PREGNANCY IN CASES 
OF TUBERCULOSIS 
OF THE LUNGS 
BY 
JOSEPH WALSH, M. D. 
Philadelphia, Pa. 
REPRINTED FROM 
THE AMERICAN JOURNAL 
OF OBSTETRICS AND DISEASES OF 
WOMEN AND CHILDREN 
VOL. LXXVII. NO. 2, 1918 
NEW YORK 
WILLIAM WOOD & COMPANY, PUBLISHERS 
1918 [Reprinted from the American Journal of Obstetrics and Diseases of Women and Children, 
Vol. LXXVII, No. 2, 1918. 
PREGNANCY IN CASES OF TUBERCULOSIS OF 
THE LUNGS.* 
BY 
JOSEPH WALSH, M. D., 
Philadelphia, Pa. 
Before the discovery of the tubercle bacillus, when the diagnosis 
of tuberculosis of the lungs was made later than at the present day, 
there were not a few clinicians who thought that pregnancy acted 
rather favorably than otherwise on the disease. Quite recently 
Cornet's(i) statistics of tuberculosis of the lungs in Prussia, show 
that though the mortality is higher in females (1.98 per thousand) 
than in males (1.76 per thousand) under twenty, in other words, 
before the child-bearing age, it is lower after twenty (2.91 to 3.46). 
We start off, therefore, with a certain amount of clinical opinion 
and some definite statistics that pregnancy does not exert an 
extremely unfavorable influence. 
In spite of this, about 1910 began a German and Italian hysteria 
for the production of abortion or induction of labor in every case 
manifesting tuberculosis whether acute or chronic, among others 
advocating this drastic measure being von Hamburger, Heimann, 
Pradella, Schauta, Ebeler, and Maragliano. The opinion in regard 
to a tuberculous woman gradually became not uncommon that, if 
unmarried, she should not marry; if a wife she should not conceive; 
if pregnant, the pregnancy should be interrupted and sterilization 
performed; if a mother she should not nurse the child. 
From my own experience, I had reason to believe that this was 
a grossly exaggerated idea of the unfavorable influence exercised by 
pregnancy, and I looked up the results in my own cases, in cases at 
the White Haven Sanatorium, and procured others in the practice 
of Dr. Flick. In this list, extending over fifteen years, are thirty- 
eight patients in all stages of the disease. They had after recog- 
nition of their tuberculosis fifty children. Of the thirty-eight 
mothers, five are dead. 
* Read at a meeting of the Philadelphia Obstetrical Society, 0 tober 4, 1917 
Copyright, William Wood & Company. 2 
WALSH: TUBERCULOSIS OF THE LUNGS 
PATIENTS IN WHOM TUBERCULOSIS WAS RECOGNIZED AND 
TREATED BEFORE PREGNANCY. 
Case No. 
