Engagements nowadays may well be thought of as equivalent to marriage when the question of syphilis is considered.  They not infrequently offer innumerable opportunities for intimacies which may or may not fall short of actual sexual relations.  Attention has been called to this situation by social workers among wage-earning girls.  It has been a distressingly frequent experience in my special practice to find that the young man, overwrought by the excitement of wooing, has exposed himself elsewhere to infection and unwittingly punished the trustfulness of his fiancee by infecting her with syphilis through a subsequent kiss.  The publication of banns before marriage is worth while, and unmistakable testimony as to the character and health of the parties concerned might well be exchanged before a wooing is permitted to assume the character of an engagement.  It is of little use to say that a Wassermann and a medical examination should be made before marriage, when the damage may be done long before that point is reached.

+Medical Examination for Syphilis before Marriage.+—­How shall we recognize syphilis in a candidate for marriage?  The prevailing idea is to demand a negative Wassermann test.  Assuredly this is good as far as it goes, but it is not so reliable as to deserve incorporation into law as sole sufficient evidence of the absence of syphilis, as has been done in one state.  From what has been said, it is plain that a single negative Wassermann is no proof of the absence of syphilis.  The subject must be approached from other angles, and when syphilis may be suspected, the question should be decided by an expert.  A thorough general or physical examination is desirable, and if this reveals suspicious signs, such as scars, enlarged glands, etc., it is then possible to investigate the Wassermann report more thoroughly by repeating the test, sending it to another expert for confirmation.  In some cases it may even be necessary to insist that the patient submit to a special test, called the provocative test, in which a small injection of salvarsan is used to bring out a positive blood test if there is a concealed syphilis.  These are, of course, measures which are seldom necessary except in patients who have had the disease.  Much depends on the attitude of the patient toward the examination and his willingness to cooeperate.  A resourceful physician can usually settle the question of a person’s fitness for marriage, and the result of a reliable examination offers a reasonable assurance of safety.

+Laws Crippling Physicians in Such Matters.+—­What shall the physician do when confronted with positive evidence that a patient who is about to marry has an active syphilis?  It is important for laymen to understand that the law relating to professional confidence between physician and patient ties the hands of the physician in such a situation.  For the doctor to tell the relatives of the healthy party to such an intended marriage that the other has active