"Man is his own star; and the soul that can Our acts our angels are, or good or ill, Our fatal shadows that walk by us still." -Epilogue to Beaumont and Fletcher Honest Man's Fortune. The physician should be a man of character and the oath of Hippocrates with slight exceptions can hardly be regarded as out of date. The first of his Aphorisms is: "Life is short and the art long; the occasion fleeting, experience fallacious, and judgment difficult." Few who quote this to-day are aware that it originally referred to the art of the physician. With your indulgence I will read the oath: THE OATH OF HIPPOCRATES. "I swear by Apollo, the physician, and Aesculapius, and Health, and All-heal, and all the goddesses, that, according to my ability and judgment, I will keep this Oath and this stipulation to reckon him who taught me this Art, equally dear to me as my parents, to share my substance with him, and relieve his necessities if required; to look upon his offspring in the same footing as my own brothers, and to teach them this Art, if they shall wish to learn it, without fee or stipulation; and that by precept, lecture, and every other mode of instruction, I will impart a knowledge of the Art to my own sons, and those of my teachers, and to disciples bound by a stipulation and oath according to the law of medicine, but to none others. I will follow that system of regimen which, according to my ability and judgment, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous. I will give no deadly medicine to any one if asked, nor suggest any such counsel; and in like manner I will not give to a woman a pessary to produce abortion. With purity and holiness I will pass my life and practice my Art. I will not cut persons labouring under the stone, but will leave this to be done by men who are practitioners of this work. Into whatever houses I enter, I will go into them for the bene fit of the sick, and will abstain from every voluntary act of mischief and corruption; and further, from the seduction of females or males, of freemen and slaves. Whatever, in connection with it, I see or hear, in the life of men, which ought not to be spoken of abroad, I will not divulge, as reckoning that all such should be kept secret. While I continue to keep this Oath unviolated, may it be granted to me to enjoy life and the practice of the Art, respected by all men, in all times. But should I trespass and violate this Oath, may the reverse be my lot." Emerson says: "That which we call character is a reserved force which acts directly by presence and without means. It is conceived of as a certain undemonstrable force, a Familiar or Genius by whose impulses the man is guided but whose Counsels he cannot impart; which is company for him, so that such men are often solitary, or if they chance to be social do not need society but can entertain themselves very well alone." Physicians, I think, as a class, are often this way; he does not count the frivolity of society which divides its day into pink teas and bridge, its conversation into ceremonies and escapes. He wants to join the society of talented men with the power of controlling talent, men of stability, full of principle, love and sympathy. Men who are not working for themselves but for others. Character is not built in a day; as we grow it grows, until it becomes as strong and steadfast as the rock of Gibraltar. The advice which Burns' father gave him was the best: "He bade me act a manly part, though I had ne'er a farthing, For without an honest, manly heart, no man was worth regarding." In this paper, the last but not the least qualification for a physician is duty. There is much in life which one cannot fathom; life is a mystery. These are three great words: "Whence, Whither, Why!" Nevertheless, we have to do our duty in whatever sphere of life we may be placed; sometimes it may be irksome, for the stepping stones along the path of duty are not all smooth. I believe no class of men feels the responsibility of duty as the physician. Human life is at stake; he may be almost holding the balance in his hand, and as a general on the field of battle, he must act quickly, wisely and well. We have had many men in our profession, and will have, who have been martyrs to their profession; no man realizes what is in him until he has been tried. The world is what we make it, look upon the bright side, the optimistic view, and it will seem bright; look upon the dark side, the pessimistic view, and it will be black. Make duty the end and aim of your life and you will feel a self-consciousness that you have played your part on this earthly stage. In the words of George Herbert: "The consciousness of duty performed gives us music at midnight." And when our work here is finished, may the time alloted be short or long, the longest time seems short; may we lay down our weapons of warfare against disease with a peaceful good-night. ATYPICAL LESIONS IN LUETIC INFECTION. In presenting this essay on atypical