HYDATIFORM DEGENERATION IN TUBAL AND UTERINE PREGNANCY. 341 



"Derleichen geringe krankhafte VerJinderungen finden sich an auserordentlichen vielen 

 Abortus, und sie scheinen die haufigste Ursache des Abortus in den ersten Monaten zu 



sein." 



How such an epoch-making conclusion not only could be forgotten, but abso- 

 lutely overlooked or disregarded, by all but a few of the scores upon scores who have 

 written on hydatiform degeneration, it is difficult indeed to understand. Gierse, 

 who took steps to ascertain what normal villi look like, stated that villi with marked 

 irregularities as described by Desormaux, Breschet, Raspail, and Seiler undoubtedly 

 were abnormal ; surmised that villi in abortuses seldom are normal, and added that 

 between the slight pathologic changes in the caliber of the villi and the most evident 

 hydatiform moles the plainest transition can be found. Among other important 

 things Gierse also recognized the early fenestration of the stroma and pictured such 

 a villus under a magnification of 250 diameters, and although reported very briefly, 

 his findings, wholly confirmed here, still wait for general recognition. 



Just as the great majority of specimens described in the literature are large, 

 so 4 of the 8 specimens originally classed as such in the Mall Collection also are 

 large, and none of the 8 are very young, as the following protocols show : 



No. 70 (Dr. Charles H. Ellis) is a small, firm, degenerate-looking, almost solid mass 

 40X30X28 mm., composed of small cysts, degenerate decidua, exudate and degeneration 

 products. As figure 8 shows, it is very similar to a very much larger specimen, No. 323 

 (Dr. V. Van Williams). The latter is a large, firm, felt-like mass 120X90X65 mm., 

 represented in figure 9. The individual cysts, which vary from 1 to 20 mm., are packed 

 together rather firmly, though a few large ones are free. The exterior of the specimen is 

 formed by a thick layer of degenerate decidua and gives only a slight indication of its true 

 nature upon closer inspection or upon examination of the cut surface. No fetal remnants 

 were noticed, and microscopic examination shows that the specimen is composed merely of 

 a large hydatiform mass which was retained for a long time and then aborted in toto with 

 the surrounding decidua and exudate. 



No. 749 (Dr. G. C. McCormick), on the contrary, is a fresh, loose, typical hydatiform 

 mass composed of loose hydatids of various sizes, as shown in figure 10. As the specimen 

 floats loosely in fluid, it fills a half-liter jar about two-thirds. A considerable portion of the 

 hydatid cysts are glued into a solid mass by bk>od, exudate, and decidua, which form a 

 layer on the exterior. 



No. 1323 (Dr. J. W. Schlieder) also is a large mass very like the preceding, which 

 completely fills a liter jar. It is accompanied by much clot and composed mainly of a 

 large, thick-walled, hemorrhagic, necrotic mass 80X50X45 mm., containing a large, 

 thin-walled cavity 65X30X25 mm., which is broken at one end. This cavity, which is 

 apparently that of the chorionic vesicle, is empty, smooth, and thin-walled, except where 

 it is composed of a characteristic hydatiform mass shown in figure 11. 



No. 1325 (Dr. Fred R. Ford), shown in figure 12, is a small, irregular mass 40X33 

 X 20 mm., the exterior of most of which is formed by a thin layer of decidua. Within this is 

 a small group of quite typical hydatid cysts, the largest of which measures about 10X5 mm. 

 The appearance of the specimen suggests that it is merely a fragment, though the amount 

 of decidua present indicates that the entire specimen probably was not much larger. The 

 history of this specimen is especially interesting because of the diagnosis of tubal pregnancy, 

 caused by the presence of a cornual myoma and the occurrence of repeated bleeding. 



By far the most interesting specimen, in some respects, of hydatiform degeneration 

 among those diagnosed as such upon gross examination in the Mall Collection is No. 1040. 