Age when 
first seen 
Number 
of 
children 
before 
treat- 
ment 
Number of 
children after 
treatment 
Years 
after 
treat- 
ment 
child 
born 
Living 
Years alive 
after 
pregnancy 
Early: 
i 
21 
0 
3 
3 
+ 
9 
2 
28 
0 
3 
3 
+ 
7 
3 
20 
O 
I 
5 
+ 
4 
4 
27 
0 
1 
2 
+ 
6 
5 
26 
I 
I 
1 
Died 
1 
6 
25 
0 
2 
3 
+ 
11 
7 
28 
0 
2 
1 
+ 
8 
26 
O 
I 
2 
+ 
2 
9 
21 
0 
I 
1 
+ 
% 
IO 
28 
c 
2 
2 
+ 
II 
ii 
35 
2 
I 
9 
+ 
3 
12 
23 
O 
3 
4 
+ 
7 
13 
22 
0 
1 
5 
+ 
2 
14 
22 
O 
1 
7 
+ 
i5 
20 
O 
1 
6 
+ 
I 
16 
21 
0 
1 
7 
+ 
¥2 
Moderately Advanced: 
17 
22 
O 
1 
11 
+ 
3 
18 
25 
O 
1 
4 
+ 
4 
iQ 
25 
O 
I 
2 
+ 
7 
20 
21 
O 
I 
2 
+ 
4 
Far Advanced: 
21 
29 
1 
2 
12 
+ 
3 
22 
26 
O 
I 
4 
Died 
23 
15 
O 
I 
6 
+ 
>2 
24 
3i 
I 
I 
2 
+ 
7 
25 
25 
0 
2 
3 
+ 
5 
26 
25 
0 
I 
10 
+ 
5 
27 
35 
0 
2 
2 
+ 
9 
The mothers divide themselves into two classes, patients in whom 
the tuberculosis was recognized before pregnancy and patients in 
whom it was recognized first during pregnancy. In twenty-seven 
the disease was recognized and treated before pregnancy and in the 
majority before marriage. These twenty-seven had thirty-nine 
children; sixteen were early, four moderately advanced, and seven 
far advanced cases of tuberculosis. Of these twenty-seven, two 
died (7 per cent.), one about three months, the other about one year WALSH: TUBERCULOSIS OF THE LUNGS 
3 
after delivery; the former a far advanced case became pregnant 
about four years after treatment; the latter, an early case, one year 
after. The remaining twenty-five are apparently as well as before 
pregnancy, though three have had three children and six two children. 
The pregnancies occurred one to twelve years after treatment, the 
average being four years. 
In eleven the disease was recognized during pregnancy, one being 
early, five moderately advanced and five far advanced. Of these 
eleven, three died (27 per cent.), one of these three being first seen 
five days before delivery, one twelve days, and one two months. 
In other words, there was no chance for treatment of the first two 
and very little for the third. All three were far advanced cases. 
Of the remaining eight two far advanced cases seen for the first 
time at the fifth month, are still under treatment. One was a 
primipara, the other a sextipara, the latter from her history having 
had tuberculosis even before the birth of the first child. The 
remaining six came through successfully and are still alive after 
periods of time varying from three months to thirteen years, the 
average being two years. 
It is to be remembered that a certain number of tuberculous cases 
advance to death each year apart from pregnancy or other complica- 
tion under the best of treatment; it is natural that some should die 
during the year of pregnancy and the puerperium. Because a 
PATIENTS IN WHOM TUBERCULOSIS WAS FIRST RECOGNIZED 
DURING PREGNANCY. 
Case No. 
Age 
Number of 
child 
Pregnant 
days 
Living 
Years alive 
after 
pregnancy 
Early: 
28 
25 
II 
.33 
+ 
I 
Moderately Advanced 
29 
I: 
3i 
III 
+ 
2 
3° 
26 
I 
30 
+ 
3 
3i 
37 
VIII 
121 
+ 
2 
32 
23 
IV 
152 
+ 
2 
33 
26 
I 
152 
+ 
13 
Far Advanced: 
34 
3i 
11 
275 
Died 
8 days 
35 
32 
VI 
152 
+ 
36 
3i 
V 
213 
Died 
M2 
37 
25 
I 
268 
Died 
K 
38 
30 
I 
152 
+ 
1 4 
WALSH: TUBERCULOSIS OF THE LUNGS 
patient dies, therefore, during pregnancy or the puerperium does not 
prove that this complication was the cause. Statistics of patients 
ten years after treatment show that apart from pregnancy about 10 
per cent, of early cases die, more than 30 per cent, of moderately 
advanced, and more than 50 per cent, of far advanced. These 
statistics of cases complicated by pregnancy, the average time since 
the pregnancy being four years, are better except the time is shorter, 
and the number of cases too few on which to base absolute conclusions. 
