is used over and over at frequent intervals, and in which there is a careless and unsanitary type of personal service, can hardly be regarded as safe.  While there is no need for hysterical alarm over such possibilities, it is just as well to provide for them.  Crowding, close quarters, and insufficient sanitary conveniences in stores and offices, in restaurants or tenements, provide just the conditions in which accidental infection may occur.  A gang of men with a common bucket and drinking cup may be at the mercy of syphilis if one member is in a contagious condition.  A syphilitic might cough into the air with little risk, since the germs would die before they could find a favorable place to infect.  But a syphilitic who coughs directly into one’s face with a mouth full of spirochetes multiplies the risk considerably.  The public towel is certainly dangerous—­almost as much so as the common drinking cup.  The possibility of syphilitic infection by cutting the knuckle of the hand against the teeth of an opponent in striking a blow upon his mouth should not be overlooked, and the occurrence is common enough for this type of chancre to have received the special name of brawl, or fist, chancre.

+Accidental Syphilis in Physicians and Nurses.+—­Another type of infection ought not to go unmentioned—­that to which physicians and nurses are exposed in operating on or handling patients with active syphilis.  Before the day of rubber gloves such things were much more common perhaps than they are now, yet they are common enough at the present time.  Most of the risk occurs in exploring or working in cavities of the body containing infected discharges.  The blood may become infected in passing over active sores.  The risk from all these sources is so considerable that it is justifiable as a measure of protection to a hospital staff to take a blood test on every patient who applies for treatment in a hospital, to say nothing of the advantage which this would be to the patient.

+Transmission by Intimate Contacts—­Kissing.+—­As we pass from the less to the more intimate means of contact between the syphilitic person and others, the risk of transmitting syphilis may be said to increase enormously.  The fundamental conditions of moisture, a susceptible surface, protection of the germ from drying and from air, and possibly also massage or rubbing, are here better satisfied than in the risks thus far considered.  Kissing, caresses, and sexual relations make up the origin of an overwhelming proportion of syphilitic infection.  Infections are, of course, traceable to the nursing of syphilitic infants.  It is through these sources of contact that syphilis invades the family especially.  Many a syphilitic who realizes that he should not have sexual relations with his wife while he has the disease in active form will thoughtlessly infect her or his children by kissing.  Kissing games are potentially dangerous, and a classical example of this danger is that of a reported case[11]