who are the victims of
crowding, poor living conditions, and ignorance. Estimates on the amount
of syphilis which is contracted in marriage are apt to be largely
guesswork in the absence of reliable vital statistics on the disease.
Fournier believed that 20 per cent of syphilis in women was contracted
in marriage. So much syphilis in married women is unsuspected, and so
little of what is recognized is traceable to outside sources, that 50
per cent seems a nearer estimate than twenty.

Chapter XII

The Transmission and Hygiene of Syphilis (Continued)

THE CONTROL OF INFECTIOUSNESS IN SYPHILIS.--SYPHILIS AND MARRIAGE

+Means for Controlling Infectiousness.+--The usual method of controlling
a very contagious disease, such as scarlet fever or measles, is to put
the patient off by himself with those who have to care for him and to
keep others away--that is, to quarantine them. This works very well for
diseases which run a reasonably short course, and in which contagious
periods are not apt to recur after the patient has been released. But in
diseases such as tuberculosis and syphilis, in which contagiousness may
extend over months and years, such a procedure is evidently out of the
question. We cannot deprive a patient of his power to earn a living, to
say nothing of his liberty, without providing for his support and for
that of those who are dependent on him. To do this in so common a
disease as syphilis would involve an expenditure of money and an amount
of machinery that is unthinkable. Accordingly, as a practical scheme for
preventing its spread, the quarantine of syphilis throughout the
infectious period is out of the question. We must, therefore, consider
the other two means available for diminishing the risk to others. The
first of these, and the most important, is to treat the disease
efficiently right from the start, so that contagious sores and patches
will be as few in number as possible, and will recur as little as
possible in the course of the disease. This will be in effect a
shortening of the contagious period, and should be recognized as one of
the great aims of treatment. The second means will be to teach the
syphilitic and the general public those things which one who has the
disease can do to make himself as harmless as possible to others. This
demands the education of the patient if we hope for his cooeperation, and
demands also the cooeperation of those around him in order that the
pressure o