[13] The figures here given are based on those of Papee, Wwednesky, Raff, Sederholm, and others.  The recently published investigations of the Baltimore Vice Commission showed that 63.7 per cent of 289 prostitutes examined by the Wassermann test had syphilis.  Of 266 examined for gonorrhea, 92.1 per cent showed its presence.  Nearly half the girls examined had both diseases and only 3.39 per cent had neither. (Survey, March 25, 1916, Vol. 35, p. 749.)

+Concealed Syphilis and Medical Examinations of Prostitutes.+—­A number of delusions center around the relation of open and secret prostitution to disease.  From the description of syphilis given in the foregoing pages, it must be apparent how little reliance can be placed, for example, on the ordinary medical examination of prostitutes as practised in segregated districts.  The difficulties of efficient examination are enormous, especially in women.  Even with the best facilities and a high degree of personal skill, with plenty of time and laboratory help in addition, extremely contagious syphilis can escape observation entirely, and even the negative result of one day’s examination may be reversed by the appearance of a contagious sore on the next.  Women can transmit syphilis passively by the presence of infected secretions in the genital canal even when they themselves are not in a contagious state.  In the same way a woman may find herself infected by a man without any idea that he was in an infectious state.  She may in turn develop active syphilis without ever realizing the fact.  Medical examination of prostitutes as ordinarily carried out does actual harm by deluding both the women and their partners into a false sense of security.  The life which such women lead, with the combination of local irritation, disease, and fast living, makes them especially likely to develop the contagious mucous patches, warts, and other recurrences, and to relapse so often that there can be little assurance that they are not contagious all the time.

Under such circumstances one might almost expect every contact with a prostitute on the part of a non-syphilitic individual to result in a new infection.  The factors which interfere to prevent such wholesale disaster are the same which govern infectiousness throughout the disease.  Local conditions may be unfavorable, even though the germs are present, or there may be no break in the skin for the germs to enter.  If the syphilitic individual is beyond the infectious period, there may be no dangerous lesions.  Here, as all through the history of infections with syphilis, there is an element of the unexpected, a favoring combination of circumstances.  Sometimes when infection is most to be expected it is escaped, and conversely it seems at times that in the “sure thing,” the “safe chance,” and the place where infection seems most improbable, it is most certain to occur.

PERSONAL HYGIENE IN SYPHILIS