350 STUDIES ON PATHOLOGIC OVA. 



the uterus are recorded more frequently as a cause of abortion among specimens 

 classed as normal and self-induction more frequently among the pathologic cases. 

 In a higher percentage of these the presence of associated diseases was mentioned, 

 however, and miscellaneous and psychic causes also were recorded. Interference 

 might be presumed to occur more frequently in cases involving pathologic condi- 

 tions, yet it is recorded more frequently in connection with conceptuses classed 

 as normal. It is not unlikely that the explanation given for the apparent increase 

 in fertility with the increase in frequency of abortion applies also to this contra- 

 dictory result. However, therapeutic intervention was somewhat more common 

 among the pathologic in a somewhat larger percentage of which no cause for the 

 termination of the gestation was assigned". The latter was the case in 76.6 per 

 cent of 264 pathologic and in 63.3 per cent of 344 normal cases out of a total of 

 608. Miscellaneous causes, such as exertion, purgative drugs, coitus, etc., were 

 assigned as frequently in the one as in the other class of cases, but the total number 

 in each group is so small that these percentages probably are not very reliable. 



That the abortion was inevitable in many, even if not in the majority, of the 

 so-called spontaneous or habitual cases, is corroborated by the fact that most of 

 the abortuses in the pathologic division are young, by far the greater majority of 

 the older. fetuses falling among the normal. Moreover, many of the larger con- 

 ceptuses also are received fresh, and in the case of those which were received as 

 the result of such complications of pregnancy as toxemia, pernicious vomiting, 

 placenta prsevia, febrile conditions, and other similar causes, these causes are 

 recorded. 



There often is no way of accounting for the termination of the so-called 

 spontaneous cases from an examination of the conceptuses alone. However, it 

 was very interesting to frequently find that the chorionic vesicle and the decidua 

 had undergone pronounced changes in the case of abortions which were reported 

 as spontaneous. Many of these fell into the first four groups of Mall's classifica- 

 tion and showed the presence of hydatiform degeneration, thus contradicting the 

 statement of Hegar (1904) that hydatiform moles almost invariably occur only 

 later in pregnancy, and confirming the statement of Solowij (1899), who claimed that 

 clinical experience teaches that hydatiform moles are aborted in toto only in the 

 first months of pregnancy. 



Indeed, pathologic conditions of the chorion and decidua seem to be especially 

 frequent causes for the termination of pregnancy during the early months, although 

 one must recall that decidual and possibly chorionic changes may be the con- 

 sequence of previous interference alone. It may long remain impossible to deter- 

 mine the true or original cause of antenatal death, for the secondary or immediate 

 cause may completely mislead one. Hegar (1902) concluded that the cause of 

 abortion not infrequently lies in the decidua alone, and that the death of the 

 cyema usually can be shown to be due to degenerate changes in the villi. He 

 came to this conclusion because he found no evidence of pathologic changes in 

 the chorions of some abortuses. That endometritis and other uterine conditions 

 pre-existent to the implantation may be responsible, especially for early abortions, 



