POST-MORTEM INTRAUTERINE CHANGES. 289 



in blood-clot, as was the case with Nos. 1938 and 2035, shown in figures 179 and 

 181. The embryo and yolk-sac of the former are almost completely disintegrated, 

 for nothing but scarcely recognizable remnants lie isolated in the chorionic cavity, 

 which is moderately filled with an amorphous coagulum. The stroma of the 

 chorionic membrane is edematous and degenerate, but contains some well- 

 preserved vessels, a few of which contain some blood-cells. The same thing is true 

 of the stroma and of the vessels of the villi, which also are in process of dissolution. 

 A moderate amount of trophoblast is present, but there is very little syncytium. 

 The epithelium of some of the villi has undergone hyaline degeneration. The 

 blood-cells in the large clot in which this chorionic vesicle, measuring 8 by 5 

 mm. in section, was embedded, are preserved fairly well, especially near the vesicle. 

 Nevertheless, the whole conceptus is very apparently in a state of rapid disin- 

 tegration and lysis. The tube-wall is very thin and the mucosa congested, hemor- 

 rhagic, and atrophic. 



It is not difficult, as a rule, to identify maceration changes in the villi, for the 

 appearances are rather characteristic, as figures 182 and 183 illustrate. But when 

 other changes, such as the obliterative process shown in figure 184, are present at 

 the same time, it is sometimes impossible to decide whether such changes as these 

 were ante-mortem or post-mortem. In this case the lumina of the capillaries are 

 plugged by what reminded Mall of "epithelial pearls," though he recognized that 

 the cells were endothelial in origin. That such an obstruction of the lumina of 

 blood-vessels can occur through a shedding, swelling, and clumping of the endothe- 

 lial cells there can be little doubt, although proliferation of the endothelium can 

 perhaps not be wholly excluded. 



The earliest noticeable external post-mortem change in the color of the embryo 

 is due to the occurrence of a greater opacity. The tissues lose their normal trans- 

 lucence, so that they look whiter and denser, and the surface also becomes less 

 glistening. Later they also become yellowish and occasionally hemorrhagic, and 

 the cutaneous surface becomes less smooth. Coincident with these changes, 

 softening and some swelling also take place, as illustrated by No. 2146, shown in 

 figure 187, and bleb formation occurs, especially on the abdominal extremity of 

 the umbilical cord and elsewhere, as previously shown in figures 54, 70, 71, and 72 

 (plate 5, Chap. IV). 



In consequence of the softening of the tissues, the upper extremities, if suffi- 

 ciently developed, tend to gradually droop, as shown in figures 58 and 66 (plate 5, 

 Chap. IV). Later, the caudal extremities also sag, and both pairs may gradually 

 develop unusual curvatures. Changes occur also in the face, for the ocular mar- 

 gins become irregular and everted, or, if the lids have fused, they may prematurely 

 open. But all these are relatively slight gross changes and merely herald the more 

 profound modifications in form if retention continues under favorable conditions. 

 What is now needed is a correlation between these early changes in external form 

 and appearance and the histologic and cytologic changes. Although the advent 

 of changes in color is quite prompt, it can safely be assumed from other evidence 



