CHORION WITHOUT AMNION OR CYEMA. 65 



is surrounded by a decidedly hemorrhagic, degenerate, and inflammatory decidua 

 and mucosa. Although some evidences of maceration seem to be present in the 

 latter, they are relatively slight and can in no way account for the condition of the 

 chorionic vesicle, the whole appearance of which suggests rapid degeneration. 

 The extent of this degeneration is indicated by the entire absence of the cyema 

 itself, by the appearance of the remaining tissues, and by the absence of remnants 

 of the amnion and yolk-sac. All these things make it impossible that the embryo 

 was well preserved up to the time of the death of the patient and the subsequent 

 autopsy. 



The presence of a severe infection in the endometrium naturally directs atten- 

 tion to the possibility of the destruction of the amnion and cyema of this specimen 

 directly from this cause. However, since there is no infection of the cavity of 

 the chorionic vesicle, such an assumption becomes untenable. Besides, the char- 

 acter of the changes in the chorionic vesicle itself makes it quite evident that this 

 degeneration was produced by other conditions than a severe sudden infection. 

 A low-grade endometritis may have been not only a contributory but the prime 

 factor, but, in view of the severe hemorrhage which surrounds the vesicle and which 

 must have produced rapid stasis and hence asphyxiation of the conceptus, it is 

 unnecessary to assume any other contributory cause whatsoever; for, as No. 

 698 so well illustrates, hemorrhage alone, no matter what its cause, is entirely 

 sufficient to effect the complete destruction of either embryo or vesicle, or of both. 

 Nor is it necessary to assume that such a severe outpouring of blood from the 

 tapped vessels in the uterine mucosa is necessarily or even probably pathologic. 

 Indeed, it may be purely accidental and the result of a number of physical factors, 

 none of which necessarily is related to diseases of either the ovum or the endome- 

 trium, or of the maternal organism as a whole. 



A very interesting specimen belonging to this group is No. 1224, a portion of 

 which is represented in figure 10. This specimen was received in an unopened 

 uterus removed by hysterectomy for cervical myoma. The conceptus, which 

 measures 36 by 25 by 13 mm., was collapsed, free in the uterus, and embedded in 

 mucus. The only content of the chorionic vesicle was a dark-grayish coagulum 

 which contained no remnant of the embryo or of the amnion. This amorphous 

 magma included only a few isolated cells, yet in spite of this fact the trophoblast, 

 which had markedly proliferated, was well preserved over large areas and many 

 of the vessels in the chorionic membrane were filled completely with erythroblasts. 

 A few degenerate masses of trophoblast and fused degenerate villi also were present. 

 Some of the villi show evidences of maceration, others of mucoid hydatiform 

 degeneration, as shown in figure 12, although they still may contain vessels. Some, 

 however, are represented by a hyalin outline only. Both the stroma and the 

 epithelium of many of the villi are well preserved, however, and the same thing 

 holds for the chorionic membrane. 



The decidua shows slight general and very marked local infiltration. Some 

 remarkably dense periglandular and peri vascular zones of infiltration are present. 



