CYLINDRICAL CYEMATA. 



141 



between them. It appears that in this case there was an 

 arrest of development of the embryo at about the 20- 

 myotome stage, but the specimen continued to develop 

 in an irregular fashion, the tissues becoming dissociated 

 and ultimately undergoing maceration. 

 (6) Decidua absent. 



No. 419. 



(1) J. Park West, Bellaire, Ohio. 



(2) A 15X5X5 mm.; B 5mm. 



(3) This is the second specimen from the same woman, 

 the first being from an abortion in March or thereabouts. 

 The woman is about 27 years old and very nervous. Last 

 period began on October 5 and was as usual. Before 

 November 5 she decided she was pregnant. November 

 23 there was a slight show, which increased and continued 

 until the abortion, November 28. There was no pelvic 

 trouble, but the uterus was very small, almost of an infan- 

 tile type. 



(4) The ovum has a hemorrhagic wall 4 to 8 mm. thick, 

 the entire mass measuring 25X20X20 mm. It contains 

 a cavity lined by an amnion measuring 15X5X5 mm., 

 and a stunted embryo which is somewhat straight and 

 measures 5 mm. in length. 



(5) The chorionic wall is of normal thickness, but very 

 degenerate. The hemorrhagic mass is also surrounded 

 with fibrous decidua, more or less infiltrated with leuco- 

 cytes. The few villa which are embedded in blood are 

 mostly necrotic, the trpphoblast being scanty, but where 

 it remains in any considerable quantity it has undergone 

 extensive fragmentation, leaving large plaques of nuclear 

 dust. Sections of the embryo show extensive dissociation 

 and maceration. The brain is solid, but the medulla and 

 spinal cord contain a lumen. The eye-vesicles can barely 

 be outlined. The branchial organs appear quite normal, 

 but the two poles of the body are atrophic. The heart, 

 which appears to be normal in form, lies free within the 

 pericardial cavity. The tissues of the lower part of the 

 body are so much macerated that it is impossible to deter- 

 mine whether or not the organs are normal in form. 



(6) Marked infiltration of the decidua; probably hyda- 

 tiform degeneration. 



No. 446. 



(1) Elizabeth Morse, Boston, Massachusetts. 



(2) B 8.5 mm. 



(3) Patient is 33 years of age and the mother of several 

 healthy children. She is overworked and lives under poor 

 hygienic conditions. Last period was October 17 and the 

 abortion December 15. 



(5) There is a piece of chorion which, upon section 

 ing, proved to be very hemorrhagic; otherwise the struc- 

 ture is poorly defined. However, there are a few necrotic 

 villi close to the chorion and the embryo. The latter is 

 markedly dissociated, but some of the organs can still be 

 made put. The brain fills entirely the head region, and 

 the spinal cord reaches to the tip of the tail. The heart, 

 pharynx, and lungs can still be outlined in their proper 

 positions. The myotomes are well outlined, and between 

 them are seen various peripheral nerves, indicating that 

 the embryo had developed normally to about the 5 or 6 

 mm. stage before the strangulation and dissociation began. 

 At the tail end of the embryo there is a large accumulation 

 of round cells which stain intensely. 



No. 451. 



(1) H. D. Senior, Syracuse, New York. 



(2) A 80X45X40 mm.; B 3.5 mm. 



(3) Patient aged 23 years; married 6 years. Five years 

 ago a child born at 8 months died at 3 months. Four years 

 ago gave birth to a 7-months child, stillborn. Three 

 years ago had 2 months' abortion, another the year follow- 

 ing, at 2 months. One year ago had a child born dead; 

 said to have been "distinctly syphilitic"; an "unusual 

 amount of liquor amnii." This miscarriage was preceded 

 by one month's flow. Last period began September 1; 

 abortion December 4 (?). 



(4) The surface of the ovum is smooth and covered 

 with decidua. The very large cavity is lined with a very 

 smooth membrane which proved to be the amnion. 



The decidua is composed of an inflammatory mass. At 

 points there are abscesses. Between the decidua and the 

 chorionic membrane the villi are packed together in an 

 inflammatory exudate. Most of the trophoblast is ne- 

 crotic, but the mesenchyme of the villi is still sharply 

 defined. The dissociation of the embryo is quite complete 

 although the form of the brain and heart can still be made 

 out. The umbilical cord is short and distended, and in 

 the chorion, opposite to its attachment, there is a sharply 

 defined epithelial tube lined with cylindrical epithelium. 

 This, no doubt, represents the distended allantois. The 

 embryo is irregular in shape and filled quite uniformly 

 with round cells. These are very pronounced within the 

 cavities of the heart, but do not invade its wall. They 

 appear to reach the heart by invading it through natural 

 channels. There is a small remnant of the Wolffian body, 

 and the eye-vesicles are still outlined by their pigments. 

 They are detached from the brain and filled with round 

 cells. The borders of the hind-brain are fairly well pro- 

 nounced, but those of the fore-brain are entirely oblit- 

 erated. The anterior tip of the head is pronounced and 

 extends beyond the brain, which makes it appear as though 

 the mesenchyme of this region had continued to grow 

 independently. No ear-vesicles can be found. 



(6) Infiltration; probably early lues. 



No. 466. 



(1) Henry Rohfling, St. Louis, Missouri. 



(2) A 29X23X16 mm.; B 4mm. 



(3) The patient, who was 35 years of age, never missed 

 her menstrual flow; always regular, 28 days from the 

 beginning of last menstruation, the periods lasting 4 days. 

 On the day of the abortion she bagan to menstruate early 

 in the morning, and at about 6 o'clock in the evening the 

 physician was called on account of pains, which patient 

 asserted resembled labor pains. On examination he found 

 a slightly dilated os and a protruding mass which felt like 

 a cyst. After strong bearing down he received the mass, 

 which proved to be an ovum, in toto. Patient had borne 

 three children, all in a healthy state. 



(4) Somewhat over half of the ovum is covered with 

 villi, 2 to 3 mm. long, very irregularly shaped, and many 

 of which show bulbous enlargements. Over the remaining 

 portion of the ovum are sparsely scattered villi about 1.5 

 mm. in length, which branch several times, but do not 

 show enlargements. 



(5) The sttoma of the villi is non- vascular, fibrous, and 

 so degenerate in many instances that few nuclei remain. 

 Degenerate erythroblasts (Hofbauer cells of Minot) lie 

 between the amnion and chorion, and the chorionic mem- 

 brane is rather fibrous. The trophoblast lies in necrotic 

 knots among the villi. A window being cut in the ovum, 

 it was examined in strong sunlight under the binocular 

 at every possible angle. There is a small amount of gran- 

 ular magma. An opaque spot is seen near one end. This 

 has the general appearance of a small embryo with a groove 

 along its dorsum. Magma covers it so closely as to prevent 

 a sharper picture. The embryo is curled sidewise upon 

 itself, and the camera drawing made of it before it was cut 

 shows that we have an extensive spina bifida reaching well 

 up into the head region. In section the embryo shows the 

 homogenous appearance so characteristic of those speci- 

 mens in which dissociation has taken place. The outline 

 of the brain is recognizable and the two optic stalks are 

 present. Only the anterior end of the brain is inclosed. 

 In the head region the epithelial covering has fallen off, 

 and round cells have accumulated around the periphery 

 of the sections. Caudal to this the central nervous system 

 opens over the back of the specimen in a broad, shallow 

 trough. At intervals ventral to this trough in the body of 

 the embryo are dense accumulations of cells, which 

 probably represent remnants of both mesodermal and 

 entodermal structures, most of which are unrecognizable. 



