Knowing the causes of this accident, it is not hard to prevent many that would otherwise take place.

Pregnant women should not do hard work, particularly if it includes lifting and reaching. They should have plenty of rest. They should not indulge in marital union if it causes fatigue or backache. As a rule, little can be done about injuries of the neck of the womb until the childbearing period is past.

When the womb is enlarged by the growing baby within it, it comes up and checks kidney action and drainage, perhaps.

Women should not smoke at all during the childbearing period, because of the recently proved and recognized ill-effects of the practice upon pregnancy, childbirth and nursing, as well as upon the babies themselves.

All couples should have their blood examined for syphilis before marriage, regardless of previous exemplary habits and morals. This disease is sometimes contracted in an innocent manner, and may not cause any symptoms to warn the unfortunate individual of its presence for a long time after it is contracted.

Usually, the beginning of an abortion may easily be recognized if one is on the alert for it. The first symptoms is apt to be pain low down in the back accompanied by a bearing-down feeling. This may or may not be accompanied or preceded by hemorrhage or rhythmic cramps in the abdomen. Sometimes hemorrhage is the first symptom. At the first appearance of any of these symptoms, the patient should go to bed immediately, and if the symptoms do not cease within an hour, the physician should be called. If called early, he may be able to prevent this calamity through the timely administration of sedatives. I refer to an abortion as a calamity, because it is a misfortune to lose a baby at any time and, once this accident happens, it is apt to happen again with even less provocation. Some women are never able to carry a child to full term again.

Abortions of any kind are much more dangerous to the mother than childbirth. For this reason, if for no other, they should be prevented, if possible. Most of the abortions due to overwork or irritable uterus, alone may be prevented easily if the foregoing advice is followed. Usually those due to syphilis, or to the use of tobacco are inevitable and cannot be prevented, once the first symptoms have manifested themselves. They may only be prevented by suitable syphilitic treatment, and abstinence from the use of tobacco.

The most alarming complication of pregnancy and the one which may cause the greatest loss of life is uremia* or kidney insufficiency. It is believed to be due to inability of the mother's kidneys to do the extra work made necessary through excretion of the waste products of mother and child. Usually it does not make its appearance until the latter months of pregnancy, but it may occur as early as in the fourth or fifth month. In some cases, as those, for instance, in which the mother has had previous kidney disease due to scarlet fever or other infection, kidney insufficiency may develop through no fault or error on her part. Very often, however, the onset is brought about by overwork, exposure, chilling, insufficient rest, overeating, constipation, or even a mild infection, such as a cold.

+ See "Uremic Poisoning" in April 1941 Sexology. In men, this usually due to ease, but in women it may be caused mechanically by pregnancy.

The expanding uterus, with its lively burden, comes up among the viscera (whose arrangement is irregular) and causes disturbances in digestion, too.

The early symptoms of kidney insufficiency are slight swelling of the ankles and the hands or fingers and puffines about the eyes. The thing to remember about this swelling is that it is present in the morning, as well as in the evening. Swelling of the ankles occurs in many normal pregnancies, but the swelling subsides after retiring and slowly recurs after the patient is on her feet again. If the swelling remains throughout the day and night, it is almost certainly due to kidney trouble. During the early stages of this disease, the patient may feel very well and not realize that she is in grave danger. Usually, before very long, she will begin to have headaches, the urine is apt to lessen in quantity and become cloudy in appearance. There may be floating spots before the eyes and in some cases, the vision becomes decidedly impaired. The most alarming symptom is convulsions- called eclampsia. They may, in severe cases, occur as early as in the sixth month of pregnancy. Usually they occur just before, during, or just after childbirth. When they occur, the patient is in great danger. A patient in danger of eclampsia must not be left alone for a moment. She may have a convulsion, roll over on her face and smother to death in her pillow, as did one of ray patients whose nurse left her alone for a few minutes.

Although kidney insufficiency is a rather rare complication of pregnancy, it is an extremely dangerous one, and the possibility of its occurrence must not be overlooked, for, in this condition, early detection and treatment are of paramount importance. Fortunately, it is easily recognized if the patient will remember the early symptoms and report to her physician at least once a month throughout pregnancy for urinalysis and for blood pressure examination. During an attack, the physician's orders to maintain complete and continuous rest in bed, and a constantly warm skin temperature must be obeyed. One of my patients who was making good progress toward recovery decided to move from one room to another and from a warm bed to a cold one. The slight chilling of the skin which resulted brought on a relapse which almost cost her her life.