expected, and a second or third negative blood test is usually the signal for their disappearance.  They are, of course, lost in the great unknown of syphilis, and swell the total of deaths from internal causes of syphilitic origin, such as diseases of the arteries and of the nervous system.  A good many have to be treated for relapses, but the amount of infection spread by them, while of course unknown, is probably small considering how many of them there are.

+Effect of the High Cost of Treatment.+—­A factor which is extremely influential in forcing average treatment and ideals on those who, if opportunity were more abundant, would be conscientious about the disease, has already been mentioned as the cost of treatment, which is such that persons with small incomes, who are too proud or sensitive to seek charitable aid, can scarcely be expected to meet.  The cost of salvarsan under present conditions is a burden that few can hope to assume to the extent that modern treatment tends to require, and the slower methods of treatment are more of a tax on the patient’s courage and determination, and less effective in preventing the danger of infectiousness, although quite as reliable for cure.  There is no more serious problem in the public health movement against syphilis than to get for the average man who can pay a moderate but not a large fee the benefits of expensive and elaborate methods of recognizing and treating a disease such as syphilis.  Some practical methods of doing this will be taken up in the next chapter.

+The Irresponsible.+—­The irresponsible attitude of mind about syphilis forms the background of the darkest and most repellent chapter in the story of the disease.  Yet we ought to confront it if we wish to master the situation.  The irresponsible person has either no regard for, or no conception of, the rights of others where a dangerous contagious disease is concerned, and often little conception of, and less interest in, what is to his own ultimate advantage.  Irresponsible syphilitics lack character first and sense next.  Many of them, through the gods-defying combination of stupidity and ignorance, cannot be approached through any channel of reason or persuasion.  The only argument capable of influencing such minds is compulsion.  Others are, of course, mental defectives with criminal and perverted tendencies.  Yet it is both amazing and discouraging to find how many irresponsibles there are in the ordinary and even in the better walks of life.  To the wilful type of irresponsible person the transmission of a syphilitic infection is nothing, and cannot weigh a straw against the gratification of his desire or the pursuit of his own interest.  The disease cannot teach such people anything, and if it cannot, how can the physician?  Such people pursue their personal and sexual pleasure, marry, spread disaster around them, and outlive it all, perhaps brazenly to acknowledge the fact.  Others, suave, attractive, agreeable,