnosed children and adults. When
medications fail to control seizures, surgery may be the most effective way to treat epilepsy. Surgery
is the most underused, yet the most rewarding treatment for epilepsy (Engel et al. 2007). For those
whose epilepsy is caused by certain conditions - such as lesions in the brain, brain tumors and scar
tissue - and medications fail to control seizures, surgery may be the most effective way to treat
epilepsy. However, this could be an option only for a small number of people with epilepsy. Because
of the large variations in types and causes of seizures, the high prevalence/incidence of this disease,
and also because of the lack of effective treatments in some cases, further research in the field of
epilepsy is needed (Engel et al. 2007). Ongoing research is focused on developing new valid
experimental models that can be used to more quickly screen potential new treatments for the
epilepsies.

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BIOΗΘΙΚΗ
BIOETHICS



Charles Susanne Bioethics to day

Bioethics to day

Charles Susanne

Université libre de Bruxelles, Laboratoire d’anthropologie

Abstract
Freedom of thinking, on this topic, as in many others, implies a freedom of philosophical choice.
The multitude of moral strong lines implies the respect and the tolerance of the pluralism of ideas
and it brings us back to the principles of equality, freedom and brotherhood.
Only theological or ideological arguments reject a planned and conscious reproduction, refuse
artificial ways of reproduction as natural for rational beings, judge as immoral techniques that
allow planning for a desired child. It seems us that in opposition to these theological strong lines a
very large secular consensus exists to consider as moral and responsible the planning of
reproduction. Recent advances in biology, and the techniques which will surely still be
developed, allow to increase the feeling of desired and voluntary reproduction.

Keywords:Bioethics, conscious reproduction, freedom of thinking, artificial reproduction

Introduction
Natural sciences are often linked to "dangerous" messages for the perception of the human person
and also for the social order. The Earth is no longer the centre of the universe, Europe is no longer
the centre of the World, a cosmological and religious order no longer directs the world or society,
the principles of human palaeontological evolution are no different from those of animal
evolution, the DNA uses the same genetic code in the whole living world and we have 99,5%
genetic similarity with chimpanzees. Consciousness covers polymorphous realities, such as
memory, perception, attention, emotions, …, and even the human mind has become the subject of
several scientific disciplines.

Life is biological

Biology is the centre of controversies, biological evolution is felt as a danger for religious beliefs,
biology disturbs also those who, at a political level, do not desire to see western biological
research demystifying (human) life and also those who continue to consider life as something
sacred.
Whoever wishes to analyze the history of Biology will be astonished by the hiatus between
scientific progress in biology and the philosophical debates around this progress, as well as the
global level of knowledge on these topics. The confrontations: evolutionism? creationism?,
progress? materialism? spiritualism?, and even the debates about the respect of the human
dimension are rarely conducted in the light of modern knowledge.
Life is biological, chemical and to-day, with advances in nanotechnology, even physical. Life is
reduced to the vital mechanisms of a cell, to the control of the genetic code of the DNA, the
regulation of the synthesis of proteins. A better knowledge of these mechanisms contributes to a
better understanding of vital functions.

Life

Biology has thus achieved a better description of human life. The vital mechanisms are reduced to
vital mechanisms of a cell, to the control of the genetic code, to the regulation of the synthesis of
proteins: biology has become chemical and physical. Consciously or not, bioethical discussions
find their origin in the demystification of human life.
However, to define human life or to define a human person implies not to be limited merely to
biological criteria, unless perhaps one considers that the humanity of a person is generated by
metaphysical causes. On the contrary, we consider that, in human beings, we must distinguish
biological life from a conscious human life and/or of the social recognition of this life. In other

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Charles Susanne Bioethics to day

words, either the definition of life is metaphysical, or life is to be perceived as a biological
continuum.
Some are proposing a "right of life", as an absolute and metaphysical right, closely linked to the
philosophy that life would be a gift of god. Conception, the fusion of an ovule and a
spermatozoon, is considered as the beginning of human life. This fertilization is eventually even
considered sacred. Naturally, this dogma has "biological consequences", for instance the belief
that the ovule after fertilization is already a person results in the belief that in vitro fertilization
should not be allowed, that abortion as well as contraception are immoral.

The biologist may only make the following observations:
1. the chemical and physical features of human life are not at all different from the features of life
in general , and from those of animal life in particular,
2. the ovule, also the ovule after fertilization, does not possess any exceptional vital character,
3. the first steps of embryonic development are not yet differentiated,
4. anatomical development can be easily described and followed, whereas maturation is more
difficult to define.

In fact, life constitutes a continuum, and there exists no scientific basis, on which the beginning of
(human) life may be defined. The definition of human life is thus totally arbitrary.
It is thus normal, when one is not linked to the aforementioned philosophical dogmas, to define
human life as a function, not of biological criteria, but of social criteria, and thus as a function of
the will to give life.