lesions manifested in syphilitic infection, I should ask your indulgence, since I fully realize, that, to a large percentage of practitioners, the entire subject of venereal infection is one that is profoundly morbid. Allowing the fact of its morbidity, we must all agree that it is the one type of infection we are called upon to treat, that upon its thorough eradication depends lives and happiness of the living and of the more sacred, the progeny, that is to follow. The statisticians have given us an invaluable insight into the relative frequency of tuberculosis and cancer, but with regard to syphilis, for obvious reasons, they have made a most dismal failure. There are not available any statistics that would give us any conception whatever of the appalling number of syphilitic and meta-syphilitic cases in our country at large and in our own immediate vicinity. The eminent syphilographer, J. William White, estimates a conservative figure, four and one-half millions cases of syphilis in the United States during the year of 1906, not including our insular possessions, which are notoriously infected with this disease. Taken in the light of frequency alone, syphilis assumes, then, the same plane as tuberculosis-with the latter disease it is essentially a sociological as well as a medical problem to solve. While syphilis was known from the days of antiquity, in 1494, it was really classified as a distinct entity in medicine. Since 1905, when Schaudin discovered the causative organism, the treponema pallidum, the advances in syphilography have far exceeded those in any one branch of medicine. It paved the way for the remarkable work of Bordet Gengon, phenomenon of complement fixation, which later Von Wasserman utilized in his most remarkable sero-diagnostic reaction, which is a triumph for the laboratory worker, since it is highly scientific but at the same time eminently practical. This is the weapon with which we are going to fight syphilis ; it is far greater an asset to our armamentarium than salvarsan; intensive courses of mercurials and the iodides have in the past done remarkable work, but we were greatly handicapped -we were not always sure we were treating syphilis, and if we were, when was it safe to stop medication? Empiricism led us to believe eighteen months to two years were safe guides, but the records of our insane asylums stand out in bold and plain type, living witnesses, as it were, that there were many, many cases to whom infection meant something worse than death itself—a living death, because we were victims ourselves of the doctrines of empiricism. The doctrine promulgated by syphilographers in the preWasserman reaction days has done irreparable harm. Treating expectantly until the secondary eruption appears is what we were told. The question naturally arises, at what stage of syphilis are the foundations laid from which later, paresis, tabes or aortic disturbances follow? The diagnosis of syphilis from the primary sore has and always will be held inefficient-other lesions constantly simulate, such as herpes progenitals, chancroid, non venereal growths and erosions from violent intercourse. In the vast preponderance of cases we look for genital chancre in close proximity to the corona. Within the past six months I have had two cases showing distinctly endo-urethral chancres: Case 1: Mr. B., age 56, married. Chief complaint: Ardor-urinae, pus discharge from the meatus. History. Two weeks after exposure, above symptoms appeared. Smear of urethral discharge was negative for diplicoccus gonorrhoae. Two injections of one to four thousand potassium permanganate-redness of meatus lessened, discharge disappeared. Within ten days patient appeared with a generalized maculo-papular eruption. Specific medication was begun, and induration along the course of the urethra gradually disappeared. Diagnosis: Endo-urethral chancre, secondary syphilis. Case 2: Mr. H., aged 26, single, September 14. Chief complaint: General malaise, soreness of throat, joint pains at night, slight pain and interference with passage of stream. History: Smear from buccal mucous membrane revealed treponema pallidum. Slight induration along under surface of penis, one and one-half centimeters posterior tocsulus. Redness of meatus. Specific treatment has given great relief to all symptoms enumerated above. Diagnosis: Endo-urethral chancre, secondary syphilis. The skin lesions in syphilis in the secondary symptoms are less likely to be confounded with other dermatoses, especially when taken in conjunction with the history of a primary sore, a period of quiescence averaging three weeks duration, the eruption having the essential characteristics, namely: Polymorphous, symmetrical circinate, non-inflammatory and ham or coppered colored. Latterly I have had several cases where deceptive skin lesions were manifested, due to iodide of potassium. Case 3: Mr. L., aged 25, January 25, 1912. Admitted having a veneral sore in 1906. Took an intensive |