164 



STUDIES ON PATHOLOGIC OVA. 



third or fourth day. When about 15 or 16 years of age 

 she had a great deal of pain over the ovaries, and her 

 physician made her stop playing tennis, etc. When about 

 18 there was a mild attack of chlorosis, with cessation of 

 menstruation for several months. She became pregnant 

 about a year after her marriage, 6 years ago. The fetus 

 was carried for 6 months, when she miscarried. Develop- 

 ment apparently had not gone much beyond 3 to 8^2 

 months. The pregnancy was accompanied by a great 

 deal of pain in the sacral region. As she did not become 

 pregnant again, she was, about 3 years ago, put under the 

 doctor's care. He finally decided to dilate the cervix, 

 curette, and put in a glass plug. At the operation he 

 found the cervix to be very brittle; he could feel it give 

 under the dilators, so that he had to give up dilating and 

 merely do a slight curettage. She became pregnant again 

 about 4 months after the operation. This time the fetus 

 was carried 4 months. The pregnancy was accompanied 

 by some pain in the back, often with bearing-down pains 

 and pains along the thighs. She became pregnant again 

 last September and miscarried at the end of January. 

 This is the specimen in which the sac was unruptured. 

 The same pains were present, but even more severe, mak- 

 ing her extremely uncomfortable and miserable. This last 

 miscarriage was hard, the severe pains lasting about 8 

 hours, as the cervix would not dilate. Each miscarriage 

 has been preceded by a bloody discharge lasting from 5 



days to a week. Dr. (the physician under whose 



care she had been) can tell you better the condition of 

 the uterus and appendages. He considers the uterus, I 

 believe, to be rather fibrous and the ovaries to be some- 

 what smaller than they should be, but says he can not 

 explain the pains, nor why, having become pregnant, she 

 should miscarry. There has never been any leucorrhea." 

 At that time it was recommended that the uterus of this 

 patient be thoroughly scraped a number of times, if neces- 

 sary; but, as the following will show, it seemed to be of no 

 value in preventing this particular disease of the fetus and 

 subsequent abortion. Five years later we wrote to Dr. 

 Fewsmith again, asking for more details regarding the 

 case. He replied that during the interim the patient had 

 been pregnant twice, each time aborting at about the 

 same period of gestation that is, about the fifth month. 

 In his opinion the fetuses aborted were about the 3-months' 



(5) The chorion is small, hemorrhagic, and atrophic, 

 and contains an embryo which, although somewhat dis- 

 torted, is normal in form. The villi are very fibrous and 

 some of them are edematpus. The trophoblast is scanty 

 and at many points has invaded the stroma of the villi. 

 There are also numerous Hofbauer cells. The intervillous 

 spaces are packed with an inflammatory mass consisting 

 of mucus, fibrin, disintegrating blood, and numerous leuco- 

 cytes. Intermingled with this mass are many small buds 

 of syncytium. The chorionic wall does not seem to be 

 any thicker than usual, and between it and the amnion 

 there is a dense layer of reticular magma, through which 

 are scattered numerous Hofbauer cells. The decidua 

 appears to be atrophic, but there is the usual fibrmoid layer 

 between it and the villi. 



(6) The decidua is markedly infiltrated and contains 

 small abscesses; hydatiform degeneration of the chorion. 



No. 4456. 



(1) See No. 445<z. 



(2) B 85 mm. 



(3) (See No. 445a, just described.) 



(4) The chorion is somewhat hemorrhagic and covered 

 with well-formed villi. The fetus is normal in shape, 

 well bent upon itself, and the cord is very much twisted, 

 being extremely thin at some points. The amnion is 

 filled with a large quantity of granular magma which forms 

 large cakes, many of which are closely adherent to the 

 embryo. 



(5) The chorion shows all the reactions of 445a but in 

 a more marked degree. A hand from each embryo was 



cut into serial sections and appears to show slight changes, 

 more pronounced, however, in 4456 than in 445a. The 

 decidua is infiltrated intensely in some places. 

 (6) Marked infiltration of the decidua. 



No. 502. 



(1) A. Shelley, Baltimore, Maryland. 



(2) A 90X60X50 mm.; B 85 mm. 



(3) Said to be a fetus of the third month. 



(4) The pear-shaped mass is quite solid, being hemor- 

 rhagic, with only a few villi protruding. It contained a 

 compressed, dried fetus, which seemed to be normally 

 developed but much shriveled, with a greatly twisted and 

 flattened umbilical cord. 



(5) Sections through the chorion at the point of attach- 

 ment of the umbilical cord show that the mesoderm of the 

 villi is very fibrous, and that the chorion is covered with 

 an inflammatory, hemorrhagic mass composed of blood, 

 fibrin, numerous leucocytes, fibrinoid substance, and villi 

 which have undergone extensive degeneration. There is 

 very little trophoblast present, but a number of syncytial 

 buds radiating into this mass, many of which are being 

 converted into nuclear dust. Surrounding each villus is 

 a space filled with fresh blood, indicating that in some way 

 the trophoblast has the power to prevent coagulation. 

 Serial sections were cut of the right hand of the embryo 

 and show dissociation of its tissues. At points the epi- 

 dermis is lifted from the underlying structures, and the 

 cleft thus formed is filled with small round cells. 



(6) Decidua absent. Very long retention; chorionic 

 membrane infiltrated. 



No. 549. 



(1) J. M. Jackson, Pittsburgh, Pennsylvania. 



(2) A 40X35X20 mm.; B 12 mm. 



(4) The specimen is covered mostly with a layer of 

 decidua and the coelom is filled with a mass of reticular 

 magma, within which is a ruptured amnion containing 

 the remains of an embryo of about the 12 mm. stage. 



(5) The tissues of this remnant are macerated and partly 

 dissociated. The chorionic wall is normal in structure, 

 but is encircled by villi which have undergone fibrous and 

 mucoid degeneration. There is very little trophoblast, 

 and some of that has undergone nuclear fragmentation. 

 There is also considerable fibrinous exudate between the 

 villi. The layer of villi is encircled by considerable fibri- 

 noid, decidua, and fresh hemorrhages. The decidua shows 

 leucocytic infiltration. The magma of the exoccelom is 

 very rich in cells, especially in small round cells. The 

 embryo is dissociated and macerated. 



(6) Some infiltration of the decidua. 



No. 586. 



(1) F. A. Conradi, Baltimore, Maryland. 



(2) A 90X55X40 mm.; B 30 mm. 



(3) Patient is said not to have menstruated for a year. 



(4) A cavity extends throughout one side of the mass. 

 This is lined with a smooth amnion in which was found a 

 compressed, extremely macerated, and somewhat muti- 

 lated embryo, measuring about 30 mm. CR. According 

 to the shape of the arms and legs, the specimen is normal 

 in form. However, on account of the color and consis- 

 tency of the tissue, it appeared to have been dead a long 

 time before the abortion. 



(5) Sections of the chorion show that its wall is ex- 

 tremely macerated and greatly thickened on one side, 

 measuring 25 mm., on account of a large hemorrhage. 

 This thickened area is composed of degenerated villi 

 intermingled with fibrin, pus, and fresh blood. The tro- 

 phoblast is mostly necrotic, and at points there are large 

 masses of nuclear dust. The villi are degenerate, and 

 many of them are invaded by leucocytes. The nuclei of 

 the chorionic wall do not stain well, and apparently are 

 disintegrating. The specimen appears to be like some of 

 those obtained from tubal pregnancy; that is, after the 



