in which a young man in Philadelphia infected seven young girls in one game, all of whom developed chancres on the lips or cheeks.  It is no great rarity to find a syphilis dating from a sore on the lip that developed while a young couple were engaged.  Certainly the indiscriminate kissing of strangers is as dangerous an indulgence as can be imagined.  Syphilis does not by any means invariably follow a syphilitic’s kiss, but the risk, although not computable in figures, is large enough to make even the impulsive pause.  The combination of a cold sore or a small crack on the lip of the one and a mucous patch inside the lip of the other brings disaster very near.  Children are sometimes the unhappy victims of this sort of thing, and it should be resented as an insult for a stranger to attempt to kiss another’s child, no matter on what part of the body.  It would be easy to multiply instances of the ways in which syphilis may be spread by the careless or ignorant in the close associations of family life, but little would be accomplished by such elaboration that would not occur to one who took the trouble to acquaint himself with the principles already discussed.

    [11] Schamberg, J. F.:  “An Epidemic of Chancres of the Lip from
    Kissing,” Jour.  Amer.  Med.  Assoc., 1911, lvii, 783.

+The Sexual Transmission of Syphilis.+—­The sexual transmission of syphilis is beyond question the most important factor in the spread of the disease.  Here all the essential conditions for giving the germ a foothold on the body are satisfied.  The genitals are especially fitted to keep the germs in an active condition because of the ease with which air is excluded from the numerous folds about these parts.  It is remarkable what trifling lesions can harbor them by the million, and how completely, especially in the case of women, syphilitic persons may be ignorant of the danger for others.  Sexual transmission of syphilis is simply a physiologic fact, and in no sense to be confounded with questions of innocence and guilt in relation to the acquiring of the disease.  A chancre acquired from a drinking cup or pipe may be transmitted to husband or wife through a mucous patch on the genitals and to children through an infected mother, without the question of innocence or guilt ever having arisen.  On the other hand, chancres on parts other than the genitals may be acquired in any but innocent ways.  It is impossible to be fair or to think clearly so long as we allow the question of innocence or guilt to color our thought about the genital transmission of syphilis.  That syphilis is so largely a sexually transmitted disease is an incidental rather than the essential fact from the broadly social point of view.  We should recognize it only to the extent that is necessary to give us control over it—­not allow it to hold us helplessly in its grip because we cannot separate it from the idea of sexual indiscretion.  There is a form of narrow-minded self-righteousness about these things that sets the stamp of vice on innocent and guilty alike simply on the strength of the sexual transmission of syphilis.  In the effort to avoid so mistaken and heartless a view, we cannot remind ourselves too often that syphilis is a disease and not a crime, and as such must be approached with the impulse to heal and make whole, and not to heap further misfortune on its victim or take vengeance on him.