sexual contact.  The patient with a concealed syphilis often lacks even the incentive to seek examination by a doctor.  It is important also to realize that when mercury has to be the only reliance, the risk of infection cannot be entirely controlled by treatment.  Contagious sores may develop even during a course of mercurial injections, especially in early cases.  It requires the combination of mercury and salvarsan to secure the highest percentage of good results.

+The Five-year Rule.+—­The truth of the matter is that, as Hoffmann says, no treatment can guarantee the non-infectiousness of a syphilitic in the first five years of his disease.  Time is thus an essential element in pronouncing a person non-infectious and hence in deciding his fitness for marriage, for example.  The person with active syphilis who has intimate relations with uninfected persons, who will not abandon smoking or take special precautions about articles of personal use which are likely to transmit the disease, is unsafe no matter what is done for him.  In spite of this qualifying statement it may be reiterated, however, that good treatment with salvarsan and mercury reduces the risk of infecting others in the ordinary relations of life practically to the vanishing point, and of course reduces, but not entirely eliminates, the dangers of the intimate contacts.

+Personal Responsibility of the Patient.+—­If we are compelled then to fall back to some extent upon the personal sense of responsibility of the patient himself to fill in the gap where treatment does not entirely control the situation, it becomes increasingly important that in the irresponsible and ignorant, when the patient fails to meet his obligation, we should push treatment to the uttermost in our effort to prevent the spread of the disease.  To supply this necessary treatment to every syphilitic who cannot afford it for himself, and make it obligatory, if need be, will be a long step forward in the control of the disease.  The educational campaign for it is well under way all over the world, and the money and the practical machinery will inevitably follow.  We have the precedents of the control of tuberculosis, smallpox, malaria, and yellow fever to guide us, to say nothing of a practical system against sexual disease already in operation in Norway, Sweden, Denmark, and Italy.

+Syphilis and Marriage.+—­The problem of the relation of syphilis to marriage is simply an aspect of the transmission of an infectious disease.  The infection of one party to the marriage by the other and the transmission of that infection to children summarizes the social problem.  Through the intimate contacts of family life, syphilis attacks the future of the human race.