International control measures for infectious disease generally date from the mid nineteenth century. We have nothing but the occasional word of contemporary doctors that such measures did any appreciable good; in the beginning, at least, efforts at control over the whole field could have had little more effect than King Canute had on the sea. In these earlier years there is no reason to think that control of VD was even considered seriously among the other problems, except through a Victorian veil of affluent respectability tinged with distaste. But let us see what was attempted.

A First International Sanitary Conference, to deal mainly with cholera and plague, was called by France as early as 1851 before much was known about sanitation in any true sense. This was three years before John Snow had pointed to the Broad Street pump as the source of cholera in London the first important landmark in modern sanitation and before anything useful was known about the transmission of plague; so it seems unlikely that the conference could have accomplished much. But the idea of such international conferences caught on, doubtless because epidemic disease was raging in Europe's growing colonial empire; and it probably seemed a good idea to talk about the problem even if that was all that could be done. In 1907 an "Office Internationale d'Hygiene Publique" was set up as a permanent center to try to revise and enforce such international sanitary regulations as there were.

According to Theodore J. Bauer, an early director of the VD division of the U.S. Public Health Service, the whole worldwide approach to VD before World War I tended to be "identified with broad social issues rather than with health," a phrase I interpret as a euphemism for attempts at repression, or meaning little more than a polite turning away from the facts. Yet as early as 1899, and again in 1902, there were international conferences "on the prophylaxis of syphilis" in Brussels, and it is of interest that in addition to recommending "distribution of leaflets emphasizing its dangers to persons entering the armed forces" the conferees did come out in favor of free treatment for all VD patients, more than a century after the same idea had been suggested in Denmark.

The need to do something about VD must have become inescapable during World War I, but the difficulties then were greater than they are now. The new diagnostic methods were revealing the extent of gonorrhea and syphilis. Nevertheless effective treatment for gonorrhea was totally lacking, and the sustained therapy with arsenical drugs required for syphilis was clearly unsuitable for mass use by the military. (see INTERNATIONAL CONTROL MEASURES FOR INFECTIOUS DISEASE PART II)