+Cure in the Secondary Stage.+—­The estimation of the prospect of recovery when the secondary symptoms have appeared and the germs are in the blood is difficult, owing to the rapid changes in our knowledge of the disease, which are taking place almost from day to day.  The patient usually presses his physician for an estimate of his chances, and in such cases, after carefully explaining why our knowledge is fallible and subject to change, I usually estimate that for a patient who will absolutely follow the advice of an expert, the prospects are well over 90 per cent good.

+The Outlook in Late Syphilis.+—­After the first year of the infection is passed, or even six months after the appearance of the secondary rash, the outlook for permanent cure begins to diminish and falls rapidly from this point on.  That means that we are less and less able to tell where we stand by the tests we now have.

In the later stages of the disease we are gradually forced back to symptomatic measures, and are often rather glad to be able to say to the patient that we can clear up his immediate trouble without mentioning anything about his future.

The gist of the first essential, then, is to treat syphilis early rather than late.  If this is done, the prospect of recovery is better than in many of the acute fevers, such as scarlet fever, a matter of every day familiarity, and better, on the whole, than in such a disease as tuberculosis. Yet this does not mean that the men or women whose syphilis is discovered only after a lapse of years, must be abandoned to a hopeless fate. For them, too, excellent prospects still exist, and careful, persistent treatment may, in a high percentage of cases, keep their symptoms under control for years, if not for the ordinary life-time.

+The Time Required for Cure.+—­Time is the second vital essential for cure.  Here we stand on less certain ground than in the matter of the stage of the disease.  The time necessary for cure is not a fixed one, and depends on the individual case.  Long experience has taught us that the cure of syphilis is not a matter of weeks or months, as patients so often expect, but of years.  For the cure of early primary syphilis ("abortive” cure) not the most enthusiastic will discharge a patient short of a year, and the conservative insist on two years or more of observation at least.  In the fully developed infection in the secondary stage, three years is a minimum and four years an average for treatment to produce a cure.  Five years of treatment and observation is not an uncommon period.  In the later stages of the disease, when we are compelled to give up the ideal of radical cure, our best advice to syphilitic patients, as to those with old tuberculosis, is that after they have had two years of good treatment, they should submit to examination once or twice a year, and not grumble if they are called upon to carry life insurance in the form of occasional short courses of treatment for the rest of their days.