Actual bioethical problems

In bioethical debates , the problem of the definition of life and death remains essential, from
abortion to euthanasia, to in vitro fertilization , to carrier mothers, to transgenic animals, to
prenatal advice, to antenatal diagnostics, and to-morrow perhaps to gene therapy.
It seems logical for human beings, in their struggle against natural forces, to use reproductive
capacities in a non-animal way. Planned and intentional reproduction must be natural for rational
beings. To reject this principle implies adopting theological premises, such as the idea that a
sexual act not desiring to be procreative is refusing a divine principle. To admit it, on the
contrary, is to make from human beings, and from his individual or collective future, the only
measure that the legislator has to take into account at the moment of the elaboration of juridical
norms, when they have to be applied to human behaviors.

The use of technologies to realize a desired parenthood corresponds to a goal of Humanity to
make parenthood more brotherly to moral responsible persons. Only on the basis of theological or
ideological arguments, this technology could be considered immoral. The increase of our
biological and technological knowledge will facilitate, without doubt, our possibilities of
planning, as well as our consciousness of a free and responsible parenthood.

Bioethics is discussed at different levels: committee in hospitals, national and international
committees. All has to be pluridisciplinary and neutral at philosophical level. But let us not be
naive! all committees are not functioning this way and many are influenced by political ideas .

What to say for instance of the European Committee of Bioethics (GEE) which WAS pluralist
and neutral. But what did Barroso under influence of religious lobbies? "His criterion of selection
was, it is Barroso himself who declared it to a parliamentary question, theology. The result is a
new commission composed of 15 members with 8 theologian and priests, lacking of any
philosophical neutrality .For instance, France is represented in the GEE by a female theologian,
member of Ordre des vierges consacrées (the Order of established consecrated virgins). By such
an unfair composition, the opinions of this commission, even before to give an opinion, are
coloured of suspicion.

Freedom of thinking, on this topic, as in many others, implies a freedom of philosophical choice;
it implies also that a religious group would not impose, directly or indirectly, its law. Sexuality
gives rise to prejudices advanced as truths. Yet personal sexual behaviors are up to individuals,

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Charles Susanne Bioethics to day

whose morals are variable in both space and time.
Thus, we must conclude in a non specific way. The multitude of moral strong lines implies the
respect and the tolerance of this pluralism, it brings us back to the principles of equality, freedom
and brotherhood

Only theological or ideological arguments reject a planned and conscious reproduction, refuse
artificial ways of reproduction as natural for rational beings, judge as immoral techniques that
allow planning for a desired child. It seems us that in opposition to these theological strong lines a
very large secular consensus exists to consider as moral and responsible the planning of
reproduction. Recent advances in biology, and the techniques which will surely still be
developed, allow to increase the feeling of desired and voluntary reproduction.
Scientific, societal and moral progress are linked, even if a direct relation between these separate
areas of progress cannot be established. Humanity has already observed that a real solidarity
exists among them. One deprives much more of freedoms by obscurantism than by excess of
scientific knowledge.

References

Lemaire J. and C. Susanne (Eds) 1996. Bioéthique: jusqu'où peut-on aller ? Ed. Université de Bruxelles, pp.
83,

Missa J.N. and C. Susanne. 1999. De L'eugénisme d'état à l'eugénisme privé. De Boeck Université, pp. 183
Susanne C et Georges Sand (Ed) 2012 Bioéthique . vers un progrès de l’humanité. Mémogrames
310p

Susanne C. 2010 Science et religion: guerre ou paix ? Le retour du creationisme, aux larmes . citoyens.
Memogrames

Susanne C., A. Cambron, M. Casado, F. Cascais, E. Rebato, M. Salona, A. Sanchez, K. Simitopoulou,
M.Szente, J. Toth, N. Xirotiris 2009 Bioethics. Global and Societal aspects.EAGB, Komotini and
Brussels 511p

Susanne C., Rebato E. and B. Chiarelli (Eds.). 2003. Anthropologie biologique, sur les traces de la biologie
humaine. De Boeck université, P. 765

Susanne C. (Ed). 1999. Reading book in bioethics: a multidisciplinary approach. Global bioethics, 97(10),
pp. 170

Susanne C. 1997. Les manipulations génétiques. De Boeck-Wesmael, pp. 222 (2d édition)
Susanne C. 1990. Euthanasie. Ed. DeBoeck-Wesmael,
Susanne C.1990. Recombinaisons génétiques: des réalisations actuelles aux applications humaines. Ed.

DeBoeck-Wesmael

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Bioethics in legislation: an interdisciplinary field of the late 20th century
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Theofano Papazissi

1. Evolution historique
De la philosophie et de la «science mystique» des anciennes sociétés, de l'époque du

romantisme, à la découverte du microscope, des antibiotiques puis des virus, jusqu’à
l’application des méthodes comme celles des transplantations d’organes et des tissus une
grande évolution technologique a eu lieu tant par rapport à la technique qu’à l’éthique.
L’évolution de la biologie, de la médecine et de la technologie ont permis la réalisation
d’interventions chirurgicales ou microchirurgicales dans l’humain ainsi que la transplantation
d’organes, des tissus sans omettre les fécondations médicalement assistées, appelées au début
du siècle, « fécondations artificielles » et de nos jours, nommées «procréation médicalement
assistée » ou P.M.A. et certaines allant jusqu’à « la grossesse pour autrui » ou G.P.A. Quant
à la génétique, la thérapie génique est un des avenirs prometteur en termes de soins pour les
maladies graves.

