anity; it can never be said with certainty that a person who
has had one attack of insanity will not have another, and persons
who have had such attacks ought not, as Blandford says (Lumleian
Lectures on Insanity, _British Medical Journal_, April 20, 1895),
"to inflict on their partner for life, the anxiety, and even
danger, of another attack." There are other and numerous cases in
which marriage may be permitted, or may have already taken place,
under more favorable circumstances, but where it is, or has
become, highly desirable that there should be no children. This
is the case when a first attack of insanity occurs after
marriage, the more urgently if the affected party is the wife,
and especially if the disease takes the form of puerperal mania.
"What can be more lamentable," asks Blandford (loc. cit.), "than
to see a woman break down in childbed, recover, break down again
with the next child, and so on, for six, seven, or eight
children, the recovery between each being less and less, until
she is almost a chronic maniac?" It has been found, moreover, by
Tredgold (_Lancet_, May 17, 1902), that among children born to
insane mothers, the mortality is twice as great as the ordinary
infantile mortality, in even the poorest districts. In cases of
unions between persons with tuberculous antecedents, also, it is
held by many (e.g., by Massalongo, in discussing tuberculosis and
marriage at the Tuberculosis Congress, at Naples, in 1900) that
every precaution should be taken to make the marriage childless.
In a third class of cases, it is necessary to limit the children
to one or two; this happens in some forms of heart disease, in
which pregnancy has a progressively deteriorating effect on the
heart (Kisch, _Therapeutische Monatsheft_, Feb., 1898, and
_Sexual Life of Woman_; Vinay, _Lyon Medical_, Jan. 8, 1889); in
some cases of heart disease, however, it is possible that, though
there is no reason for prohibiting marriage, it is desirable for
a woman not to have any children (J.F. Blacker, "Heart Disease in
Relation to Pregnancy," _British Medical Journal_, May 25, 1907).

In all such cases, the recommendation of preventive methods of
intercourse is obviously an indispensable aid to the physician in
emphasizing the supremacy of hygienic precautions. In the absence
of such methods, h