d or wife through a mucous patch on the genitals
and to children through an infected mother, without the question of
innocence or guilt ever having arisen. On the other hand, chancres on
parts other than the genitals may be _acquired in any but innocent
ways_. It is impossible to be fair or to think clearly so long as we
allow the question of innocence or guilt to color our thought about the
genital transmission of syphilis. That syphilis is so largely a sexually
transmitted disease is an incidental rather than the essential fact from
the broadly social point of view. We should recognize it only to the
extent that is necessary to give us control over it--not allow it to
hold us helplessly in its grip because we cannot separate it from the
idea of sexual indiscretion. There is a form of narrow-minded
self-righteousness about these things that sets the stamp of vice on
innocent and guilty alike simply on the strength of the sexual
transmission of syphilis. In the effort to avoid so mistaken and
heartless a view, we cannot remind ourselves too often that syphilis is
a disease and not a crime, and as such must be approached with the
impulse to heal and make whole, and not to heap further misfortune on
its victim or take vengeance on him.

+Extragenital and Marital Syphilis.+--Estimates of the ratio of genital
to non-genital or so-called extra-genital infection in syphilis vary a
good deal, and are largely the products of the clinical period in the
history of the disease before the days of more exact methods of
detecting its presence. The older statistics estimate from 5 to 10 per
cent of all syphilitic infections to be of non-genital origin, while the
remaining 90 per cent are genital. As we become better able to recognize
hidden syphilis, we shall probably find that the percentage of
non-genital infections will increase.

The physician's suspicions are easily aroused by a genital sore, less so
by one on the lip or the tonsil, for example. The same thing is true of
the layman. Syphilis which starts from a chancre elsewhere than on the
genitals runs the same course and may conceal itself quite as
effectively as syphilis from the usual sources, and for that reason may
even more easily escape notice because misinterpreted at the start. It
is my personal impression that careful study of patients with syphilis,
and of those who live with them, would bring to light many overlooked
extragenital infections, especially among those