Ces nouvelles recherches médicales ont permis l’allongement de la durée de la vie
(transplantations d’organes, supports mécaniques etc.), la fertilisation des personnes stériles
ayant perdu tout espoir d’avoir des enfants, le diagnostique de la fin de vie (mort cérébrale).
De même la recherche essaie d'avancer sur des sujets particuliers telles que les thérapies des
maladies soient héréditaires utilisant des cellules souches embryonnaires1, soient incurables,
grâce à la thérapie génique2 ou pour des recherches neurologiques ne se trouvant encore
qu’au niveau expérimental. Aussi la logique et l'éthique générale de la société ont bien
évolués.

L’application de ces méthodes n’a toutefois pas été établie sans être réfléchie face
aux implications induites. Une grande antinomie des valeurs existe entre le diagnostic
prénatal concernant l’intervention eugénique, l’euthanasie, le trafic d’organes ou des tissus
pour la transplantation. La transplantation d’organes a vu naître le commerce des organes
humains des personnes vivantes ou mortes3. La procréation médicalement assistée (P.M.A.) a
donné l'espoir d'avoir des enfants, et par conséquence a permis aux personnes stériles de
pouvoir concevoir des enfants. Au fils du le temps, les phénomènes pathologiques ont fait
apparaître la commercialisation de la matière humaine qu’elle soit d’ordre cellulaire,
génétique4, de la grossesse pour autrui ou celle menée après la ménopause5 ou la mort du mari
(l'arrêt Parpalaix, en France).

La découverte de la structure de l’ADN a été découverte au début du siècle dernier.
Depuis, la recherche dans ce domaine n’a cessé d’évolué tant dans son rôle cellulaire que
dans la compréhension de sa structure et de ce qui en découle. L’intervention de l'AND et
l’influence du code génétique des personnes a fait possible la sélection du sexe6 ou autre
modification génétique, qui d'ailleurs sont interdit par la loi. La thérapie génique est mise au
point dans les années 90 et ce, au niveau expérimental.

Les problèmes soulevés par la mise en pratique de ces nouvelles techniques scientifiques
concernent aussi bien la biologie qui facilite, entre autre, la fécondation médicalement
assistée, la médecine comme la gynécologie réalisant in utéro, l’implantation de l’embryon
soit la chirurgie qui s’occupe de la transplantation d’organes ou des tissus humains. Sans
omettre bien d'autres applications concernant l’allongement de la durée de la vie ou de l'aide
à la personne handicapée, apparue grâce à la robotisation.

1 Lowagie, Cellules souches embryonnaires : entre questions éthiques et espoirs thérapeutiques, p.
115, dans "Liberté de conscience, Liberté pour la science", 2014

2 Michaud, La thérapie génique, dans Droits de la personne : «Les bio-droits», Aspects nord-
américains et européens, 1997, p.

3 Les articles 19-20, chapitre VI, de la Convention européenne pour les droits de l’homme et la
biomédecine, en Oviedo 1997, sont consacrés à la donation des organes et les articles 21-22, du
chapitre VII interdisent le profit et l'utilisation d'une partie du corps humain.

4 Coester-Waltjen, Die Künstliche Befruchtung bei Menschen-Zulässigkeit und die zivilrechtliche
Folgen, dans 56. DJT, B 1986.

5 Papazissi, Problèmes juridiques et éthiques de la procréation médicalement assistée après la
ménopause, dans Revue Hellénique de droit international, 2/2000, Annexe, p. 579-590.

6 La sélection du sexe est permise pour éviter une maladie transmissible par le sexe, art. 14 de la
Convention sur les droits de l'homme et la biomédecine 1997, art. 1455 §2 AK (Code civil hellénique).

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Bioethics in legislation: an interdisciplinary field of the late 20th century

L’utilisation plus aisée du patrimoine génétique comme le sperme, l’ovule, l’ovocyte ou
même de l’embryon, bouleverse les règles de la filiation tant paternelle que maternelle. En
outre, la possibilité technique d’avoir plusieurs ovocytes permet la création d’un grand
nombre de zygotes congelés posant alors le problème des embryons surnuméraires dont
l’avenir met en question la notion juridique de l’embryon7. Cette problématique soulevée par
les généticiens ne concerne pas seulement les juristes mais doit s’ouvrir aux philosophes,
toutes autres sortes d’humanistes8.

La doctrine de la Bioéthique cherche des réponses et solutions aux problèmes éthiques et
réexamine les valeurs.

