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Professor Founder has just given in one of his remarkable lessons the line of action to follow when consulted by a syphilitic woman. This varies with the social status of the patient. If irrégulière, that is to say a woman who is kept or a prostitute she must be told at once the nature of her ailment so as to put her on her guard against the dangers of infecting others if she persists in maintaining relations with them. If on the contrary it is a married woman the line of conduct is much more delicate. To declare rudely that she is affected with syphilis is to risk, if the husband is the culpable one, causing domestic trouble, and separation in the family. If one simply gives a prescription without saying anything, this usually amounts to nothing for she does not fail to instruct herself upon the real nature of the drugs employed and thus learns the truth. Theoretically it is better to place the burden on the husband of keeping from the wife so far as is possible the nature of the disease which she has received from him. The husband must thus be taken into the case and entrusted with the direction of the care to be taken and the carrying out of the treatment. For this reason Professor Fournier does not advise giving the patient at the first visit a prescription which could awaken suspicion. A local treatment without mercury should suffice, the patient must be told that there are certain points in the case which do not appear quite clear, and for which reason a conversation with the husband will be necessary, or that there are certain things you wish to recommend to the husband, and ask to have him sent to see you. If the woman is innocent, that is to say if she has had relations with her husband alone, she will readily comply with your request. From this time on you have only to come to an understanding with the husband keeping as much as possible from the knowledge of the wife the real nature of her complaint. However too much secrecy can not be expected, for after a certain period of this prolonged and mysterious medication the woman begins to suspect the truth, but the object has already been attained, scenes of violence have been avoided which in the commencement would have been precipitated by a sudden discovery of the true nature of the disease and usually regrettable separations and divorces are avoided. But to act as we have suggested we must be quite sure of our premises. We must be assured that it is from the husband alone and not from some other that the contagion has come for in the opposite case it would be the same as saying to the husband "your wife has syphilis and as you haven't it, she must have contracted it from some one else." So as not to commit such a blunder care must be taken in speaking to the husband before having the full assent of the wife. If she is innocent she will have no reason to oppose the conference, if she is guilty, that is to say if she has had relations with other persons she will without doubt take you at once into her confidence.
J Cutan Genito-Urin Dis.
April 1892;10:170-171.