The fact that in these cases of active or latent syphilis the disease has been acquired criminally does not in itself affect the state of the question one way or another--a criminal syphilitic has a right to his reputation and goods despite his moral condition; but even where the disease has been acquired without moral guilt the syphilitic is always a formally or materially unjust aggressor in a prospective marriage to an innocent and uninfected woman, and is to be treated accordingly. If a woman may kill an unjust aggressor in defence of her chastity, and if _quod liceat per se licet per alium_, her natural protectors, kin, physician, and so on, may at least divulge the secret of the man's condition in defence of her from a fate which in many respects is worse than rape. In keeping with this matter of entrusted secrets it is worth noting that physicians should remember that the case histories they leave after them at death, or which they leave unguarded in their offices, are likely to be read by some third party who has no right to the secrets they contain. Case histories which the patients would not have divulged should be kept in cipher so far as proper names and addresses are concerned. CHAPTER XX GONORRHEA IN MARRIAGE Gonorrhea is caused by the gonococcus discovered by Neisser in 1879. The name was given to the disease in the second century by Galen, who supposed that the condition is a spermatorrhea. The infection begins as a surface inflammation and gradually penetrates more or less deeply into the underlying tissues. In the male, gonorrhea may affect any part of the body; and when the disease is chronic it is a source of infection for years. If a man who has had gonorrhea wishes to marry after careful treatment, most physicians will permit him to do so if he passes the customary tests which indicate cure, but he is always dangerous. The tests are: (1) the microscopic and cultural examinations of the centrifugalized morning urine--the washings from the urethra must be negative after repeated trials and over a space of months; (2) the microscopic and cultural examinations of urethral spontaneous and artificial discharges must be negative in the same manner; (3) the microscopic and cultural findings of the secretion expressed from the prostate and seminal vesicles must be negative in the same manner; (4) urethroscopic examinations of the anterior and posterior urethra must show no unhealed lesions; (5) the complement fixation test is to be repeatedly negative. The complement fixation test is like a Wassermann reaction, but the antigen should be polyvalent. This test does not give a positive reaction where no gonorrhea is present, but it is often negative where the gonococcus is present. Hence a positive result has value, but a negative result has little or no value. All these tests are to be tried repeatedly, and if negative for months, the physician may say the man is