SPECIMENS COMPOSED OF VILLI ONLY. 57 



Upon attempting to correlate the clinical data with the objective examination, 

 it was found that in one case in which abortifacients were held responsible for the 

 termination of pregnancy, an intense infection was present. This was true also 

 in four other cases, in which it was specifically stated that infection was absent, a 

 conjunction of things to be referred to again. 



B. TUBAL. 



In contrasting the tubal specimens composed of villi only with similar speci- 

 mens from the uterus, the lesser number of villi contained in the tubal cases is very 

 striking. It may be recalled that the number of villi found in uterine specimens 

 varies from none to large hydatiform masses weighing several pounds. But even 

 aside from the latter, which properly do not belong in this group, villi found in 

 uterine specimens are far more numerous, as a rule, than in the tubal cases. One 

 of the main reasons for this difference lies in the fact that the tubal specimens as 

 a whole undoubtedly are much younger and hence less resistant. Their youth may 

 be explained very largely by the anatomical conditions under which development 

 proceeds in the tube and in part probably also by the efforts at abortion which 

 probably are inaugurated very early through the occurrence of tubal peristalsis. 

 It is not unlikely that this peristalsis may expel most of the villi, with the surround- 

 ing blood-clot, into the peritoneal cavity, leaving behind only a few stragglers. 

 In the absence of anything truly comparable to decidual development within the 

 tube, the villi at best must be embedded less securely and also may degenerate 

 faster when once detached. Moreover, in the absence of such a nidus as the'hyper- 

 trophied endometrium, the whole development of the conceptus necessarily must 

 be retarded. 



Most of the villi in tubal specimens lie isolated in the contained blood-clot; 

 hence matting of the villi was practically absent and calcification and coagulation 

 necroses were not seen, facts which suggest the occurrence of early interference 

 with development. Sometimes a few villi which lay near each other were decidedly 

 necrotic, but they were not fused into a large, solid mass by degeneration or by 

 inflammatory products in any of the cases in this group. This fact and the ap- 

 pearance of the clots would seem to suggest that there often is a constant trickling 

 of blood from the distal extremity of the tube, so that old clots form slowly, new 

 blood being added more or less constantly, thus prolonging the life of some villi, 

 or at least of the chorionic epithelium. In several cases the villi were quite well 

 preserved, though fibrous, but by far the greater number were decidedly degen- 

 erate. Except in instances in which the whole villus was necrotic, the epithelium 

 was preserved better than the stroma, a fact which probably may be explained by 

 the presence of fresh blood. In all except the necrotic specimens, the epithelium 

 not only was well preserved, but also was not infrequently very active, as noted in 

 several instances by Mall (1915). Considerable masses of trophoblast were present 

 in a number of instances, and smaller sj^ncytial masses (or more frequently syncytial 

 buds) also were seen. Usually some portions of both were extremely well pre- 

 served, and in one instance large masses of degenerate trophoblast completely filled 



