336 HYDATIFORM DEGENERATION IN TUBAL AND UTERINE PREGNANCY. 



probably would be safe to assume that most of the tubal pregnancies occur also at 

 this time. Consequently, it might well follow that the ratio of tubal hydatiform 

 degeneration to the number of pregnancies occurring in the later actually might be 

 greater than that in the earlier decades. 



The structural changes in hydatiform degeneration will be considered more 

 fully in connection with the uterine cases. Suffice it to say that since I directed my 

 attention especially to hydatiform degeneration I have been able to recognize its 

 presence repeatedly at sight in relatively young vesicles (1 cm. large) not only from 

 uterine but also from tubal pregnancies. This is, of course, especially true in the 

 former, for the chorionic vesicles of these often are quite characteristic, and if 

 inspection with the unaided eye or with a reading glass under a magnification of 2 

 diameters fails to reveal the true nature of the specimen, examination with a binocu- 

 lar under a magnification of 10 or 20 diameters often makes immediate identifica- 

 tion possible. 



UTERINE. 



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

 during the last few decades, even, is a rather wearisome task. By far 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 still is regarded as a rare condition. Indeed, many of those 

 reporting "a case" frankly say so, and although the incidence of hydatiform degen- 

 eration is estimated variously by different authors and investigators, there seems 

 to be entire agreement that it is a rare, even if not an extremely rare condition. 

 This opinion seems to be shared even 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, 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 somewhat 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 Williamson would indicate 



