jority of the victims of syphilis are not innocent of wrong, but they pay a terrible penalty for their weakness. At best it means many months of hard and disagreeable treatment, and at worst there is almost no limit to the suffering it may entail.

At first a purely local condition, starting with a sore of variable size at any point to which the germs gain access, these germs multiply and soon spread through the blood and lymph to all organs and tissues of the body. A few weeks after infection a rash usually develops which may resemble many other skin diseases and is often the first symptom to send the patient to the physician.

A YOUNG MAN'S STORY.

Not long ago a young man of twenty came into a doctor's office with his body covered by a bright red rash. At first he absolutely denied the possibility of syphilitic infection but later on he broke down and cried, confessing that he had been taken by a much older man to the home of some women whose reputations in the community were of the wrong type.

After a night of drinking and carousing he crept home much ashamed of himself and vowed in great fear that he would never be guilty again. He had been told of the dangers, but when a week or ten days elapsed and nothing happened, his mind became more at ease. However, nearly four weeks after the eventful night a slight sore developed. In greater fear than ever he went to his older friend, who laughed at him and burned the sore with caustic. Again the mind of the youth became at ease, for the sore healed in a day or two, leaving scarcely any evidence of its existence.

Six weeks later the rash appeared and he now had sense enough to apply to a physician. He was told that he had syphilis and that had he gone to a physician when he first noticed the sore his chances of cure would have been immeasurably better. It was explained to him that at that time the germs could have been found swarming in the sore and a diagnosis made at once; that a diagnosis made during that stage of the disease followed by the proper treatment almost assures the individual of a speedy cure, while the longer treatment is postponed the more difficult a cure becomes.

But what of the origin of this disease? From where did it come? How did it begin? How long has it been known? DISPUTE ABOUT ORIGIN OF SYPHILIS.

The first knowledge of syphilis is somewhat shrouded in mystery, and for over four centuries medical men have debated

concerning its origin. Did this new world-wide disease have its beginning in the dim recesses of antiquity to be transmitted in an uninterrupted stream to modern times, or was it born over night, as it were, at the close of the fifteenth century? Was syphilis known to the ancients, or did Columbus' men contract it from the natives of the new land and introduce it into Europe on their return?

Those who claim for syphilis an ancient origin quote from the Bible and other early writings to substantiate their claim. The story of the death of King David's first son by Bath-sheba after seven days of life, and David's subsequent lamentations concerning his ailments, especially the condition of his bones, are cited to prove that the author of the Psalms contracted syphilis from the wife of Uriah, and, while quite suggestive, are not conclusive. Still others have gone so far as to assert that certain prehistoric bones found in Japan and other regions show evidence of this disease.

The claim to the American origin of syphilis is based largely on the rapid spread of the disease over Europe soon after the return of Columbus. At this time it assumed a most virulent epidemic form, decimated whole communities, maimed tens of thousands for life, and caused untold sorrow and suffering.

Now KNOW CAUSE OF DISEASE.

In the early days of the knowledge of syphilis many strange ideas of its cause were entertained. It was thought to be due to the winds and the rains, to the stars, to the wrath of God, to poisonous water, to the eating of human flesh. However, after a time the light began to dawn, the idea of a living poison or virus as the cause of the disease grew in the minds of medical men, and with the advent of bacteriology, the science of germs, many attempted to find the microbe which produces it. From time to time numerous workers thought this had been discovered, but on closer investigation the germs which they described were found to be present in other diseases, or even in healthy people, or they were proved not to be germs at all. It was left for Schaudinn, a German scientist, first to describe the microbe of syphilis.

On the third day of March, 1905, this worker while searching in the fluid from a skin eruption of a woman suffering from the disease, saw some minute, spiral, cork-screw shaped bodies move slowly across the field of his microscope. They were very, very small, averaging about two five-thousandths

of an inch in length, and only one fifty-thousandth of an inch in diameter. After finding these same organisms in several similar cases and failing to find them in other diseases, Schaudinn reported his discovery to the medical world.

At first learned scientists looked with doubt on the findings of this great worker; it could not be that the long-sought goal had been attained! But soon doubters began to believe, until to-day the Spirocheta pallida is recognized by the whole scientific world as the cause of the great red plague.

WORLD-WIDE IN EXTENT.

The extent of syphilis is almost beyond belief and one of its. most striking features is its world-wide distribution. There is scarcely a spot on the globe where human beings reside which has not harbored this disease. It is found in the gold camps. of the Yukon, and among the ivory hunters of the Congo, on the vast steppes of Siberia, and the plains of Argentine. It is, however, especially a disease of dense population, whether temporary or permanent. In the great cities of the world, London, Paris, New York, its victims are numbered by the thousands, and such multitudes as gather together for great fairs and expositions, as Chicago, St. Louis and San Francisco leave syphilis in their wake.

