Artificially induced premature labor sometimes causes more damage than normal parturition at term. Much depends upon the methods used for the induction of the abortion. The insertion of bougies, catheters, or sounds is always contraindicated in advanced tuberculosis. Hirst of the University of Pennsylvania[149] thinks the notion that tubercular women improve in pregnancy is "a superstition," and that such women should neither marry nor have children. De Lee[150] holds that tubercular women should not marry because the woman is likely to infect her husband and children. He thinks the disease grows worse in pregnancy, and that hemorrhage is frequent except in chronic ulcerative tuberculosis. In this last condition pregnancy does not ordinarily aggravate the condition. In tubercular laryngitis complicating pregnancy, Küttner found the mortality to be 90 per cent. Such laryngitis is usually fatal, whether pregnancy is present or not. When there is a miscarriage in tuberculosis, the infection often becomes florid and resembles pneumonia. Advanced cases have a tedious and dangerous labor, with dyspnoea and occasionally hemorrhage or cardiac exhaustion. Edema of the lungs is not infrequent. [149] _A Text-book of Obstetrics_, p. 427. Philadelphia, 1912. [150] _The Principles and Practice of Obstetrics_, p. 480. Philadelphia, 1913. Williams of Johns Hopkins University, in the 1903 edition of his _Obstetrics_, tells of a woman who died of tuberculous peritonitis a short time after parturition. The uterus was studded with tubercles and its interior was covered with tuberculous ulcers. The tubercle bacillus had been found in cultures taken from the interior of the uterus during life. Her child was born perfectly healthy and remained so. Williams says in the same place that the induction of premature labor because of tuberculosis is justifiable only in the interests of the child, and this only in those rare cases in which the woman is so ill that she probably will die before term. Norris[151] of Philadelphia agrees with Williams that induction of premature labor is useless, and he says all authorities unite in this opinion. [151] _Pennsylvania Medical Journal_, February, 1916. A tubercular woman should not nurse her infant because she will infect it and exhaust herself. Infants are very susceptible to tuberculosis. Birch-Hirschfeld, in 1891, first demonstrated tuberculosis in the fetus, and Schmorl found it in the placenta in 50 per cent. of a series of cases that he examined. Infection of the child _in utero_, however, is extremely rare even by the placental way. There is a high death-rate from tuberculosis among infants, but the infection is postnatal. Dietrich of Berlin found that the death-rate from tuberculosis among children in Prussia is higher during the first year of life than in any other year.