Syphilis appeared in Sweden in 1497. It was recognized as a sexually transmitted disease that rapidly spread in the upper classes and later to the poor. It ravaged the country in the eighteenth and nineteenth centuries. At that time the concept of venereal disease included all sexually transmitted diseases. Preventive measures were introduced. They were based on information, medical intervention and elimination of risk factors. Registration of hospitalised patients was introduced in the eighteenth century. The highest incidence of syphilis occurred during the First World War. In the last decade the incidence of sexually transmitted disorders has abruptly decreased. Thus the yearly incidence of gonorrhoea has decreased from 40,000 to 500 cases. The law demands contact tracing with obligatory testing. People who deliberately expose others to risk may be condemned to isolation for an unrestricted time. This legislation has probably contributed less to the successful containment than the fact that information on aids and sexually transmitted diseases has reached all the population, and made it aware of the risks and produced changed behaviour, especially among prostitutes, homosexual men and drug addicts.

This article examines changes in the treatment of venereal disease in mid-nineteenth-century France in light of theoretical developments in the understanding of these diseases. It focuses on three theories of venereal disease: the orthodox theory of the "unity" of gonorrhea and syphilis; the physiological theory of François Broussais, which essentially denied the actual existence of such a disease; and Philippe Ricord's new doctrine of venereal disease, a theory that is often credited with having established the distinction between syphilis and gonorrhea. The argument is that theoretical considerations played a major role in the evaluation of the relative merits of these theories and that any understanding of the appeal of Ricord's new doctrine must consider not only its pathological claims but its therapeutic implications as well. This was not, however, simply an instance of theory applied. These two aspects of Ricord's new doctrine, its pathology and its therapeutics, were inextricably bound up with one another, so that judgment of the one necessarily entailed judgment of the other. The argument is that therapeutic practice should not be seen simply as a downwind consequence of changes in the theoretical understanding of disease, but rather as an integral part of the process of change. These were the kinds of developments that led doctors to believe that French medicine was making very real progress at mid-century.

It is well known that arthritis can be associated with venereal disease. Nowadays septic arthritis and reactive arthritis (usually classified as Reiter's syndrome) are distinguished. To place current knowledge within its historical context we reviewed the medical literature on sexually acquired arthritis in the nineteenth century and examined the medical records of London teaching hospitals from this period. We used original sources of rheumatological literature at major London libraries, including the Heberden library of the Royal College of Physicians, and visited the archives at three London teaching hospitals to review original case records and examine diagnostic registers. The first clear description of arthritis associated with venereal disease was given by Swediaur (1798/1809) in French. It became relatively common in London from 1820 onwards with 13 cases described in the literature between 1818 and 1836. It accounts for 3% of admissions at University College and St Bartholomew's Hospitals between 1835 and 1839 and also 3% of admissions at the London Hospital from 1895 to 1900. In the 50 years after Swediaur's report, arthritis associated with venereal disease seemed quite common. This may have been related to the industrial revolution or other social diseases. Historical observations suggest its evidence may vary considerably with time.