230 STUDIES ON PATHOLOGIC OVA. 



degenerations were large specimens mainly, it well may be, and according to certain 

 authors it is true, that such cases occur later in the reproductive life of women. Yet 

 it certainly is significant that Findlay, in tabulating 500 such cases from the 

 literature, found that 275, or 55 per cent, occurred before the thirty-fifth year, and 

 of 36 specimens from the Carnegie Collection 23, or 63.6 per cent, came from 

 women below this age. It may also be recalled that 78 per cent of Kehrer's 

 50 cases and 90 per cent of Bloch's occurred before the fourth decade. That 

 hydatiform degeneration may occur very early in life is suggested by the remark- 

 able case of Strieker (1879) in a precocious child of 9 years. 



Fourteen out of 23 cases, or 61.3 per cent of the uterine series, in which the age 

 was given, occurred at or before the thirtieth year, and 18, or approximately 

 80 per cent, at or before the thirty-fifth year. These things abundantly empha- 

 size the conclusion, reached by some investigators, that hydatiform mole is 

 not absolutely more common at or near the menopause; but it nevertheless may be 

 relatively more common. That is, the number of hydatiform moles aborted after 

 40, compared with the total number of pregnancies or births after 40, actually may 

 be greater than this ratio before 40 years. 



From calculations based on data given by Lewis and Lewis, the average 

 number of births occurring after 40 years in Sweden, Norway, Denmark, Bruns- 

 wick, Berlin, Budapesth, France, and Scotland is 9.9 per cent. This agrees 

 remarkably well with Bloch's estimate of 10 per cent. But if 77.2 per cent of 

 the cases of hydatiform mole occur below 40, and 22.8 per cent after that year, 

 then it is evident that hydatiform mole nevertheless is relatively more common 

 after than before 40 years, for approximately one-fourth of the cases of hydatiform 

 degeneration would be associated with one-tenth of the births. This would be an 

 increased frequency of 300 per cent after 40 years. A similar result would be 

 obtained by comparing Findlay's or Williamson's series. Hence, hydatiform 

 degeneration, though absolutely less, is relatively more frequent in later life. This 

 fact, however, does not necessarily imply that age in itself is responsible for the 

 increased incidence after 40. A comparison of the incidences of hydatiform degen- 

 eration in young and old primipara3, of good health, might elucidate this question. 



These statistics are not in agreement with the prevailing opinion that hydati- 

 form moles are more common in multipart than in primiparse. Indeed, they 

 suggest rather that after the first conception, which was normal in a large per- 

 centage of these young women, something happened which interfered with the 

 normal development of succeeding conceptions. That, it seems to me, is extremely 

 significant and very suggestive. Here is a group of relatively young women, over 

 50 per cent of whom had borne but twice and some only once, and then gave birth 

 to a hydatiform mole. While I realize the necessity for circumspection, especially 

 in these matters, these facts seem to me to suggest that something happened to 

 a normal endometrium. Other facts also point in the same direction. 



