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Accidents of Pregnancy.Under the conditions now prevalent in civilized society miscarriage is astonishingly frequent, for the investigation of many thousand cases has shown that one out of every three wives miscarries before she attains the age of 30 years. This, probably, falls below the actual frequency, because in the earlier months miscarriage is often unnoticed by the woman herself, and may even escape the observ ation of a physician in attendance. Furthermore, this accident occurs more frequently in the later than in the earlier years of child-bearing. Abortion may, of course, take place any time subsequent to conception ; and it not infrequently happens during the first few weeks that no symptom is exhibited which attracts especial attention. The ordinary menstrual period fails to appear in a woman previously regular. Her suspicions are perhaps aroused, but if a discharge appears a few days later, she assumes that the period was simply delayed, and explains in this way also the unusual pain and increased flow. It often happens, indeed, that one monthly period will be passed entirely, but that at the next period there will be an unusually abundant and painful menstruation. In such cases the woman rarely suspects that the clots discharged contain a blighted fætus ; yet such is in fact often the case. These instances do not usually require the attention of a physician ; but they are, nevertheless, important facts for the woman to remember, since they often serve to explain subsequent disease of the womb. Practically, abortion is not usually certainly recognized as such by either patient or physician until the third month of pregnancy, at which time it occurs with especial frequence. It is fortunate, however, that during this period ? the eighth to the twelfth week ? abortion is not attended with as much danger to the mother as occurs subsequently. The most dangerous period for the occurrence of abortion extends from the tenth to the twentieth week ; a miscarriage happening during this time usually requires the utmost care and skill of the physician to avert a fatal issue. This should be borne in mind, so that if the symptoms of abortion ? to be presently mentioned ? occur at this time, a physician should be immediately summoned, since his services are even more imperatively demanded than in delivery at full term. Causes.?Abortion may be induced by causes affecting either the mother or the foetus ? more commonly the former. Among the physical causes may be mentioned any serious disease, especially the fevers, accompanied with a rash upon the skin ; for it may be stated, in general terms, that a pregnant woman rarely undergoes an attack of smallpox or scarlet fever without abortion. Mechanical injuries also frequently induce miscarriage, which, as is well known, is very apt to follow falls, blows upon the abdomen, excessive straining, whether in lifting heavy bodies or in attempts to evacuate the bowels and bladder. Yet it is astonishing to observe what an amount of violence will sometimes be borne without exciting miscarriage. For instance, a noted physician of Scotland used to relate that his coachman once drove right over a woman who was in the eighth month of pregnancy, inflicting serious injuries upon her. The doctor, thinking that miscarriage must necessarily ensue, caused inquiries to be made, but found, to his surprise, that the pregnancy was not disturbed, and that the woman gave birth to a healthy child at full term. Excessive emotion, such as fear, anger or grief, may sometimes be followed by this accident; so,too, may the abuse of purgative medicines. Thus the diseases consequent upon pregnancy ? such as morning sickness, irritation of the bowels and bladder ? sometimes, though rarely, proceed to such a degree as to cause abortion. Another fruitful cause of premature expulsion of the foetus is disease of the womb ; in these cases there is often a certain regularity in the abortions ; that is to say, this accident occurs uniformly at the same period in several successive pregnancies. On the side of the fætus various causes may induce abortion, of which it is necessary to refer to only one : It is a well-established fact that if either parent have been previously subject to a certain contagious disease the wife is very apt, especially in the first years subsequent to this event, to have repeated miscarriages; usually, too, if the fætus die from whatever cause, miscarriage generally follows within a few weeks. While we cannot enumerate all the causes of abortion, nor indicate the means for distinguishing these causes one from another, we would impress upon the mind of every woman the necessity of consulting her medical adviser if she have once had an abortion ; for it is a curious fact that women seem to acquire a habit of abortion, and that their chances for miscarrying are very much increased if they have once miscarried, no matter from what cause. Symptoms.