CHAPTER VIII. 

 HYDATIFORM DEGENERATION IN UTERINE PREGNANCY. 



To read even the titles of articles on "molar" pregnancies which have appeared 

 during the last few decades is a rather wearisome task. The great majority 

 of the articles concern themselves merely with the report of "a case" or (rarely) 

 of "several cases" of hydatiform moles. The recent cancer literature stands 

 in marked contrast to this, for not even the general practitioner would think 

 of reporting a routine case of cancer of the breast, let us say. The significance of 

 these facts is self-evident, and whatever else they may mean they do imply that 

 hydatiform mole is still regarded quite generally as a rare condition. Indeed, many 

 of those reporting "a case" frankly say so, and although the incidence of hydati- 

 form degeneration is estimated variously by different authors and investigators, 

 there seems to be entire agreement among them that it is a rare, even if not an 

 extremely rare condition. This opinion seems to be shared also by those general 

 practitioners whose long practice runs high up into the hundreds or even into the 

 thousands of obstetrical cases. Indeed, many general practitioners declare that 

 they have not seen a single case of hydatiform mole during the practice of a 

 long life. 



This prevailing opinion can not be attributed solely to the influence of the 

 schools or to books, but is based upon the actual experience of the individual 

 practitioner and upon his conception of what constitutes hydatiform degeneration. 

 This is illustrated, for example, by Menu (1899), who said that a small hydatiform 

 mole weighs 300 grams, a large one 8,000, with an average weight in his series of 

 cases of 1,700 grams. But even specialists in charge of hospitals have reported 

 experiences similar to that of the general practitioner. Pazzi (1909), for example, 

 stated that although he had observed more than 6,000 cases of labor in his private 

 and hospital practice, he never met with a case of hydatiform mole. Moreover, it 

 would seem that only some specialists have come to regard the condition as some- 

 what less rare than was heretofore supposed. This is well expressed by Williams 

 (1917), who wrote: "Hydatiform mole is a rare disease, occurring, according to 

 Madam Boivin, once in 20,000 cases. On the other hand, the statistics of William- 

 son would indicate that it may be found but once in 2,400 cases." Williams adds, 

 however, that in his own experience it occurred even more frequently than stated 

 by Williamson; and Essen-Moller (1912), on the basis of 6,000 cases treated 

 between 1899 and 1908, gives the incidence at the Frauenklinik at Lund as 3 

 per 1,000. My former colleague, De Lee (1915), in commenting on hydatiform 

 degeneration, also stated that he "frequently found in aborted ova one or more 

 villi degenerate and forming vesicles"; and similar remarks were made also by 

 others, notably by MuUer (1847), Marchand (1895), Veit (1899), van der Hoeven 

 (1900), Hiess, and according to him also by von Hecker, Langhans, Weber, and 

 Frank el. Findlay (1917) also regards "it as fair to conclude with Veit, Freund, 



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