2. De la bioéthique à l’éthique
La bioéthique est une notion apparue dans la dernière moitié du siècle passé. Bien que
les diverses expertises datent depuis le début du 20ème siècle des références sont parfois bien
plus antérieures.
Une des premières, fut celles du serment d’Hippocrate. Ce serment relativement vaste
prend en considération la moralité médicale comme valeur universelle. L’institutionnalisation
de la bioéthique est rattachée au procès de Nuremberg9.
La première fois que l’éthique fut évoquée dans le domaine de la médecine, a été après la
deuxième guerre mondiale. Le Procès de Nuremberg est identifié comme point de départ de
l’expression de la bioéthique moderne. Il est reproché aux médecins nazis d’avoir transgressé
toutes les règles de la moralité médicale par l’application des pratiques de la médecine ou de
la recherche expérimentés dans les camps de concentration. Indépendamment des résultats de
ces recherches, les moyens étaient inhumains et «l’utilisation» des personnes était gratuite et
cruelle. Pendant le procès, le reproche aux médecins nazis fut qu’ils avaient violé toutes les
règles déontologiques par l'amoralité de leurs méthodes médicales ou de leurs recherches.
C'était le premier rapport contemporain faisant référence à l’éthique. La défense a refusé
l’argument sous prétexte que elle ne pouvait ni valider ni argumenter cette notion, car elle
n’avait pas de caractère juridique. La première référence «juridique» fut inscrite dans le Code
de Nuremberg. Il parait qu’à partir de ce moment, le terme de bioéthique se trouve dans la
bibliographie10.
Le terme «bioéthique» est composé de deux mots «bio» et «éthique». Il pourrait
correspondre la traduction d’un terme grec. Ce qui n’est pas juste. Ce terme n’a jamais existé
en tant que tel dans le vocabulaire grec. Il s’agit d’un emprunt. Pourtant son origine
étymologique est bien grecque. Le mot «bios» signifie «la vie» dans tous les sens du mot,
comme l’existence, la durée de la vie, ou la vie même comme qualité. L’«éthique» provient
du mot «Ηθική», mais hors de la langue grecque, il est utilisé au sens du mot grec
«δεονηολογία»/«déontologie», d’ou le «Déon» signifie le devoir, l’obligation, le bien faire. Le
mot éthique est synonyme de la morale, de la dignité, du bien faire. Alors la bioéthique est
l’évolution de l’éthique en ce qui concerne la vie et l’existence humaine11.
De nos jours, ces pratiques proviennent des différents domaines de la science qui font
naître des problèmes concernant toutes ces disciplines. Il s’agit d’une doctrine
interdisciplinaire dont le sujet central est l’homme. Dans le cadre de cette dernière, on
reconnaît des droits à l’homme, une notion spéciale ayant à faire avec l’individu comme
substance matérielle. La Convention Européenne pour les Droits de l’Homme et la
Biomédecine concernent les droits de l’Homme dans cette notion et pas de l’être social.

7 Edelman, Le Conseil constitutionnel et l'embryon, dans La personne en danger, 1995, p. 487. -395-
8 Forget, Alexandre, Actes : dans Liberté de pensée et de recherche en Europe, 2014.
9 Gateau, Le pluralisme normatif en bioéthique.., dans La bioéthique en question, p. 18.
10 Gateau, ibid.
11 Petit Robert, 2010, Bioéthique: Discipline étudiant les problèmes moraux soulevés par la
recherche biologique, médicale ou génétique. Éthicien: Spécialiste des problèmes d'éthique, "médecins;
chercheurs; philosophes; éthiciens; religieux se retrouvent régulièrement".

3

Theofano Papazissi

Dans ce cas, des «bio-droits» sont alors utilisés pour désigner «l’ensemble des droits
individuels et subjectifs touchant la personne humaine dans ses relations avec son propre
corps et avec le corps d’autrui»12.

Ce n’est pas la première fois que des droits concernant le corps humain sont bafoués et
cela a toujours existé. Ainsi de nouvelles notions pourraient voir le jour avec la création du
terme de «bio-droits». L’évolution de la biomédecine a donné d’une part, un caractère plus
individuel et d’autre part un plus collectif au sens de l’influence de l’héritage humain.
Certaines pratiques biomédicales concernent la personne comme individu (transplantation
d’organes) mais d’autres concernent l’humanité (thérapie génique). Or, les «bio-droits»
concernent la santé et le corps humain comme des biens protégés par la loi et le respect du
code génétique humain comme bien de l’humanité.

Le résultat d’une recherche scientifique peut être une découverte, comme celle d’ADN.
En revanche, les méthodes technologiques font suite à des recherches expérimentales comme
par exemple les méthodes de congélation des embryons. La différence est importante car les
découvertes concernent un secret de la nature qui n’a rien à faire avec l’intelligence humaine.
Tandis qu’une invention est le résultat de cette intelligence. En conséquence, pour cette
dernière, il y a un droit de patente valeur opposée absolument au premier cas13.

