96 STUDIES ON PATHOLOGIC OVA. 



extremely enlarged cartilaginous extremities. Although no measurements were 

 taken and no exact comparisons made with normal specimens, it is not unlikely 

 that the extremities of some of these developing cartilages are somewhat enlarged, 

 although not necessarily as the result of growth. 



A survey of a considerable number of these fetuses shows that the distortion 

 of the extremities, and indeed also those of the trunk, are purely haphazard. 

 They seem to follow no law, except perhaps that of gravity, but often are in diverse 

 directions in the different extremities of the same fetus. Whether or not the initial 

 sag is in the same general direction in all the extremities depends considerably 

 upon the age of the fetus. Below a length of 25 to 30 mm. the limbs still extend 

 stiffly from the body, and in these specimens both pairs of the extremities usually 

 droop, as represented by Nos. 651o and 1710, shown in figures 58 and 66. After 

 the extremities assume their normally flexed posture the abnormal positions 

 which they then take become far more diverse. This is well illustrated by Nos. 

 1751 and 1931, shown in figures 67 to 68. Similar distortions are present also in the 

 digits, as shown in figure 69. Nor do fetuses of corresponding ages necessarily 

 show the same degree of distortion, or possess distortions in the same general 

 direction, even if they show approximately the same degree of maceration. How- 

 ever, the degree of distortion nevertheless is roughly correlated to the degree of 

 maceration and the duration of the post-mortem intrauterine retention. Fresh 

 and unmacerated specimens never show the characteristic distortion. 



The haphazard character of these distortions seems to indicate quite con- 

 clusively that they did not result from contractures arising during the gradual 

 death of the fetus. To be sure, the loss of tone accompanying gradual death or 

 following it must finally become extreme, but since the specific gravity of the 

 amniotic fluid, even when altered, is so little if any less than that of the fetus itself, 

 it is difficult indeed to see just why marked changes in the position, even if not 

 in the form, especially of the extremities, can occur without the instrumentality 

 of external pressures. 



The umbilical cord of many of these specimens, especially of the fetus com- 

 pressi, is abnormally and often extremely twisted and thin. As is well known, 

 this twisting is unlike that normally present, though it seems always an accentua- 

 tion of it. I have never seen it occur in a direction opposite to that normally 

 present in a given cord. That most of the extreme torsion of the cord is purely 

 a post-mortem and not an intra-vitam phenomenon is indicated by the fact that 

 these extremely tortuous cords always can be untwisted easily up to the point of 

 the customary twisting. The excessive tortuosity also varies more in degree, and a 

 single turn does not always involve the same length of cord in fetuses of approxi- 

 mately the same age, even when about the same amount of twisting is present in the 

 entire cord. Indeed, a single turn may occupy different lengths of the cord of the 

 same fetus, and it is not uncommon to find only a portion of the cord twisted and 

 the rest of it wholly untwisted, a fact which probably can be attributed in part to 

 the varying degree of maceration. 



While observing the nature of this twisting more closely, it became evident 

 to me that it probably was not produced intra-vitam, but rather resulted from post- 