I know of only three patients on whom abortion was performed, 
and all against advice. All three were far advanced and showed 
some exacerbation of the tuberculosis apparently due to the opera- 
tion, and I thought almost as much of an exacerbation as is usual 
to labor at term. Two of the three died four years after the opera- 
tion, and I have no reason to believe from other experiences that 
they would have died in any shorter time if the pregnancy had gone 
to term. Both women were well-to-do and children could have been 
taken care of without their help. 
ABORTION IN CASES OF TUBERCULOSIS. 
Case No. 
Age 
Number of child 
Living 
Years alive after 
abortion 
39 
37 
IV 
Died 
4 
40 
33 
I 
Died 
4 
41 
35 
VI 
+ 
3 
From advocating abortion in selected cases, certain German and 
Italian writers gradually came to the interruption of pregnancy at 
whatever stage seen, and then to sterilization in order to prevent 
further pregnancies. The earlier writers advocated ligation of the 
tubes, later ones removal of the ovaries, in order to produce an 
artificial menopause, thereby allowing the woman to get the ad- 
vantage of the subsequent gain in flesh, which frequently ensues. 
Still others, however, came to believe an artificial menopause harmful 
on account of the accompanying nervous symptoms and proposed 
instead removal of the body of the uterus, leaving the ovaries and 
the neck of the uterus to permit the continuance of menstruation. 
Taking the statistics of Ebeler(2), a recent German writer, who 
operated on thirty-one cases, doing what he considered most suitable 
in the individual case, we find that he had 13 per cent, of deaths. 
Taking all of my cases I had also 13 per cent, of deaths, but in 
addition my thirty-eight cases had fifty children. 
Taking the worst statistics I have, namely, those of the eleven WALSH: TUBERCULOSIS OF THE LUNGS 
5 
women seen for the first time during pregnancy, of whom three 
(27 per cent.) died, and applying them to the number of actively 
tuberculous pregnant cases seen in the United States in a year, 
namely, 32,000, we find that of this 32,000, 8700 mothers would 
die. Subtracting from these the ones who would die of the opera- 
tion according to Ebeler's statistics, we find 32,000 mothers operated 
on and 32,000 children sacrificed to allow less than 5000 mothers 
to live who would not live anyhow. 
Finally, though a certain number of Germans and Italians advo- 
cate the extreme measures which I have indicated, there are others, 
like Runge, Lohlein, Jaffe, Kleinwachter, and most of the French 
school with Pinard at its head, whose experience makes them forbid 
the interruption of pregnancy in all stages, for even when the 
tuberculosis is advanced and acute they contend that at best it is 
only the destruction of a healthy life in order to lengthen a sickly 
one. 
CONCLUSIONS. 
I. Active cases of tuberculosis should be advised against marriage; 
quiescent cases especially after treatment and education bear the 
duties of marriage sufficiently successfully that if they wish to marry 
they may be allowed to do so. 
II. Quiescent cases becoming pregnant, if put on a rigid regime, 
may be expected to come through the pregnancy with but little, if 
any, advance of the tuberculosis. 
III. Active cases becoming pregnant run definite risk, yet the 
operations for abortion, especially those associated with sterilization, 
have a mortality making the continuation of the pregnancy more 
desirable. 
2026 Chestnut Street. 
REFERENCES. 
1. Cornet. Tuberculosis, Nothnagel's Practice, Saunders & Co., 
1904, p. 276. 
2. Ebeler. Praktische Ersebnisse der Geburtshilfe und Gyndkoloeie, 
1914, vi, p. 87. $$•00 • Year in Advance. 
Single copies, 50 Cents. 
THE 
AMERICAN 
Journal of Obstetrics 
AND 
DISUSES OF WOMEM AMO CHILDREL 
A MONTHLY JOURNAL. 
z 
EDITORS 
BROOKS H. WELLS, M. D. 
tQEORGE W KOSMAK, M. D. 
WILLIAM WOOD A COMPANY 
PUBLISHERS 
Bnlertd m aaooQd-eUaa matter. Jen. X isoa. at Uhe Poet Office al York Pa.. Under the AxM 
of Gonrrcaa of March I, KTh