J. WHITRIDGE WILUAMS 191 



during pregnancy, or even before its inception, and later by 

 placing the child in such environment as will offer the greatest 

 probability for its future development. 



I. BEFORE PREGNANCY. Ordinarily, the obstetrician is rarely 

 able to institute prophylactic measures before conception, as only 

 a limited number of patients seek advice in this regard. Fre- 

 quently, they present some evident deformity, which makes them 

 anxious to learn whether pregnancy can be undertaken with 

 safety; while a large number desire to prevent the repetition of 

 some disastrous experience in previous pregnancies, or to avoid 

 the repeated occurrence of abortion or premature labor. 



In the latter class of patients, great good may often be accom- 

 plished by prophylactic measures. Thus, the cause of repeated 

 abortion is usually associated with displacements of the uterus, 

 inflammation of its lining membrane or some other abnormality of 

 the generative tract, and can be removed by appropriate treatment. 

 Likewise, the occurrence of repeated premature labor is frequently 

 dependent upon some underlying condition, such as syphilis, 

 chronic Bright's disease, certain heart lesions, abnormal irritability 

 of the uterus, or chronic lead or arsenical intoxication, and the 

 only hope for a normal ending lies in their cure or alleviation. 



One of the most important subjects upon which the obstetric- 

 ian's advice is sought is concerning the effect of childbearing upon 

 tuberculosis. We now believe that the occurrence of pregnancy in 

 a woman suffering from the disease is a very serious matter ; for, 

 although she may go through pregnancy and labor without appar- 

 ent harm, or even seem to improve in health, the disease tends 

 to flare up after the birth of the child and may rapidly end 

 fatally. For this reason tuberculous women should be dis- 

 suaded from marriage, or, if the disease develops later, they 

 should be taught the dangers of childbearing, and induced 

 to undergo such treatment as may lead to the cure or arrest 

 of the disease before becoming pregnant. 



With the general education of the public in this regard, the 

 physician is frequently consulted as to the advisability of inter- 

 rupting pregnancy should it occur. This is a question which 

 cannot be dismissed lightly; and I feel very strongly that inter- 

 ference is clearly indicated whenever the existence of the disease 

 is recognized during the course of pregnancy. On the other hand 

 in tuberculous women who knowingly become pregnant, and espec- 

 ially after abortion had previously been induced on that account, 

 the problem becomes more complicated; and we are confronted 

 with the question as to whether it is justifiable to resort repeatedly 

 to the induction of abortion in order to avoid dangers against 

 which warning had previously been given. In such cases, I do 

 not believe that interference is indicated, as the responsibility 



