+The Meaning of “You are Cured."+—­How do we judge whether a patient is radically cured or not?  Here again we confront the problem of what constitutes the eradication of the disease.  In part we reckon from long experience, and in part depend upon the refinement of our modern tests.  Repeated negative Wassermann tests on the blood over several years, especially after treatment is stopped, are an essential sign of cure.  This must be reinforced, as a rule, by a searching examination of the nervous system, including a test on the fluid of the spinal cord.  This is especially necessary when we have used some of the quick methods of cure, like the abortive treatment.  When we have used the old reliable course, it is less essential, but desirable.  Can we ever say to a patient in so many words, “Go! you are cured”?  This is the gravest question before experts on syphilis today, and in all frankness it must be said that the conservative man will not answer with an unqualified “Yes.”  He will reserve the right to say to the patient that he must from time to time, in his own interest, be reexamined for signs of recurrence, and perhaps from time to time reinforce his immunity by a course of rubs or a few mercurial injections.  Such a statement is not pessimism, but merely the same deliberate recognition of the fallibility of human judgment and the uncertainty of life which we show when we sleep out-of-doors after we have been suspected of having tuberculosis, or when we take out accident or life insurance.

Chapter X

Hereditary Syphilis

It seems desirable, at this point, to take up the hereditary transmission of syphilis in advance of the other modes of transmitting the disease, since it is practically a problem all to itself.

Syphilis is one of the diseases whose transmission from parent to child is frequent enough to make it a matter of grave concern.  It is, in fact, the great example of a disease which may be acquired before birth.  Just as syphilis is caused only by a particular germ, so hereditary syphilis is also due to the same germ, and occurs as a result of the passage of that germ from the mother’s body through the membranes and parts connecting the mother and child, into the child.  Hereditary syphilis is not some vague, indefinite constitutional tendency, but syphilis, as definite as if gotten from a chancre, though differing in some of its outward signs.

+Transmission of Syphilis From Mother to Child.+—­It is a well-known fact that the mothers of syphilitic children often seem conspicuously healthy.  For a long time it was believed that the child could have syphilis and the mother escape infection.  The child’s infection was supposed to occur through the infection of the sperm cells of the father with the germ of syphilis.  When the sperm and the egg united in the mother’s body, and the child developed, it was supposed to have syphilis contracted from the