3. Des législations internationales sur la Bioéthique
Divers rapports, conventions, et déclarations ont été élaborés depuis la fin de la
deuxième guerre mondiale sur l'éthique de la médecine, comme la déclaration d'Helsinki de
l'Association médicale mondiale en 1964 (revue plusieurs fois jusqu’en 2013), le Rapport
Belmont aux Etats Unis en 1979, la Convention sur les Droits de l'homme et la biomédecine
du conseil de l'Europe en 1997, la Déclaration universelle sur la bioéthique et les droits de
l'homme de l'Unesco en 2005 etc. La convention du Conseil de l'Europe comme la déclaration
universelle d'Unesco pourraient avoir influencé diverses législations internes.

3.1. La Convention Européenne sur la Biomédecine
Au niveau européen, le 4 Avril 1997, il a été signée à Oviedo, à l'initiative du Conseil de
l’Europe, la Convention Européenne pour "la protection des droits de l’homme et de la
dignité de l’être humain à l’égard des applications de la biologie et de la médecine:
Convention sur les droits de l’homme et la biomédecine". La Convention fut ouverte à la
signature des Etats m2embres du Conseil de l’Europe; des Etats non membres ont participé à
son élaboration, ainsi que ceux de l’Union européenne (art. 33 §1). Elle fut également ouverte
à la ratification, l’acceptation ou l’approbation (art. 33 §4). Cinq Etats, incluant au moins
quatre Etats membres du Conseil de l’Europe, devaient avoir exprimé leur consentement à
être liés par la Convention, afin qu’elle entre en vigueur, conformément aux dispositions du
paragraphe 4 du même article.
Dans l'article 1 §2 de la Convention est exigé, que chaque partie doit prendre dans son
droit interne les mesures nécessaires pour donner effet à ses dispositions. Cette disposition
désigne la notion obligatoire de la Convention. La Grèce, un des cinq premiers pays à avoir
signé la Convention, l’a ratifiée par la loi 2619/19.6.1998 et l’a ainsi rendue droit interne. La
Convention est entrée en vigueur le premier jour du mois qui suivait l’expiration d’une
période de trois mois après la date à laquelle les dits Etats auraient exprimé leur consentement
à être liés par elle. Cette date fut le 1.12.1999.
La Convention contient des dispositions sur les conditions de l’application de la biologie
et de la médecine, les conditions du traitement médical, le consentement à toute intervention
dans le domaine de la santé, le respect de la vie privée, le droit à l’information, le génome
humain, la recherche scientifique, le prélèvement d’organes et de tissus sur les donneurs
vivants à des fins de transplantation, l’interdiction du profit et utilisation d’une partie de corps

12

13 Dans ce sens la directive 98/44/EK (transposée dans l’ordre juridique grec par le Décret
321/2001) ne permet pas de délivrer des patentes aux découvertes.

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humain. Cette Convention est le compromis minimum entre des pays européens,
communautaires et autres, et pays tiers14 sur des sujets bien précis de biomédecine.

La Convention ne traite pas du tout des problèmes contemporains très difficiles et
importants comme la P.M.A., la notion juridique de l’embryon, la définition de la mort
cérébrale, la durée de la congélation des ovocytes ou des embryons, de la fécondation de
l’ovocyte après la mort du mari avec le sperme du mari décédé ou la possibilité de la P.M.A.
pour les célibataires ou les personnes homosexuelles, suivi de toute une série de cas et de
problèmes. La raison de cette lacune est l’incompréhension entre les pays utilisant ce type de
technologie. Certains s’intéressent aux droits de l’homme sans avoir rien à perdre tandis que
les seconds n’ont pas ce luxe sans doute à cause des investissements et des intérêts financiers.

Cependant, la Convention prévoit des protocoles additionnels dans des domaines
spécifiques en vue de développer ses principes (art. 31). Dans ce cadre-là, il a déjà été signé à
Paris, en janvier 1998, le premier protocole additionnel interdisant le clonage. Un autre
protocole additionnel concernant la transplantation d’organes et des tissus d’origine humaine
était signé le 24.1.2002 à Strasbourg. Il fut mis en vigueur le 1.5.2006, après avoir été ratifié
par 5 pays dont les 4 pays Membres du Conseil de l’Europe. Le protocole relatif à la
recherche biomédicale était ouvert à la signature le 25 janvier 200515.

