CHAPTER IV. 

 ANALYSIS OF ABORTUSES CLASSED AS PATHOLOGIC. 



GROUP 1. SPECIMENS COMPOSED OF VILLI ONLY. 



A. UTERINE. 



Among the series of over 2,000 abortuses in the Carnegie Collection I have so 

 far been able to find only a few specimens which undoubtedly fall into the category 

 of intrauterine absorption. Among these are Nos. 698, 970, 1640, and 1926. 

 Nevertheless, not even in these cases had total absorption occurred, and from 

 evidence to be considered I have really come to doubt whether absolutely complete 

 absorption occurs in man in any but the earliest stages of development or under 

 the rarest conditions. 



As stated by Mall, specimens of the first class of the pathologic division, 

 i.e., those composed of villi only, are obtained very largely from tubal pregnancies. 

 Nevertheless, Mall emphasized that "a very large number belonging to this group 

 would be found in uterine pregnancies also if our methods of collection and study 

 were as reliable as they are for tubal pregnancy." Of the 353 uterine specimens 

 classed as pathologic among the first 1,000 accessions, only 17, or 4.8 per cent, 

 are composed of villi only, as compared to 35, or 32.4 per cent, of 108 tubal speci- 

 mens. That is, specimens composed of villi only are nearly seven times more 

 common among tubal than among uterine gestations. However, this is due almost 

 wholly to the fact that the uterine specimens are fairly representative of the whole 

 period of gestation, while the tubal specimens are derived almost wholly from the 

 first two months of pregnancy. Specimens composed of villi only would form 

 about the same proportion among uterine abortuses contained in the first two 

 groups of the pathologic, as among the tubal, but they form only 12.9 per cent of 

 all uterine specimens contained in the first four groups of this division. Hence 

 the inference that the great majority of tubal conceptuses come to an early death 

 seems indicated by these facts alone. 



That villi only are so frequently found in tubal pregnancies is probably due 

 also to the occurrence of tubal abortion, in consequence of which the conceptus 

 may be ejected from the tube but some of the villi left attached, and more especially 

 to the effect of repeated hemorrhage. The conceptuses often are strangulated as 

 a result of hemorrhage which detaches them completely and then leads to their 

 disintegration. Although the villi may be, but probably are not, inherently more 

 resistant than the rest of the chorionic vesicle, some of them usually survive, be- 

 cause in the absence of a decidua which becomes detached, they remain attached 

 to the implantation site, thus retaining their connection with the source of nourish- 

 ment. In uterine specimens this is impossible, for the entire decidua is cast off. 

 For these, and probably also for other reasons, Mall found that villi almost always 

 can be detected by microscopic examination of serial sections of the implantation 



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