HYDATIFORM DEGENERATION IN TUBAL AND UTERINE PREGNANCY. 331 



possible to say whether he meant that he himself or Blasius observed two cases. 

 I should judge that the latter is the idea it was meant to convey. To these 7 

 authenticated cases I would add that of Maxwell (1910). In reading Maxwell's 

 description one must feel that he himself regarded the case as one of hydatiform 

 mole, but deferred to the opinion of the "Committee." This is suggested also by 

 the title of his article. The illustration which accompanies Maxwell's article is so 

 very suggestive, and his description so characteristic of hydatiform mole, that it 

 seems very probable indeed that the specimen really was such. Maxwell states, 

 for example, that "sections of the villi embedded in the wall of the tube have the 

 typical structureless, bloated appearance of such pathological villi; and though 

 there is no central cavitation in the villi, their structure, associated with the active 

 proliferation of the Langhans layer, suggests that one is looking at a stage just 

 short of vesicle formation." Moreover, as I am about to show, hydatiform mole is 

 so very common both in tubal pregnancies and in uterine abortions as to increase 

 still further the likelihood that Mar.well's case actually was one of hydatiform mole. 

 This is merely an opinion, and only a completer description or an examination 

 of the specimen itself could decide the matter. 



In connection with what was said before, it is interesting that Maxwell also 

 emphasized that epiblastic activity is increased in all abnormal sites of implantation, 

 and any one interested in the problems of tubal pregnancy and acquainted with 

 Mall's (1915) findings will be struck by Maxwell's statement that microscopical 

 examination of many cases of tubal gestation lends no weight to the view that chronic 

 inflammation of the tubes is at all a common causal factor of tubal pregnancy. Nor 

 can I refrain, in this connection, from quoting the uncontradicted opinion of Doran, 

 expressed in the discussion of Maxwell's case, that tubal gestation "probably repre- 

 sents some general deterioration in the generative power among civilized women." 



To the 8 cases contained in the literature I wish to add 48 found among the 

 first 1,187 accessions from the Mall Collection. Nor is it necessary to stop with 

 these, for this collection contains many more not here included. It is merely a 

 matter of recognizing the specimens by a routine examination, and since this paper 

 has been written a number of specimens have been recognized among the daily 

 accessions of tubes received through the unselfish efforts and the scientific interest 

 of practitioners in all parts of the nation. 



In addition to over 100 free specimens of uterine hydatiform degeneration, 

 I have also seen more than a dozen fine specimens in large sections of uterine 

 implantation sites, and some entire specimens still embedded in pregnant uteri and 

 tubes. Indeed, how many cases of hydatiform degeneration one can find in concep- 

 tuses in tubal or hysterectomy specimens will depend very much upon the care 

 with which the examination is made, for the condition undoubtedly is extremely 

 common, and not rare, as heretofore supposed. 



Although the alleged menstrual age of these conceptuses ranged approximately 

 from 6 to 218 days, most of them were young empty chorionic vesicles or mere 

 remnants of such. Portions of quite a number still were implanted within the tubes, 



