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taken on voluntarily. Few indeed are the women who would bear more than three unsound children willingly! And without doubt ignorant, coerced and unwilling motherhood is detrimental to the child even if its ill effects are not evident in early infancy. The difficulty in this type of case is very frequently due to the carelessness of one or both of the couple who may be haphazard, or too mentally deficient, carefully to follow out instructions given. Such cases, of course, raise the important question of permanent sterilization, notes on which will be found on p. 53.

The use of contraceptives in order to space the desired births of normal people is generally indicated, even on the part of the healthiest woman.

The idea that lactation is a sure contraceptive is, of course, most unreliable and misleading; and although it is less common for a woman to become pregnant when nursing, it is by no means impossible, and she may become pregnant without menstruation intervening. An illustration is given of a case personally known to me for years:—