The moral conclusion is that artificial abortion in pregnancy complicated with tuberculosis is never indicated except when the good of the child is at stake in the last stage of gestation. CHAPTER XIX SYPHILIS IN PREGNANCY AND MARRIAGE Syphilis in pregnancy at times assumes peculiar malignancy. The virulence depends on the patient's power of resistance, and whether or not there are septic microörganisms mixed with the syphilitic spirochetes. There are, moreover, varying strains of spirochetes which differ in virulence, or there are familial idiosyncrasies. Tropical syphilis is worse than northern infections, and syphilis of the nervous system is often incurable. Fournier was of the opinion that a syphilitic woman who becomes pregnant is more likely to abort than a pregnant woman who becomes syphilitic. The percentage of fetal deaths is also greater in the first class than in the second. The longer a woman has been syphilitic, provided she has not been treated for the disease, the worse the prognosis for the duration of the pregnancy and the life of the fetus. The earlier in pregnancy the syphilis appears, the worse the prognosis for gestation. General fetal mortality in syphilis under the best circumstances is 75 per cent. Syphilis should be looked for in every case where the cause of an abortion is not evident. Ruge holds that in 83 per cent. of repeated abortions syphilis is at fault; late abortions are characteristic of this disease. Inoculation with syphilis before conception almost always results in abortion. In 130 women studied by Le Pileur there were 3.8 per cent. still-births before infection by syphilis, but 78 per cent. after infection. In premature labor the child is, as a rule, born dead; less frequently it is born syphilitic; still less frequently it is born apparently sound, but the syphilis appears later; in a few cases, when the maternal syphilis is old, the child may be born normal. Interruption of gestation is the commonest symptom in syphilis complicating pregnancy. The labor itself is affected: the pains are weak and tardy. Abnormal presentations occur frequently when the fetus is dead. Chancres on the cervix may cause obstruction, and there may be indurations so dense as to necessitate cesarean delivery. The perineum may become so friable as to tear, as De Lee says, "like wet paper."