We are delighted with this positive, generous and wide-ranging review by Professor Virginia Berridge, approbation from whom on this subject is praise indeed.
We were very much aware when compiling this volume that there were many topics relating to the European history of venereal disease which we were not going to be able to include, partly for reasons of space and partly for lack of appropriate or available contributors.
Professor Berridge rightly notes - as the 'spectre at the feast' - the lack of a chapter addressing the international diffusion of ideas and provisions relating to the treatment and control of VD. Inspired by the earlier work of Paul Weindling (1) and the more recent magisterial overview by Peter Baldwin of State responses to the 'Great Scourge' in modern Europe, (2) further research is certainly needed to chart and explain the multi-lateral trade flows in medical, legal, and cultural discourses surrounding VD. Our essays already signal the importance of these flows; for example, the impact of the 1899 Brussels International Medical Congress of 1899 on venereologists and policy-makers in a range of European countries; the evident international significance of Parent-Duchatelet in shaping the regulatory discourse surrounding prostitution and disease; and the explicit 'export' agenda of the imperial campaigns of the Social Hygiene Movement.
A second theme which is perhaps too implicit in the book and deserves, as Professor Berridge suggests, somewhat more transparent treatment, is the changing status and nature of the specialisms which dealt with VD. What emerges from the case studies is a continuing dialogue between medicine and the law in defining the relationship of the State to the diseased citizen, and a shift, albeit often contested, in the nature of medical expertise surrounding VD associated with the rise of a new public health, laboratory-based specialism. A common feature is also the degree to which VD policy-making remained a contested area of professional power both within the medical profession and between the agencies of public order, public health and public morality. Thus, Bolea documents the tensions between private and public practitioners in defining the new medical space of the VD clinics in 1920s Spain, Macpherson and Tuck reveal the tensions between western and 'native' medicines in interwar Hong Kong and Uganda, and Evans notes the protracted tensions between local authority medical officers and hospital venereologists within the post-1945 British National Health Service. Other chapters, such as those of Bolea on Spain and Freund and Sauerteig on Germany, reveal similar professional conflicts over the control of VD cases between medical, police, and social work authorities. We would add that there is certainly a good deal more to be written on the more internalist professional aspects of the international medical history of venereology and the relationship between treatment and scientific advances.
The coverage of the book inevitably had limitations. Non-British Imperial and Colonial responses to the problem of VD deserved fuller treatment. A serious omission is a chapter on France in the twentieth century, where, in spite of the advent of salvarsan and the public health model which became pervasive in other European countries, regulation and licensing of prostitutes remained a major element until the post Second World War closure of the brothels.(There is some coverage of this in Baldwin's Contagion and the State in Europe but a more focused study would be extremely valuable). We would also have liked to include more on the situation in Central and Eastern Europe. Additional insights into the differing social responses to (and stigmas associated with) gonorrhoea and syphilis in European society would have been instructive. Much of the historical literature tends to treat VD as a monolithic category but culturally they were often differentiated. Moreover, even when one endeavours to include an exhaustive account of the existing historiography, to the point of inserting recently published or discovered items after the submission of the manuscript, there will always be some items that authors will be kicking themselves that they managed to leave out. This unfortunately happened with the Lewis et al. volume on STDs and AIDS in Asia and the Pacific (3) . This was an unhappy omission especially as, although we did not strictly follow the model of organisation used by the editors of that volume to draw out common themes, it formed a very valuable starting point for our own deliberations. As Professor Berridge comments, we decided to eschew a 'one size fits all' approach, while asking our contributors to bear in mind a number of common themes which we felt would be productive in a comparative context. Other bibliographic omissions include Philip W. Setel, Milton Lewis, and Maryinez Lyons (eds) Histories of Sexually Transmitted Diseases and HIV/AIDS in Sub-Saharan Africa (1999) and Karen Jochelson's The Colour of Disease : Syphilis and Racism in South Africa, 1880-1950 (2001), which appeared too late to be taken into consideration.
The omission of any specific consideration of HIV/AIDS was a policy decision taken at an early stage of the progress of this volume. We felt that the history of the 'classic' or 'traditional' STDs deserved attention in its own right, and that the implications for current issues should remain implicit. As Professor Berridge points out, the history of policies and attitudes towards VD has ramifications for a range of areas of interest which have, perhaps, been occluded by treating it as a precursor model or awful warning for the age of AIDS.
One final theme that might have fruitfully been addressed is the shift in the nature of the sources employed by historians of VD over recent decades and its impact on the historiography of the subject. The more traditional public health narrative has tended to rely on official publications and circulars - along with the archives of the major medical, social purity and social hygiene institutions - together with the reports of women's organisations and other pressure groups, sometimes leavened by the use of surviving photographs. However, with the greater use of content and discourse analysis, historians and sociologists have focused more on the texts and iconography of VD propaganda; whether those issued by the social hygiene agencies in the form of pamphlets or films or by government information departments - sources which often reveal much more of the underlying cultural assumptions and norms underpinning medical provisions and social policy. However, one of the major innovations in research into syphilis and other VD in modern Europe has been the use of case notes and hospital registers along with other demographic data to access for the first time the medical history and life-experiences of syphilitic patients as opposed to the views and concerns of policy makers. For reasons of confidentiality, especially of the census records, in most countries this exercise has not been feasible for the period after 1870. A major exception is the recent work of Anna Lundberg in Sweden (4) , With the help of the demographic data base in Umea, she has undertaken a very imaginative and extremely innovative exploration of the social make-up of the venereally- diseased patient population and of the impact of VD on their life-chances and patterns of family formation. What she finds is that adult mortality rates and marriage rates of venereally-diseased patients were not significantly different from the control group, and that, in late 19th century Sweden, there was every chance that former venereally-diseased patients could enjoy a relatively normal profile of life expectation and family formation. Clearly, this is the type of research that if replicated elsewhere will open up an entirely new phase in the social historian's interpretation of the 'Great Scourge' in Modern Europe.- giving an entirely new insight into the social meaning of VD in modern European society.
(1) P. Weindling, 'The Politics of International Co-Ordination to Combat Sexually Transmitted Diseases, 1900-1980s' in V. Berridge and P. Strong (eds) AIDS and Contemporary History (1993), ch. 5.
(2) P. Baldwin, Contagion and the State in Europe 1830-1930 (1999).
(3) M. Lewis, S. Bamber and M. Waugh (eds), Sex, Disease, and Society: A Comparative History of Sexually Transmitted Diseases and HIV/AIDS in Asia and the Pacific (1997)
(4) A. Lundberg, Care and Coercion: Medical Knowledge, Social Policy and Patients with Venereal Disease in Sweden 1785-1903 (1999).