CHORION WITH AMNION. 73 



evidences of the presence of an old inflammatory condition also, and in spite of 

 the small size of the conceptus has a menstrual age of 200 days. Since the coalesced 

 fetal membranes are extremely thick indeed, the thickest of any specimens of 

 this size that came to my attention one might assume that the chorionic vesicle 

 probably grew after the death of the embryo. That some growth occurred is not 

 at all impossible, but it does not seem likely that this growth was considerable. 

 The decidua is very necrotic and a considerable number of inflammatory areas are 

 present. Consequently, it seems more likely that the fibrosis of the membranes 

 and of some of the villi is the result of other things than retention only. As is 

 well known, extremely long retention of the dead conceptus has long been regarded 

 as very common in lues. This specimen is interesting also because if the fetus had 

 been present, no matter in how macerated or mummified a condition, the con- 

 ceptus, instead of falling into this group, would have been classified in group 7. 

 The same thing is true no doubt of other specimens also, and seems to suggest that 

 an attempted classification on an etiological basis may throw more light on the 

 genesis of the various morphological types here described, even if it would be 

 largely tentative. 



Of the 44 specimens out of the first 1,200 accessions which fall into this group, 

 24, or 54.5 per cent, showed evidences of infiltration. But, since the decidua often 

 was not included in the sections, and generally also not in the respective gross 

 specimen, these percentages can not represent the true state of affairs. It is true 

 that the same thing may be said if the incidence of infection, as indicated by 

 infiltration, is determined upon the basis of those cases only in which the decidua 

 is present, for all cases in which the chorionic vesicle, unaccompanied by decidua, 

 contains evidences of infection are then excluded. Nevertheless, that the decidua 

 in all such specimens, if present, would be found infiltrated can scarcely be doubted, 

 for all these chorionic vesicles are small. If we take the 54.5 per cent of the 

 cases in which the decidua was present and not too degenerate, we find that 100 

 per cent of them showed infiltration. In 16 of these specimens, or 66.6 per cent, 

 the infiltration was marked, and in 8, or 33.3 per cent, it was slight. The sections 

 of one specimen showed no evidences of infiltration, and in a second specimen the 

 decidua was too degenerate. In 7 instances, Nos. 408, 468, 922, 771a, 814, 960a, 

 and 985, of those suggesting infection, its presence was noted in the history. One 

 of these was a case of peritonitis ; another, that of an old gonorrhea with salpingitis ; 

 two of leucorrhea, one since girlhood; two of endometritis; and one of gonorrhea 

 and syphilis. In three cases, Nos. 159, 813, and 976, the infiltration was severe 

 locally and may have been both luetic and pyogenic in character. In one of the 

 cases of probable lues the presence of this disease was suspected by the physician, 

 and although a Wasserman test was found negative, changes suggestive of lues 

 were present in the chorionic vesicle. 



Fifteen of the cases, or 34 per cent, showed the presence of undoubted 

 hydatiform degeneration. In some of these cases the change apparently was 

 incipient, and in 3 cases not included in the 14 no definite conclusion could be 



