From an historical point of view it has been interesting to study published opinions of authorities on obstetrics concerning the question of so-called medical complications encountered in their specialty. In the first edition of DeLee's Obstetrics1 (1913) "glycosuria" is considered as an entity, and the prognosis of diabetes (50 per cent mortality) is discussed without reference to any collateral features such as the simple one of proper treatment of diabetes. The fifth edition 2 (1928) states that "today with proper treatment mortality is much lower, and in most cases pregnancy may be carried through to term." Proper treatment naturally means treatment by men trained in the field of metabolism.The earlier pessimistic statistics regarding the outlook for the pregnant woman with heart disease or diabetes are almost completely lacking in what might be called comparative control. The gloomy prognoses are based almost entirely on comparisons of pregnant ill women with pregnant well women. No real attempt is made to compare the statistics of diabetic pregnant women with the general statistics on diabetes for women of the same age. Yet such a study is the only logical method of obtaining information of real importance in evaluating the effect of pregnancy on diabetes. It must be recalled that before the days of insulin many nonpregnant women of child bearing age lived only a few years, a fact often neglected in considering the effect of pregnancy on diabetes. The same fact, of course, is true for young women with heart disease.With the emphasis placed on the obstetric point of view there developed a paradoxical philosophy of therapy. A case of organic heart disease or of diabetes mellitus in which a surgical condition affecting the kidney develops remains primarily a medical case with surgical complications. But a woman with organic heart disease who becomes pregnant immediately is treated as a case of pregnancy with medical complications. This position no longer is tenable ; on the contrary, the medical side of the combination should become the paramount issue, the pregnancy the complication. It is our purpose in this paper to maintain this thesis, using heart disease, disturbances of the thyroid gland From the Chicago and diabetes as illustrative examples to prove that the pregnant woman with so-called medical complications can be better studied, better diagnosed and better treated when the emphasis is placed on the medical aspect.It is beyond our purpose to attempt a review of the voluminous literature bearing on the subjects under discussion. We wish to give merely an outline of the development of our own experiences. During the progress of this study many papers appeared from various other clinics emphasizing the medical point of view, so that gradually the pendulum has swung to a position which internists at least must consider more rational. An article such as that by W. D. Reid,3 which appeared in January, 1930, on the prognosis of heart disease in pregnancy represents an aspect of the ques¬ tion practically ne...
