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Group I.-Firstly tbere is a group of diseases which invariably run a downhill course. There may be temporary improvement, or long periods in which the patient's condition remains nearly stationary, but in all the expectation of life is reduced. Amongst these the most notable are chronic rheumatic carditis, chronic nephritis, diabetes, and some nervous diseases, such as disseminated sclerosis. There can be no doubt that in pregnancy in a patient the subject of these diseases there is a serious risk to the life of the mother and a bigh probability that the disease will be made worse and most of us will agree that sterilization is desirable in these conditions. In some instances it may be possible to allow the patient to have one or more children before sterilizing, in others pregnancy may be completely contra-indicated. In hospital practice one must not forget that the care of the child after birth may throw a considerable strain on the mother and so make her disease worse. In some instances, as for example in a case of disseminated sclerosis, the patient may be quite unable to care for her child, and although, strictly speaking, this is outside our immediate consideration, this point may, in fact, influence us in our decision to sterilize after terminating pregnancy. Let us consider a case of mitral stenosis. In a slight case with no history of recurrent attacks of endocarditis it may be possible for the patient to produce two or three children without obvious detriment to her cardiac condition. After that she should be advised to have no more, and be instructed in a good contraceptive technique. If this fails, one must decide between hysterotomy and sterilization or full-time labour, followed by sterilization in the puerperium. In mitral stenosis of moderate severity one might advise Ceesarean section at term with sterilization. In

Discussion on the Sterilization of Women, Including Indications (Medical and Eugenic), Technique and Legal Position