As regards the marriage of any woman suffering from tuberculosis we must take into consideration a fact that medical experience has conclusively established, namely, that the processes of generation have an unfavorable influence upon pulmonary tuberculosis. P. 259.
During pregnancy tuberculosis advances with such rapid strides that pregnancy and lying-in accelerate the fatal event. In some cases of consumption it is the first pregnancy that is the most perilous, but in other cases a later pregnancy proves more perilous. P. 260.
Dr. S. Adolphus Knopf, M.D., Professor of Medicine, Department of Phthisio-therapy of the New York Post Graduate Medical School and Hospital; Senior Visiting Physician to Riverside Hospital-Sanatorium for the Consumptive Poor of the City of New York, etc.
Reprinted from the Women’s Medical Journal, September, 1915.
Of the 150,000 who it is estimated die annually from tuberculosis in the United States, I venture to say 50,000 have been bread winners. Estimating the value of such a single life to the community at only about $5,000, this makes a loss of $250,000,000 each year. Another third, I venture to say, represents children at school age. They have died without having been able to give any return to their parents or to the community. Making the average duration of their young life only 7.5 years, and estimating the cost to parents and the community at only $200 per annum, the community loses another $75,000,000. The value of lives of little babes, children below and above school age, adolescents not yet bread winners, and men and women no longer able to earn their living can not be estimated in exact figures, but is reasonable to suppose the total annual financial loss from tuberculosis in the United States to be at least half a billion dollars. This does not include the expenditures for hospitals, sanatoria, clinics, dispensaries, colonies, preventoria and other agencies, devoted to the solution of the tuberculosis problem.
In the face of these figures and the suffering, misery and disappointment of parents who lose their children after having tenderly loved and cared for them for some years, I wonder if there can be any doubt in the minds of sane men that it would have been better if these children had never been born. Surely all this is race suicide instead of race preservation.
Not so very long ago I was asked by a young colleague to aid in the diagnosis of tuberculosis in a day laborer. The man earned $12 a week, was thirty-six years of age on the day the examination and diagnosis was made, had been married fourteen years, and his eleventh child had been born on his last birthday; four or five had already died, two of them of tuberculous meningitis. A glance at the rest of the family showed that nearly all of them were predisposed to tuberculosis, if not already infected, and that a few years of continued underfeeding and bad housing would finish their earthly career. With two or three children to provide for the family might have lived in relative comfort; with better food and better home environments the father might never have become tuberculous and none of the children might have contracted the disease. The commonwealth would have been the gainer by two or three mentally and physically vigorous future citizens.
Only a few days ago, while an article for the Journal of Sociologic Medicine was in preparation, an Italian woman presented herself to me for examination. She gave her age as fifty-six, and had married quite young. She had borne her husband seventeen children, of which, however, only four were living. Some had died in infancy, some at school age, and some during adolescence. What useless suffering! What useless economic loss to the individual family and society at large. Upon examination, I found the woman’s mental condition even worse than her physical status. The repeated pregnancies, the frequent diseases in the family, thirteen deaths among her children, had made a mental and physical wreck of her. Yet the woman belonged to the better and well-to-do class of our population of Italian birth. What would her condition have been if she had also had to share in the struggle for the existence of the family, and had had to work in sweatshops or factories, as so many of the poor Italians have to do?
When pregnancy means danger to the life of the mother, or exacerbation of an existant mental or physical ailment, as, for example, tuberculosis, which is always aggravated by child-bearing, every conscientious physician should do his utmost to prevent childbirth in such an invalid.
Where there is tuberculosis or any other serious transmissible disease in one or both of the parents, or there is danger that it may be transmitted to the offspring, it should not only be the right but the sacred duty of the physician to prevent the conception of any physically and mentally handicapped offspring destined to become a burden to the community.