3.2. La déclaration d’Unesco
En Octobre 2005, la 33ème Conférence Générale de l’Unesco avait adopté une
déclaration concernant la Bioéthique et les droits de l’Homme. Le but de cette Déclaration qui
s’adresse aux Etats, est de traiter «des questions d’éthique posées par la médecine, les
sciences de la vie et les technologies qui leur sont associées, appliquées aux êtres humains, en
tenant compte de leurs dimensions sociales, juridiques et environnementales». Cependant, la
Convention «permet, dans la mesure appropriée et pertinente, de guider les décisions ou
pratiques des individus, des groupes, des communautés, des institutions et des sociétés,
publiques et privées». Dans sa mesure, la Déclaration essaie de mettre des principes, comme
d’ailleurs, la Convention Européenne d’Oviedo à l’application des méthodes et des
découvertes scientifiques.
Elles contiennent des dispositions presque identiques que les sujets de la Convention
d’Oviedo, tel que le consentement de la personne à toute intervention médicale et le respect
de la vie privée. Mais en réalité, elle s’occupe d’un grand nombre de domaines de la vie
sociale et commerciale. Ainsi, la Déclaration se réfère à l’égalité, la justice et l’équité, la non-
discrimination et la non-stigmatisation, le respect de l’intégrité personnelle, le respect de la
diversité culturelle et du pluralisme et beaucoup d’autres.
Cette Déclaration spécifie le respect des Droits de l’Homme dans des domaines
contemporains sous des conditions autres que celles des autres Déclarations, mais pas
contraires au respect de la dignité et l’intégrité de la personne et de ses droits et de ses libertés
fondamentales (article 28 de la Déclaration).

4. Des législations des pays européens sur certains sujets de la Bioéthique
L’application des résultats de la recherche scientifique a soulevé la nécessité de régler
divers problèmes juridiques. Les législations des divers pays européens ont introduit des lois
sur certains de ces domaines.

4.1. Sujets techniques
a. Transplantation d'organes

14 Les autres pays ayant participé, selon l'article 33 du rapport explicatif, étaient l'Australie, le -397-
Canada, le Saint-Siège, le Japon et les Etats-Unis d’Amérique.

15 Kohler-Vaudaux, Le début de la personnalité juridique et la situation juridique de l'enfant à
naître, 2006, Papazissi, Questions de bioéthique dans la convention d'Oviedo par rapport à la L.
3089/2002, Mélanges à Pelagia Faltsi, 2007, p. 1097 ff=Chroniques du Droit privé 2006 p. 385.

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Theofano Papazissi

Au milieu du siècle passé, la transplantation d’organes était pratiquée avec succès
comme méthode thérapeutique16. Tous les pays de l'Europe ont introduit depuis longtemps
des lois sur la transplantation d'organes et des tissus. La Convention du Conseil de l'Europe a
consacré son chapitre VI sur le sujet du prélèvement d'organes et des tissus sur des donneurs
vivants à des fins de transplantation. Son article 19, intitulé "Règle générale" définit la notion
du prélèvement dans le cadre juridique, tandis que l'article 20 traite du consentement comme
condition indispensable de cette opération. Le parlement européen et le Conseil des ministres
de l’Union européenne ont adopté, le 7 juillet 2010 la directive relative aux normes de qualité
et de sécurité des organes humains destinés à la transplantation. Les dispositions de la
directive devaient être transposées dans les législations internes des Etats membres le 27 Août
2012, au plus tard.

La Grèce a introduit la loi 3984/2011 afin d’être en conformité avec la directive de 2010.
Cette loi a remplacé la loi 2737/1999 "Transplantations des tissus et organes humains" qui, à
son tour, avait remplacée la loi 1383/1983 "Prélèvements et transplantations des tissus et
d'organes humains". La L. 821/1978 fut la première loi en Grèce ayant réglée spécifiquement
la transplantation d'organes et des tissus aussi bien que la mort cérébrale.

b. Procréation Médicalement Assistée
La méthode de la recherche biomédicale la plus généralement appliquée est celle de la
procréation médicalement assistée. Au début des pratiques, l’insémination médicalement
assistée était appelée « fécondation artificielle». Les méthodes appelées couramment P.M.A.
en 1978, ont fait naître un grand espoir après la naissance, à Londres, du premier bébé né par
fécondation in vitro.
En 1984, la Suède a introduit la L. 1140 du 20 décembre 1984 concernant l'insémination
artificielle (IAD) puis en 1988 la L. 711 du 14 juin 1988 portant sur la fécondation in vitro
(FIV). La première est ouverte aux femmes mariées ou en concubinage17, tandis que la
deuxième interdit la FIV hétérologue. Quant à l'enfant, il est autorisé à connaître son origine.
De plus, la Suède est un des pays qui à partir de 2005 reconnaît aux femmes homosexuelles le
droit à la PMA et à partir de 2009 permet aux couples de même sexe de se marier.
En 1987, la Norvège a adopté par la L. 68, du 12 juin, les mêmes dispositions que la
Suède.
En 1988, l’Espagne fut le premier pays ayant introduit des lois spéciales concernant la
P.M.A. La première loi se réfère la reproduccion asistida humana (L. 35, 22.11.1988) et la
deuxième porte sur les embriones (L. 42, 28/12/1988). La loi 14, du 26 Mai 2006, applicable
aujourd'hui, a modifié la L. 35 du 22.11.1988 qui, entre-temps, avait été réformée en 2003.
En 1990, en Grande Bretagne, la loi «Human Fertilisation and Embryology Act» règle
les conditions principales de la P.M.A. En 2008, le 13 novembre, cette loi était remplacée par
la loi actuelle18, relative à la fécondation et à l'embryologie humaine, qui devait entrer en
vigueur en avril 2009 pour les dispositions relatives à la filiation et en octobre 2009 pour les
autres cas.
En 1991, l’Allemagne, influencée par son expérience historique, a mis en vigueur une
loi pénale à la protection de l’embryon l’ «Embryonenschutzgesetz» (1990). Cette loi, la seule
purement pénale prohibe la plupart des pratiques de recherche sur l’embryon. Les directives
de l'Ordre fédéral des médecins sur la procréation médicalement assistée, adoptées en 2006
comblent les lacunes de la loi.

