48 STUDIES ON PATHOLOGIC OVA. 



very largely upon the further development and utilization of this already unique 

 collection and upon the degree of cooperation which can be secured from clinicians 

 and administrators. 



After considerable reflection upon this classification, and some experience 

 in its daily application to material as received from physicians, I shall permit my- 

 self certain suggestions, especially since they were invited by Mall himself. It 

 would seem that a division of all conceptuses into the long-established classes of 

 normal and abnormal has certain advantages. This would be true even if it were 

 as difficult to discriminate between the normal and the abnormal or atypical as 

 between the normal and the pathologic. A careful structural examination can 

 always decide the former, at least after the establishment of an arbitrary limit for 

 the range of normal variation. But until we can recognize the earliest morphologic 

 and cytologic changes resulting from pathologic conditions, it often must remain 

 impossible to decide between the normal and the pathologic. That day seems to 

 lie far in the future much farther, indeed, than the possibility of a final determina- 

 tion regarding the normality or abnormality in form of early cyemeta or chorions. 



A division into normal and abnormal also would avoid the awkward necessity 

 of classifying monsters as normal and of putting all specimens composed of normal 

 villi, of normal empty, damaged, chorionic vesicles, and of normal ruptured cho- 

 rionic and amnionic vesicles into the pathologic division. A grouping into the 

 normal and abnormal also would enable us to frankly recognize the fact that 

 normal specimens may become decidedly macerated, but should therefore not be 

 grouped among the pathologic. Furthermore, it would enable us to recognize the 

 possibility, first emphasized by Giacomini, that normal cyemeta possibly may be 

 changed so as to perfectly simulate the atrophic and stunted forms. 



The division of abnormals also could be understood as including not only 

 specimens resulting from anomalous development, i. e., true malformations, but 

 also those which have been affected by disease. Some of the latter, if not anoma- 

 lous also, would fall in the group of normals, as they rightly should. Moreover, 

 unless it can be confidently assumed that abnormal ova and spermatozoa have no 

 existence, some of the cyemata now classed as pathologic evidently are not the 

 direct products of disease. A specimen certainly may be abnormal without 

 being pathologic and pathologic without being abnormal in form. 



Phisalix (1890) also called attention to the fact that an embryo which is 

 pathologic is not necessarily abnormal. A fetus that dies in utero while the mother 

 is suffering from an infectious disease may well be, and often is, pathologic, but 

 it is not necessarily abnormal. Neither is a specimen necessarily pathologic which 

 dies under fortuitous circumstances and is retained sufficiently long so that macera- 

 tion changes very materially alter its form. Likewise, fetuses which die as a 

 result of extreme twisting or strangulation of the cord, or from premature sep- 

 aration of the placenta, or from some other accident of pregnancy, are not neces- 

 sarily pathologic. Yet all these, if retained sufficiently long, might, under the 

 present classification, fall into this division. 



