As for the temperament of the mother, it has been claimed that the nervous, the bilious, the sanguine, were, in turn, causes. This seems to be true, in particular of the latter. Many women, indeed, who are of full habit, and lose profusely at their periods, miscarry readily, and this usually at a time which coincides with the menstrual epoch. As for the form of temperament, nothing has been proved; indeed the nervous is often dependent on functional uterine disease, and to this, then-fore, must we look for explanation of the miscarriage.
On high temperature as a cause Depaul attaches much importance. In warm climates, uterine hemorrhages are of common occurrence, and these in turn may provoke miscarriage. We refer here only to climatic temperature, and not to elevation in the mother, the result of disease.
In mountainous countries, further, miscarriage is frequent, and we are told by Saucerotte and Jourdanet that the women of such regions are accustomed to resort to the valleys in order to avoid miscarriage.
Madame Boivin and Madame Lachapelle admit, as a further cause, epi demic influence, but, although such is the case with animals, it cannot be considered so in the human female. It is especially during famines and sieges that this cause has been supposed t,o hold, but, evidently, here there are other factors at work.
Finally, there are a number of women in whom there exists a habit of aborting, either because the genital system functionates badly, or because the menses are irregular, often scanty or painful, or else, because the geni tal system seems to lack vigor. These women, pale, feeble, and subject to leucorrhcea, possess, frequently, this trait in common with those of the sanguine temperament, that they suffer from menorrhagia; but they are always irregular in menstruation. Stolz has further pointed out that stout women are often sterile, and that, when they do conceive, they are predisposed to miscarriage, doubtless because local nutrition is at fault, and the fluids intended to nourish the fcetus are insufficient for its de velopment.
Every acute or even chronic disease of the mother may become a cause of miscarriage, when such diseases affect profoundly the respiration, the circulation, or the temperature. Of these diseases, there are certain which act more powerfully than others. (See Pathology of Pregnancy.) Diseases of tho uterus: metritis, endometritis, interstitial, and sub mucous fibroids, verktions, flexions, organic disease of the cervix, espe cially of the body. Still further: adhesions of the broad and round liga ments, of the tubes and ovaries, since they may interfere with the development of the uterus. Again, inflammations of the bladder, of the rectum; neighboring tumors, pelvic deformities, which prevent the regu lar development of the uterus or retrovert it.
Finally, there are certain women who, without special cause, miscarry over and over again, and it would seem as though in them there existed special irritability of the uterine fibre. The sphincter of the uterus seems to be weakened, and, when pregnancy ensues, the least effort overcomes it. This has been called laxity of the fibres of the cervix. This irrita bility of the uterus determines the premature appearance of contractions, the cervix yields, the membranes rupture, and miscarriage occurs, without other cause than thid excessive irritability of the uterine fibres.
Jacquemier has studied, in particular, uterine congestion at; a frequent cause of miscarriage, and we reproduce his views: " Active or passive congestions of the uterus are the most frequent causes of miscarriage. They excite the uterus to contract abnormally, and determine often ex travasations between the uterus and the placenta. These extravasations are the result of rupture of the vessels which go from the uterus to the placenta. Indeed, in many miscarriages, the determining factor is the existence of hemorrhage, or its manifestation internally or externally.
"All stout women are not equally predisposed to uterine congestion. Those who are plethoric, and have hemorrhages apart from pregnancy, are equally more inclined to puerperal hemorrhage than others. The very existence of pregnancy inclines to further congestion. This organ is then much more vascular than before. New blood-vessels are sent ramifying through the placenta and the decidua, and these vessels are soft in texture, and easily t,orn. The moderate and regular contraction of the uterine muscular fibre for the moment empties the uterus of the excess of blood which distends these vessels; but let this contraction be over strong, spasmodic, or local, and the connection between the ovum and the•uteras may be changed, and hemorrhage occur between it and the uterus. Further, it should be remembered that at the dates corre sponding to the suppressed menstrual periods, the uterus is still further temporarily congested, and every accoucheur has noted the frequency of miscarriage at dates coinciding with the menstrual cycle." It remains to note as causes of miscarriage: tight clothing, which in terferes with the abdominal circulation, moral emotions, mechanical shak ing, such as results from carriage or horseback riding; external trauma tism, which acts either directly on the uterus, or indirectly by determin ing congestion of the organ; violent muscular efforts; operations on the genital organs; efforts at criminal abortion; drugs which have an oxy tocic influence. Many of these causes, as Jacquemier truly says, only suffice when they act with great intensity, or in women who are predis posed to miscarry.