16 La plus célèbre transplantation d’organe fut celle réalisée par le Professeur Ch. Barnard en
Afrique du Sud. Il s’agissait de la première transplantation d’un cœur.

17 De nos jours il y a une réflexion sur la possibilité des femmes célibataires d'avoir accès à la
PMA, lorsque 800 femmes par an cherchent ce type de procréation à l'étranger (Le Figaro, 21.05.2015).

18 La révision d'anciennes lois promulguées en janvier 2004, a fait l'objet d'une consultation
publique dans le second semestre de l'année 2005. Les débats parlementaires commencés à la fin de
l'année 2007 ont été clôturés au mois d'octobre 2008.

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En 1992, le 1er juillet, en Autriche était mise en vigueur la loi concernant "la médecine
de la reproduction". Il s'agit d'une loi à la fois civile et pénale, plus proche de l'esprit de la loi
allemande que du libéralisme anglo-saxon.

En 1994, la France a mis en vigueur deux lois. La première concerne le respect du corps
humain et la seconde relative au don et à l’utilisation des éléments et produits du corps
humain, à l’assistance médicale à la procréation et au diagnostic prénatal. En 2004, une
nouvelle loi concernant l’embryon fut mise en vigueur. Depuis, la France avait instauré un
régime d’interdiction assorti de dérogations données par l’Agence de biomédecine. La loi de
2011 a posé le principe de l’interdiction sauf dérogation. En revanche, la loi du 6 août 2013
suit une autre logique, puisque on passe au système d’autorisation19.

En 1997, le Danemark a introduit une loi sur la fécondation in vitro définissant les
principes généraux à l'assistance médicalement assistée. A partir du 4 septembre 2006, entre
en vigueur la L. 923 reprenant l’ensemble des différents actes.

En 1998, le 18 Décembre, la Suisse a mise en vigueur sa loi fédérale20 sur la PMA. Cette
loi était modifiée le 3 Octobre 2003.

En 2002, le 20 juin aux Pays Bas, est introduite une loi concernant l’embryon ne
contenant que des dispositions sur la recherche de ce dernier. En revanche, elle ne contient
que peu de règles sur l'assistance médicale à la procréation. En outre, elle comprend des
dispositions concernant la fonction des établissements autorisés à l'exercice de cette activité.
Cependant, des questions non réglées par cette loi ont été prévues dans d'autres lois générales
(comme l'égalité de traitement, la fécondation in vitro etc.).

Le 11 mai 2003, la Belgique adopte une loi relative à la recherche sur les embryons in
vitro21. Le 27 juillet 2007, est promulguée une autre loi relative à la procréation médicalement
assistée et à la destination des embryons surnuméraires et des gamètes22. Elle détermine les
règles principales applicables à la PMA. Dans la pratique, ces textes sont complétés par divers
arrêtés royaux. Auparavant, le vide législatif était comblé par l'autodétermination des
professionnels de la médecine.

En 2004, en Italie la loi 40 du 19 février sur la procréation médicalement assistée définit
les principes de ces techniques. Le vide législatif était modéré jusqu’en 2004 par
l'autorégulation des professionnels.

En Grèce, à l’exception de la loi concernant la transplantation d’organes et de tissus, il y
a des dispositions introduites par les L. 1329/1983 et principalement, L. 3089/2002 dans le
Code Civil et le Code de la Procédure Civile par rapport à la P.M.A. En outre, il existe une loi
spéciale concernant l’application des méthodes de la procréation médicalement assistée (L.
3305/2005). La loi 3089/2002 permet la procréation médicalement assistée pour des raisons
de santé du couple stérile (art. 1455, 1456 AK23). Sous des conditions précises, comme
l'autorisation judiciaire, elles ont permis la procréation pour autrui (art. 1458 AK) et la
procréation post mortem (art. 1457 AK). La loi reconnaît encore la recherche sur l’embryon
(art. 1459 AK) ainsi que le clonage thérapeutique (art. 1455 § 1 AK). Le choix du sexe n'est
permis que pour des raisons médicales (art. 1455 § 2 AK).

4.2. Sujets éthique: La fin de la vie

a. La mort cérébrale.

