HYDATIFORM DEGENERATION IN TUBAL PREGNANCY. 237 



hydatiform formations could be recognized on other villi also. Hence it would seem 

 that Krueger's case must be added to the authenticated cases of hydatiform degen- 

 eration in the tubes. 



So far as I am able to learn, then, the literature contains reports of but 9 cases 

 of hydatiform mole occurring in the tube, and of these 2 or 3 cases are not well 

 authenticated. These 9 cases are formed by the 2 cases of Blasius or Hennig, that 

 of Otto, of von Recklinghausen and Freund, and of Wenzel, the 2 of Groom, that 

 of Matwejew and Sykow, and that of Krueger. A critical reading of Hennig's 

 book on diseases of the tubes and tubal pregnancy makes it quite clear, however, 

 that Hennig merely said that Blasius discovered "tubal moles" and that he ob- 

 served 2 and Behm 1 case of abortion of tubal moles. From the context it is also 

 very clear that Hennig was not discussing hydatiform moles, although it is not 

 possible to say whether he meant that he himself or Blasius observed 2 cases. 

 I should judge that the latter is the idea it was meant to convey. To these 7 

 authenticated cases I would add that of Maxwell (1910). In reading Maxwell's 

 description one must feel that he himself regarded the case as one of hydatiform 

 mole, but deferred to the opinion of the "committee." This is suggested also by 

 the title of his article. The illustration which accompanies Maxwell's article is so 

 very suggestive, and his description so characteristic of hydatiform mole, that it 

 seems very probable indeed that the specimen really was such. Maxwell stated, 

 for example, that "sections of the villi embedded in the wall of the tube have the 

 typical structureless, bloated appearance of such pathological villi; and though 

 there is no central cavitation in the villi, their structure, associated with the active 

 proliferation of the Langhans layer, suggests that one is looking at a stage just 

 short of vesicle formation." Moreover, as I am about to show, hydatiform mole is 

 so very common in tubal pregnancies as to increase still further the likelihood that 

 Maxwell's case actually was one of hydatiform mole. However, this is merely 

 an opinion, and only a completer description or an examination of the specimen 

 itself could decide the matter. 



In connection with what was said before, it was interesting that Maxwell also 

 emphasized that epiblastic activity is increased in all abnormal sites of implanta- 

 tion, but anyone interested in the problems of tubal pregnancy and acquainted 

 with Mall's (1915) findings will be struck by Maxwell's statement that microscopi- 

 cal examination of many cases of tubal gestation lends no weight to the view that 

 chronic inflammation of the tubes is at all a common causal factor of tubal preg- 

 nancy. Nor can I refrain, in this connection, from quoting the uncontradicted 

 opinion of Doran, expressed in the discussion of Maxwell's case, that tubal gesta- 

 tion "probably represents some general deterioration in the generative power 

 among civilized women." 



To the 8 cases contained in the literature I wish to add 48 found among the 

 first 1,200 accessions from the Carnegie Collection. Nor is it necessary to stop with 

 these, for this collection contains many more not here included. It is merely a 

 matter of recognizing the specimens by a routine examination, and since this paper 

 has been written a number of specimens have been recognized among the daily 



