HYDATIFORM DEGENERATION IN UTERINE PREGNANCY. 225 



abortion was attributed to influenza, although, in view of the presence of hydati- 

 form degeneration, it was inevitable. Influenza, to be sure, may have been the 

 immediate cause and may have precipitated the abortion, but uninterrupted 

 development of the hydatiform degeneration also would have done so. More- 

 over, the appearance of both fetuses suggests that they died shortly before the 

 abortion, and this is confirmed by a comparison of the menstrual and anatom- 

 ical ages, which differ by 6 and 10 days, if the larger or smaller fetus is used for 

 the determination of the latter age. However, if we can finally assume that the 

 menstrual age of all conceptuses exceeds their true age by about 10 days, then 

 they must have lived up to the tune of abortion, or, strictly speaking, a few days 

 beyond it. That death of the cyema is not the cause of hydatiform degeneration 

 is indicated also by such specimens as No. 2411, represented in figures 143 and 

 144 (plate 14, Chap. X), a twin, double-ovum pregnancy, in which both the 

 cyemata and the chorionic vesicles show considerable and apparently the same 

 degree of maceration (figs. 145 to 147). Since both chorionic vesicles also show 

 the presence of quite general hydatiform degeneration, it is evident that if the 

 latter had arisen only after the death of the cyemata the vesicles should not 

 show anything like a corresponding degree of maceration, unless perhaps the 

 time of retention had been considerable. 



Many other specimens of single pregnancy could be used to illustrate the 

 same thing, and since the development of hydatiform degeneration undoubtedly 

 is not a fulminating one, it might be expected that considerable development 

 of it might occur before the death of the cyema, which is due apparently to the 

 obliteration of the villous circulation. Since blood-vessels can and do arise in the 

 chorionic villi quite independently of those in the cyema, it also seems possible 

 that young chorionic vesicles showing hydatiform villi with disappearing blood- 

 vessels may be found, even if the intra-cyemic circulation never developed or never 

 united with the extra-cyernic or chorionic circulation. Such a surmise does not 

 imply, however, that hydatiform degeneration never begins before the blood- 

 vessels appear. 



Of the many explanations which have been offered for the advent of hydati- 

 form degeneration, none seems to be better established than that of endometritis. 

 This was first emphasized by Virchow (1863). Lwow (1892) also reported 4 

 cases in patients under his care in whom lues could be excluded, and in whom he 

 held endometritis responsible. Emanuel (1895) was the first, it seems, to demon- 

 strate the presence of cocci in inflammatory foci of round cells in the decidua 

 accompanying a case of hydatiform mole. Veit (1899) also believed that disease 

 of the decidua is the cause of hydatiform degeneration. Veit further stated that 

 Waldeyer, Jarotzky, and Storch also believed that an irritative condition of the 

 decidua is responsible. Stoffel (1905) also found cocci other than gonococci present, 

 and says he can not avoid holding endometritis responsible in his case. The asso- 

 ciation of hydatiform degeneration and endometritis was noted also by Marchand 

 (1895), Oster (1904), and Sternberg; also by Essen-Moller, who reported the phe- 