- The symptoms of miscarriage vary with the period of pregnancy. In the earlier months there is often but little to indicate that this process is interrupted; indeed, as has been remarked, abortion may occur before there is any positive knowledge or even strong suspicion of pregnancy. During the first month or two the symptoms are usually indistinguishable from those of a painful menstruation ; the only sign to arouse suspicion is an excessive flow containing possibly clots of blood. At this time it is not, however, a matter of so much consequence, since miscarriage is then attended with less danger ; yet even then it is important to know, if possible, the true state of the case, since although there is no immediate peril to life, yet the foundation for menstrual disorders and diseases of the womb is often laid by neglect to recognize and attend to miscarriage in the early months ; for it must be remembered that the womb increases in size from the very beginning of pregnancy ; and when this process is interrupted, whether at full term or earlier, a certain time is required in order that it shall return to its former size. It is for this reason chiefly that rest and quiet are essential after confinement; and the same reasons demand that same rest and quiet after an abortion, even in the early months. If, therefore, there be any reason for suspecting the possibility of pregnancy ; if after missing one or two periods there occurs an apparently painful menstruation, accompanied with an excessive discharge including, perhaps, clotted blood, the woman should observe the usual precautions ? should maintain the recumbent posture and avoid all mental and physical effort for some days after the flow has ceased. Miscarriage occurring between the tenth and twentieth week is often accompanied by symptoms which indicate serious physical disturbance. Not infrequently one of the first indications is a severe chill, followed by fever, thirst, nausea and, of course, general indisposition. These symptoms, often accompanied by palpitation of the heart, coldness of the feet and dizziness, sometimes mislead the patient and her friends into suspecting some other difficulty. After some hours or days, however, the seat of the trouble is usually indicated by pain in the lower part of the back and abdomen, often shooting down the thighs. This pain at first continues, then becomes periodic in character, resembling, indeed, the true labor pains; and at this time there appears, if not already present, a discharge of blood. These two symptoms, pain and flooding, are regarded as characteristic of miscarriage ; but it should be remembered that they may also occur without miscarriage ; and indeed that miscarriage might occur, on the other hand, with but little pain and slight flooding. Treatment.- The object of treatment depends upon the conditions, that is, upon the extent to which the miscarriage has already proceeded. Generally speaking it is, of course, desirable to arrest the expulsion and to quiet the womb, so that pregnancy may be continued to its natural termination. This is usually practicable, but not always, even when the nature of the difficulty is immediately recognized, for if the foetus be already dead, it is impossible to prevent miscarriage when once inaugurated. Yet decision of this question must be referred in every case to medical adviser who should always be called at once. There are, however, certain measures which may be taken with advantage in every case until the arrival of the physician furnishes more exact instructions for the particular case in question. Whenever flooding occurs during pregnancy, whether accompanied with pain in the back or not, the woman should remain perfectly quiet, retaining the horizontal posi tion until the flooding ceases ; this is especially demanded if the patient have suffered miscarriage previously. She should lie upon a hard bed with no more covering than is necessary to protect her ; should eat only the blandest food?milk, arrowroot, broths ; should avoid all nervous and emotional excitement, and even unnecessary movements in the bed, since every movement will probably be followed by a gush of blood. If these remedies be inefficient in controlling the flooding, fifteen drops of laudanum may be administered and repeated if necessary after an interval of two hours. The application of towels or flannel wrung out in cold water over the bowels is sometimes advantageous, but may defeat its own object by inducing contractions of the womb ; it is therefore better to omit this measure until the arrival of the physician. Prevention. - The prevention of miscarriage is theoretically quite simple, but practically not always feasible. It may be summed up in the words of Dr. Tilt, who says: ? The way to prevent miscarriage is to lead a quiet life, particularly during those days of each successive month when, under other circumstances, the woman would menstruate, and to abstain during those days, not only from long walks and parties, but also from marital intercourse. ? It is especially desirable that women should observe these precautions during the first pregnancy, since, as has been already remarked, the occurrence of one miscarriage creates a decided predisposition to a repetition of this accident, which may, therefore, happen afterwards upon very slight provocation. If, in spite of all precautions, miscarriage does occur, it becomes necessary to observe especial care in avoiding it during subsequent pregnancies. In such cases it is generally advised that there should be a total abstinence from intercourse until after the sixth month, after which time the dangers of miscarriage are less. 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