Theoretical change and therapeutic innovation in the treatment of syphilis in mid-nineteenth-century France

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 Francois 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.