19 Loi n° 2013-715 du 6 août 2013 tendant à modifier la loi n° 2011-814 du 7 juillet 2011 relative -399-
à la bioéthique en autorisant sous certaines conditions la recherche sur l’embryon et les cellules
souches embryonnaires, JORF n° 0182 du 7 août 2013, p. 13449.

20 L'article 119 de la Constitution fédérale, Procréation médicalement assistée et génie génétique
dans le domaine humain, prévoit la compétence législative en la matière à la Confédération. Dans le
même article sont énumérés les principes que la loi doit respecter.

21 Moniteur belge, 28 mai 2003.
22 Moniteur belge, 17 juillet 2007.
23 AK=Astikos Kodix=code civil grec.

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Theofano Papazissi

L'évolution de la technologie et de la médecine ont permis aux personnes de prolonger
leur vie grâce aux nouvelles molécules, aux nouvelles technologies par des appareillages
appropriés, voire de nos jours par des thérapies spécifiques. Le résultat de ces applications
permet aux malades de vivre plus longtemps. Deux questions essentielles se posent alors : la
qualité de la fin de vie de la personne et le coût ainsi que les conséquences des méthodes face
aux soins qui pourraient être récupérés pour des financements.

Des dispositions législatives relatives à la fin ou aux prolongements de la vie se trouvent
dans les lois concernant les transplantations d'organes et citent la mort cérébrale. Cette
définition était énoncée comme coma dépassé en 1959 à l'Hôpital Claude-Bernard par
l'infectiologue Pierre Mollaret et le neurologue Maurice Goulon. Les critères n’ont été définis
qu’en 1968 et ce n’est qu’à partir de cette époque qu’ils se définissent par rapport aux
évolutions de la science.

En Grèce, la mort cérébrale est citée pour la première fois dans la loi 821/1978
concernant la transplantation d'organes. La Loi 3984/2011 dans l'article 9, §§ 5, 6, aussi bien
que la loi précédente 2737/1999, déterminent la mort cérébrale comme la fin de vie de la
personne et ordonnent au médecin l’arrêt de toute aide mécanique sauf dans le cas de
prélèvements d'organes. C’est ainsi qu’il pourra délivrer le certificat de décès.

b. La procréation post mortem
La procréation post mortem n'est pas une pratique généralement adoptée dans les
législations comme méthode reproductive. Divers faits sont pris en compte, tel que la non
reconnaissance du respect dû à l'enfant né, occasionnant la naissance d'un orphelin lors du
deuil de son père. Dans cette logique la méthode est interdite en Allemagne24, au Danemark25,
en Italie26 et en Suisse27.
Toutefois, il existe des systèmes juridiques qui permettent la méthode de l'insémination
post mortem comme pour la Belgique, l'Espagne28, les Etats Unis29, la Grèce30, les Pays-Bas31,
le Royaume-Uni32 où l'insémination et le transfert d'embryons post mortem sont explicitement
autorisés. Au Portugal33, contrairement à l’insémination post mortem, le transfert d’embryon
post mortem est autorisé à condition que l’embryon soit déjà conçu au moment du décès du
mari. La veuve peut, après examen de sa demande et respect d’un délai raisonnable, obtenir le
transfert de l’embryon.
Le Code civil grec prévoit dans l'article 1457 les conditions qui permettent la procréation
post mortem en cas de décès du mari ou du partenaire aussi bien que celles de la filiation en
cas de naissance. Il s’en suit, que la procréation post mortem ne peut pas être appliquée aux
femmes.
La condition d’autorisation de cet article sur la procréation post mortem est l'autorisation
judiciaire qui d'ailleurs, dépend de deux autres conditions réunies, à savoir : ladite personne
souffrait d’une maladie liée à un danger probable de stérilité ou sa vie était en danger ou soit

24 Loi de 1990 sur la protection de l'embryon. Les directives de l'Ordre fédéral des médecins
actuellement en vigueur ont été adoptées en 2006.

25 Loi de1997 sur la fécondation artificielle.
26 La loi du 19 février 2004 sur la procréation médicalement assistée n'autorise pas cette
intervention quand l'un des parents est mort.
27 Loi fédérale du 18 décembre 1998 sur la procréation médicalement assistée.
28 Loi du 26 mai 2006 sur les techniques de reproduction humaine assistée, prévoit implicitement
le transfert d'embryons post mortem.
29 Ils vont même plus loin en autorisant non seulement le transfert d’embryons mais aussi les
prélèvements de gamètes post mortem (1er cas en 1978).
30 La loi de 2002 relative à l’assistance médicale à la reproduction humaine et complétée par la loi
de 2005 qui concerne l’application de méthodes de procréation médicalement assistée (PMA).
31 La loi du 20 juin 2002 sur l'embryon n'interdit pas le transfert d'embryons post mortem.
32 Loi de 1990, révisée en 2008, relative à la fécondation et à l'embryologie humaine. Loi de 2003
relative à la procréation médicalement assistée post mortem.
33 Loi parlementaire du 26 juillet 2006 sur l'assistance médicale à la procréation au Portugal
(article 22).

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