402 GYNECOLOGY 



secretion and is a prominent indication that the tissues are favor- 

 able to the reception of the ovum? 



Recently various authors have suggested a connection between 

 abnormal conditions of the ovary or corpus luteum and aberrant 

 developments of the ovum. Thus several cases have been described 

 in which hydatidiform mole has been associated with disease in the 

 ovary, especially cystic degeneration. Pick has recently made a 

 careful study of a case in which excessive production of lutein tissue 

 was found in the ovaries, and he regarded this condition as the 

 cause of excessive chorionic development, leading to the formation 

 of hydatidiform mole. In chorioepithelioma this author, Runge, 

 and Jaffe have also described excessive production of lutein cells 

 in the ovary, which they are inclined to consider as the cause of 

 the chorionic growth. In several specimens of ovaries examined 

 by Pick, Stoeckel, Runge, and others, in addition to cystic changes 

 in Graafian follicles and corpora lutea, collections of lutein cells 

 were found scattered through the ovarian stroma. Careful study 

 of a larger series of ovaries must be made before any positive state- 

 ment can be made in regard to the association of changes in them 

 with abnormal development of the ovum. It is certainly difficult 

 to explain the occurrence of hydatidiform mole in a twin pregnancy 

 by the lutein secretion hypothesis. If over-production of the latter 

 be the sole cause, it is strange that both ovums should not be sim- 

 ilarly affected. 



The Antagonism between Maternal Organism and Ovum. For 

 several years the idea has been steadily gaining ground that the 

 maternal organism during pregnancy is very commonly affected 

 by circulating toxic substances, and that many disturbances, both 

 of major and minor importance, are caused thereby. This view 

 has been chiefly prominent in recent investigations concerning the 

 nature of eclampsia. Though little success has been obtained in 

 the identification of specific toxins, there has been plenty of specu- 

 lation as to their source and nature. The maternal organism has 

 been considered the chief source of their production, the contri- 

 bution of the ovum being generally regarded as of minor import- 

 ance. 



Recently, however, a new theory attributes to the latter a much 

 more prominent role than has hitherto been suspected. In addi- 

 tion to the passage into the maternal circulation of the waste pro- 

 ducts of fetal metabolism, it is believed that there is a continual 

 warfare between the chorionic layers of the ovum and the maternal 

 tissues, that the proliferating and invading tendencies of the for- 

 mer are continually antagonized by the latter, and that a toxic 

 chorionic internal secretion is produced which is neutralized or 

 destroyed by maternal influences. 



