STUNTED CYEMATA. 87 



entire conceptus in consequence of chronic endometritis, or in consequence of 

 other chronic changes, or even perhaps in consequence of toxins, seems likely, 

 however. Hence, although the cyemic circulation be maintained in the main, 

 lack of nutrition nevertheless might occur locally and show itself first in outlying 

 cyemic parts, as in the tips of the extremities or in the facial relief, in which places 

 slight changes in form easily become evident. However, the fact that the present 

 group of stunted cyemata is limited to a comparatively early age very seriously 

 contradicts such an assumption, and the well-known fact that ill-nourished, 

 stunted, viable infants are born with certain constitutional diseases would seem 

 to imply the occurrence of stunted forms in all groups of pathologic cyemata and 

 perhaps also the occurrence of stunted chorionic vesicles as well. 



Excellent examples of stunting are No. 2473, a 13 mm. fetus, and No. 675, 

 a 10 mm. fetus, represented in gross and in median section in figures 35 and 36. 

 The head of No. 675 has been so deformed as to look like that of a frog, and the 

 whole outward form has become rounded. Since this specimen was retained long 

 after death, marked maceration changes had occurred, and it is a question to 

 what extent the changes in form here shown can be attributed to maceration 

 alone. The limb-buds in these stunted embryos soon become more rounded, 

 smoother, and shorter, or even somewhat clubbed, losing all details of form as 

 illustrated by No. 2233, represented in figure 34. The head loses its natural curves 

 and becomes atrophic or reduced; the maxilla is often beaked and the mandible 

 depressed greatly, thus producing gaping. In some cases the mandibular region 

 may fuse with the chest, as represented in figure 37 (No. 788a), and with increase 

 in flexure the eyes may come to lie practically opposite the liver. The caudal 

 region looks stubbed or flattened, the caudal process being less evident. Both 

 local and diffuse epidermal thickenings are not uncommon, and sloughing of the 

 epidermis is frequently preceded by bleb formation. The umbilical cord is often 

 distended, especially near its attachment to the abdominal wall, and at this point 

 decided bleb formation is common. 



Miiller (1847) also noticed instances of bleb formation on the umbilical cord 

 and stated that Albinus and Sandifort called them "processus infundibuliformis" 

 when they occurred at the point of attachment of the cord to the abdomen. 

 Miiller further stated that Ruysch described a cord so full of "hydatids" that 

 he spoke of it as being a " concatenatio vesiculorum. " 



The internal organs of the specimens become distended, lose their clear out- 

 lines (as illustrated by No. 983a, shown in figure 38), blood-cells seem to pass out 

 from the vessels in all directions, the normal cell relations are disturbed, cytolysis 

 occurs, nuclei of various cell types become pycnotic and circular in outline, until 

 all areas of the specimen seem to be composed of one type of cell only. This is 

 due to the fact that all nuclei have assumed a similar form and appearance, but 

 in more advanced stages these nuclei, too, disappear and only a homogeneous 

 necrotic mass remains to represent the fetal tissues. 



The length of the fetuses in this group varies from 4.5 to 20 mm., and the 

 menstrual age from 30 to 127 days. But neither the former nor the latter can be 

 regarded as more than roughly indicative of their true age; for, although 30 days is 



