+Extragenital and Marital Syphilis.+—­Estimates of the ratio of genital to non-genital or so-called extra-genital infection in syphilis vary a good deal, and are largely the products of the clinical period in the history of the disease before the days of more exact methods of detecting its presence.  The older statistics estimate from 5 to 10 per cent of all syphilitic infections to be of non-genital origin, while the remaining 90 per cent are genital.  As we become better able to recognize hidden syphilis, we shall probably find that the percentage of non-genital infections will increase.

The physician’s suspicions are easily aroused by a genital sore, less so by one on the lip or the tonsil, for example.  The same thing is true of the layman.  Syphilis which starts from a chancre elsewhere than on the genitals runs the same course and may conceal itself quite as effectively as syphilis from the usual sources, and for that reason may even more easily escape notice because misinterpreted at the start.  It is my personal impression that careful study of patients with syphilis, and of those who live with them, would bring to light many overlooked extragenital infections, especially among those who are the victims of crowding, poor living conditions, and ignorance.  Estimates on the amount of syphilis which is contracted in marriage are apt to be largely guesswork in the absence of reliable vital statistics on the disease.  Fournier believed that 20 per cent of syphilis in women was contracted in marriage.  So much syphilis in married women is unsuspected, and so little of what is recognized is traceable to outside sources, that 50 per cent seems a nearer estimate than twenty.

Chapter XII

The Transmission and Hygiene of Syphilis (Continued)

THE CONTROL OF INFECTIOUSNESS IN SYPHILIS.—­SYPHILIS AND MARRIAGE

+Means for Controlling Infectiousness.+—­The usual method of controlling a very contagious disease, such as scarlet fever or measles, is to put the patient off by himself with those who have to care for him and to keep others away—­that is, to quarantine them.  This works very well for diseases which run a reasonably short course, and in which contagious periods are not apt to recur after the patient has been released.  But in diseases such as tuberculosis and syphilis, in which contagiousness may extend over months and years, such a procedure is evidently out of the question.  We cannot deprive a patient of his power to earn a living, to say nothing of his liberty, without providing for his support and for that of those who are dependent on him.  To do this in so common a disease as syphilis would involve an expenditure of money and an amount of machinery that is unthinkable.  Accordingly, as a practical scheme for preventing its spread, the quarantine of syphilis throughout the infectious period is out of