Joslin[202] reported seven cases of diabetes associated with pregnancy. Four of the seven are now dead, one by suicide, one from uremia, one from coma, one from tuberculosis. Of the three living one is in good condition, one is not well and she has lost two of three children, and one is very ill with diabetes. In persons beyond middle age diabetes with proper treatment may go on for from ten to fifteen years before it is fatal, but it quickly kills young patients. A young woman at the marriageable age who has diabetes will die anyhow in two or three years, and if she marries and becomes pregnant she will die very probably in her first pregnancy. [202] _Boston Medical and Surgical Journal_, November 25, 1915. When the child is viable, and the diabetic mother shows albuminuria, progressive weakness, or diacetic acid in marked quantity, it may be necessary to perform therapeutic abortion; but if this is done no anesthetic may be used, and great precautions should be taken to avert physical and mental shock. Even ergot acts badly with these cases. The last sacraments should be given in good time, especially if coma threatens. When labor begins in a diabetic and everything appears to be normal the sacraments should be given, because there is always danger of sudden collapse and death. CHAPTER XXII CHILDBIRTH IN TWILIGHT SLEEP A method of effecting painless childbirth through the use of scopolamine and morphine was first used in 1902 by Steinbuechel, and in 1906 Gauss, of the University of Freiburg in Baden, reported a series of five hundred obstetrical cases in which scopolamine and morphine had been used. The woman's condition was called in Freiburg a _Dämmerschlaf_, a Twilight Sleep, because she is somnolent and forgetful of pain. In 1903 the chief obstetricians in several of the leading American and German universities tried the drugs, but they quickly abandoned the method because they found it dangerous and unscientific. The process was exploited here by _McClure's Magazine_,[203] _The Ladies' Home Journal_, and other lay periodicals. The articles in these magazines were written by persons who are not physicians, and their erroneous statements are misleading. _The Ladies' Home Journal_, however, while favoring the method, published letters from several leading obstetricians in the United States, all of whom are opposed to the use of these drugs during parturition because they had tried them and found them unscientific. The method is illicit morally, and it is unscientific. [203] June, 1911.