It has been affirmed that Iceland is peculiarly free from this disease. If such is the case, it would seem that this is due, not to geographical situation, but to the simple lives and morality of the inhabitants. It is, however, a matter of common observation among physicians in certain rural districts that this disease is rarely encountered.

Many estimates of the actual prevalence of syphilis have been made. Fournier, the great French physician, thought that fifteen per cent. of the adult population of Paris, and Erb believed that twelve per cent. of the adults of Berlin were infected.

The medical department of the United States Army published figures collected before this country entered into the World War which indicate that thirty per cent. of the young men of the country of the general class from which recruits. to the army come are syphilitic, while five per cent. of the young men of the class of college students are infected.

MILLIONS SUFFER FROM DISEASE.

One of America's most eminent pathologists from postmortem examinations of a large number of cases estimates the

incidence of syphilis in America at the startling figure of thirty per cent.

The truth probably lies somewhere between these figures, but undoubtedly there are between five and ten millions of people in the United States suffering from this disease.

Of course it must not be thought that every one of this vast army of sufferers has a breaking out of the skin. Far from it. A large percentage are totally ignorant of the nature of their disease, or even that they are diseased at all. Furthermore, unless the physician be constantly on the alert he may often be led to draw wrong conclusion by symptoms which are found in many other diseases. The great Osler once said to his students, "Know syphilis in all its manifestations and relations and all other things clinical will be added unto you." By this he simply meant that syphilis may attack any organ or portion of the body and may resemble nearly any known disease.

A patient may present himself to the physician complaining of vague symptoms, a slight headache, a shortness of breath, a tremor of the hands, failing eyesight, or what not, with no thought of an infection long since forgotten, or remembered only as the light punishment of the folly of youth. Or the patient may be the innocent victim of an infection in the early course of which the disease had been so slight as to pass unnoticed. The symptoms which are present might be due to a dozen causes, but one by one the skilled physician will weed them out, a blood test will be made, and the individual will be confronted with the fact that he is suffering from syphilis of some of the internal organs.

It

A young woman who had been told by her home physician that she was suffering from tuberculosis of the lungs applied to her doctor for advice about going to another climate. seemed that she had had a cough for a year or more, ran a slight afternoon temperature and had lost considerable weight. A careful examination revealed the fact that, in addition to the signs of disease of the lungs, the central nervous system (the brain and spinal cord) showed evidence of abnormality. This was suspicious, and as all patients, regardless of the condition for which they consult the physician, should be subjected to a blood test for syphilis, it was done in this case. The test showed that the young woman was suffering from syphilis, and when the germs of tuberculosis could not be found in the

sputum it was decided that the lung disease was probably syphilis and not tuberculosis.

The patient denied any knowledge of infection, but as she had been married some years previously to a young man who had died suddenly of "heart disease," treatment for syphilis was strongly urged. The rapid improvement of the lung disease as well as the patient's general condition left little room for doubt as to the correctness of the diagnosis.

MOTHER CAN TRANSMIT DISEASE.

Syphilitic disease of the brain and spinal cord are among the most serious conditions in the whole field of medicine. Softening of the brain, general paralysis and locomotor ataxia are now known to be due solely to the invasion of the brain or spinal cord by the germs of syphilis.

In the inherited or congenital form of the disease, which is now recognized by most authorities as occurring only when the mother has it, although the father may, and usually does, have it also, we find much the same picture as in the acquired form. The child may be born with active manifestations present, but more frequently is born apparently healthy, and in a few days, or a few weeks, or even as long as a few months, it develops symptoms of the disease. Or the child may appear healthy at birth and remain apparently so for years, even, as in one case recorded as many as thirty-eight, when it begins to show the unmistakable signs.

There is an old adage which says that syphilis never kills. This statement is utterly false. In that portion of the United States which is known as the registration area, that is, where the causes of death are required by law to be recorded, and which comprises a little over two-thirds of the entire country, there were more than 13,500 deaths due to syphilis in all its phases reported for the year 1916. Undoubtedly many more deaths due to this disease occurred where physicians reported other causes, out of deference to the relatives of the patients. And furthermore, out of the more than 100,000 deaths reported as due to diseases of the heart, certainly a large percentage of the heart disease was caused by syphilis. Typhoid fever claimed less than 10,000 victims during the same year, while smallpox, once the scourge of the race, killed but 114 persons. LABORATORY TESTS IN DIAGNOSIS.

It will be seen from what has been said that the recognition, or diagnosis, of syphilis at any stage is of the utmost impor

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