ter carefully explaining why our knowledge is fallible and
subject to change, I usually estimate that for a patient who will
absolutely follow the advice of an expert, the prospects are well over
90 per cent good.

+The Outlook in Late Syphilis.+--After the first year of the infection
is passed, or even six months after the appearance of the secondary
rash, the outlook for permanent cure begins to diminish and falls
rapidly from this point on. That means that we are less and less able
to tell where we stand by the tests we now have.

In the later stages of the disease we are gradually forced back to
symptomatic measures, and are often rather glad to be able to say to the
patient that we can clear up his immediate trouble without mentioning
anything about his future.

The gist of the first essential, then, is to treat syphilis early rather
than late. If this is done, the prospect of recovery is better than in
many of the acute fevers, such as scarlet fever, a matter of every day
familiarity, and better, on the whole, than in such a disease as
tuberculosis. _Yet this does not mean that the men or women whose
syphilis is discovered only after a lapse of years, must be abandoned to
a hopeless fate._ For them, too, excellent prospects still exist, and
careful, persistent treatment may, in a high percentage of cases, keep
their symptoms under control for years, if not for the ordinary
life-time.

+The Time Required for Cure.+--Time is the second vital essential for
cure. Here we stand on less certain ground than in the matter of the
stage of the disease. The time necessary for cure is not a fixed one,
and depends on the individual case. Long experience has taught us that
the cure of syphilis is not a matter of weeks or months, as patients so
often expect, but of years. For the cure of early primary syphilis
("abortive" cure) not the most enthusiastic will discharge a patient
short of a year, and the conservative insist on two years or more of
observation at least. In the fully developed infection in the secondary
stage, three years is a minimum and four years an average for treatment
to produce a cure. Five years of treatment and observation is not an
uncommon period. In the later stages of the disease, when we are
compelled to give up the ideal of radical cure, our best advice to
syphilitic patients, as to those with old tuberculosis, is that after
they have had two years of good treatment, they should submit to
examina