64 STUDIES ON PATHOLOGIC OVA. 



specimen is normal," although under later microscopical examination he found it 

 "difficult to make out any structure whatsoever. In fact, even the nuclei of the 

 chorionic membrane have disappeared entirely, leaving only a fine reticular struc- 

 ture." One might say of this specimen, a photograph of some of the villi of which 

 is shown in figure 11, that only an extremely finely textured, disordered web of 

 hyalin material composes the apparently intact chorionic vesicle and the envelop- 

 ing villi. What we really have here is a cast of the entire chorionic vesicle, includ- 

 ing villi, which is formed by hyalin degeneration products that have preserved 

 the form of the vesicle in every detail. From these things it is evident that only a 

 little longer retention of this vesicle in utero would have sufficed to effect its com- 

 plete disappearance. It does not therefore follow, however, that the disintegra- 

 tion products necessarily would have been completely absorbed. They might, to 

 be sure, have been expelled, at least in part, with the decidua. 



The finding of this specimen recalled a personal communication made to me 

 by Professor Mall which suggests that a small cyema received some years ago 

 probably was in a similar structural condition. This specimen was found appar- 

 ently well-preserved and normal in form when the intact chorionic vesicle was 

 opened in the laboratory, but had completely disintegrated a few moments later. 



An exceedingly interesting specimen bearing upon this question of intrauterine 

 destruction and absorption of conceptuses is one received from Dr. R. W. Ham- 

 mack, of Manila. This specimen, No. 970, which was referred to in the preceding 

 chapter, was found in the uterus at autopsy. The uterus contained some blood- 

 clot, and the decidua was described by Mall as being "covered with hemorrhagic 

 nodules measuring in general about 10 mm. in diameter. One of these, located 

 medially, is larger than the rest, and a narrow block of tissue cut out of it and 

 sectioned was found to contain part of an ovum. The ovum with its villi measures 

 3 by 5 mm. The crelom is filled with a homogeneous substance, through which are 

 scattered individual cells and also some strands of tissue from the chorionic mem- 

 brane. The villi are about 0.5 mm. in length and covered with an active tropho- 

 blast. This layer of trophoblast ramifies into the adjacent tissue, is intermingled 

 with a great deal of fibrinoid substance and cells, and penetrates the blood-sinuses. 

 There are many buds of syncytium and considerable inflammatory reaction in the 

 surrounding tissues. Towards the lumen, the ovum is covered with decidua 

 reflexa, marked off with a layer of fibrinoid substance. The sections examined show 

 no trace of an embryo." On account of the swollen condition of the chorionic mem- 

 brane and the lack of sharpness of the mesenchyme, it is evident that pronounced 

 degeneration of this conceptus has occurred. However, the internal limits of the 

 chorionic membrane are well defined and the mesenchyme has become decidedly 

 loosened, disordered, and degenerated. Groups of mesenchyme cells have wandered 

 out into the magma, which contains cellular detritus also. The stroma of most of 

 the villi is decidedly degenerate and in some cases is represented by a coagulum 

 containing cellular remnants surrounded by necrotic epithelium. The syncytial 

 islands are ill preserved and the trophoblast also is degenerate. The entire ovum 



