It is apparent, now, why it is that miscarriage may be different, ac cording to the period of gestation at which it occurs, and the conditions which determine it.
Having stated the above general views, we begin at once the study of miscarriage.
Frequency.—Is miscarriage a frequent accident? According to hospi tal statistics, it is rare, but nevertheless it is of very common occurrence. The reason for this discrepancy is that miscarriage during the early weeks is generally not noticed. Many women believe that the menses are sim ply retarded, and although they may suspect a miscarriage from the pas sage of clots, or crampy pains grea,ter than they usually suffer when men struating, they do not consult a physician, and even if they did there would still be doubt, seeing that the ovum is not likely to be found in the clots which have been passed. Even if the woman knows she is mis carrying, she does not go to the hospital, but household remedies are WM ally administered. It is only in his private practice, therefore, that the physician can really be certain, and even then only in part, of the mis carriage. The same uncertainty exists in regard to the frequency at different periods of pregnancy. While many authors believe that miscar riage occurs oftener from the third to the fourth month, Jacquemier, De paul, Cazeaux, state that this is true only in the first two or three months.
Depaul is even more precise, and places the period of greatest frequency at two and a half to three and a half months, from thence diminishing in frequency up to term. Opposed to this opinion is Jacquemier, who, with out agreeing fully with Madame Lachapelle, in whose experience the sixth month was the time of election, rather than earlier in pregnancy, declares that at this month it is settled that miscarriage occurs with certainly as great frequency as in the earlier months. This view, while true of pre mature labor, appears to us exaggerated as applied to miscarriage, and we believe vrith Depaul that the latter is of greatest frequency from two months to three and a half. Still we are speaking now purely of certified miscarriages, and it still holds true that many an ovum is shed unnoticed during the first four to six weeks; this isnot astonishing when we remem ber that it is only at three months, to three and a half, that the placenta is developed, and that up to this time the feebleness of the adhesions which bind the ovum to the uterus, and the ease with which extravasa tions may take place between the chorion and the decidua reflexa, render it an easy matter for the OVUM to be disturbed.
Is miscarriage more frequent in case of female than of male fcetuses? Morgagni and Desormeaux have so held, but their opinion is based on absolutely no statistical data. Jacquemier is in doubt on this point; Ca zeaux is inclined to agree with Desormeaux, because at term the propor tion of boys to girls is as 16 to 15, and therefore it is possible the miscar riage of females may be more frequent.
Causes.—These may depend on: 1st. The father; 2d. The mother; 3d. The ovum; 4th. Criminal attempts or external violence.
1st. The father may be the cause of mise,arriage through constitutional or acquired means. Men too young or too old; those whose constitution is weakened by debauchery, or excesses, or disease, these are likely to be get a fcetus not fit for development. Further, the influence of syphilis in the father is, to-day, admitted universally, and the lesions presented by the fcetus are so distinctive in such cases that they point at once to syphilis of the father.
2d. In women who are very young, with body incompletely developed, and menstruation not normally established, with tissues delicate and fee ble; in women who are old, with tissues dense, and brittle—in these miscarriage is frequent. Depaul absolutely denies this, but Jacquemier affirms that it is not unusual to see women miscarry with the greatest ease the nearer they are to the age when aptitude for conception usually ceases. We have, ourselves, seen three children, of thirteen, thirteen and a half, and fourteen years, respectively, confined at term, but these chil dren in their physical development were in advance of their age.