270 STUDIES ON PATHOLOGIC OVA. 



cases of supposed uninterrupted menstruation fall into the last group, although it 

 is not impossible that rarely hemorrhage may occur only at the dates of normal 

 recurrence. This would seem possible because of the defective inhibition of the 

 returning normal impulses exercised by the dead or dying conceptus and the 

 retrogressing corpus luteum. This conclusion harmonizes with the tendency to 

 abortion which seems to be present at the time of periodic hyperemia and hyper- 

 irritability in some of these cases. 



Although dissolution of the embryo or fetus alone has long been known to 

 occur, there seems to be no convincing evidence in the literature of the occurrence 

 of intrauterine autolysis and absorption of entire conceptuses. Moreover, as 

 already stated, it is to be doubted very seriously whether complete intrauterine 

 absorption is possible after the formation of the skeleton has been well begun. 

 The fetal parts at this time are so resistant that the uterus is stimulated to expel 

 the macerated remnants long before absorption of them can occur. Furthermore, 

 complete absorption would also seem to be hindered by the physical conditions 

 which obtain in the human female. Only so long as the decidua capsularis 

 is relatively thick, and hence effectively prevents the escape of the products of 

 autolysized embryonic tissue, does complete absorption of a young uterine 

 conceptus seem to be possible. The same thing is probably true in some cases 

 of tubal pregnancy, although the occurrence of early and repeated, or even 

 prolonged, hemorrhage in them makes complete intratubal absorption much 

 less likely. However, that complete intrauterine absorption actually seems to 

 occur in the human female, it is my purpose to establish. 



The occurrence of missed abortion and also of missed labor have long been 

 matters of common knowledge among physicians. But these are phenomena 

 usually connected with the later months of pregnancy. In the overwhelming 

 majority of these cases the fetus was retained for a considerable period after its 

 death and then aborted in a more or less macerated condition. Under these cir- 

 cumstances it may, to be sure, undergo absorption in part, but expulsion of macer- 

 ated or even calcified remnants of the fetus nevertheless eventually occurs. That 

 this is so, even after an exceedingly long period of retention in utero, is shown 

 splendidly by the case of Schaeffer (1898). In view of the exceedingly common 

 occurrence of retention of conceptuses in utero, it is surprising that as late as 1896 

 Graefe succeeded in collecting only 58 cases of missed abortion from the literature. 

 Graefe stated, however, that he himself met with 11 cases in 7 years, to which 

 number he added 12 observed by a friend. Nevertheless, from these facts one 

 might assume that retention of conceptuses after death is a rare rather than a 

 very common thing. The explanation probably lies in the fact that the term 

 "missed abortion" is understood as referring to advanced rather than to early 

 cases of pregnancy. Retention of the latter for varying periods of time is exceed- 

 ingly common, however, and one might say that retention is the rule, for it is 

 exceedingly rare that a fresh, wholly unmacerated conceptus is obtained through 

 abortion unprovoked by mechanical means or acute disease. Hence post-mortem 



