HYDATIFORM DEGENERATION IN TUBAL AND UTERINE PREGNANCY. 347 



That hydatiform degeneration is incomparably more common in the earlier 

 than in the later months of pregnancy, thus justifying the comparison made with 

 measles, is substantiated by statistics covering the material examined. From these 

 it is evident that, excepting cases of large hydatiform masses originally classed as 

 hydatiform degeneration from inspection of the gross specimens alone, practically 

 all the specimens are relatively young. This is true especially of those from tubal 

 pregnancies, and we may hence regard it as established that hydatiform degenera- 

 tion is a change which is exceedingly common in the earlier months of pregnancy, 

 just as measles is common in childhood, and that it becomes progressively less 

 common as the end of pregnancy is approached, just as does measles as senility is 

 approached. The obstetrician does not see most of the cases of hydatiform degen- 

 eration, for they merely are reported as miscarriages and the specimens often are 

 destroyed or retained unrecognized by the general practitioner or the midwife. 

 They often are aborted spontaneously and completely with the decidua and rarely 

 are still contained in a closed decidual cast when they reach the laboratory. 



The spontaneity of the abortion, especially in early cases, was emphasized also 

 by Storch in the above quotation. Cortiguera (1906) is reported by Pazzi (1908 3 ) 

 also to have declared that many moles disappear wholly without leaving a remnant, 

 even if occurring repeatedly in the same woman, and Donskoj also stated that many 

 of those aborted do not come to the attention of physicians because of their harm- 

 lessness. This, however, does not imply that those which persist and develop into 

 large masses are equally harmless, and it must be remembered that it is upon these 

 that the current opinion regarding the tendencies to malignancy of the hydatiform 

 mole is based. 



The conclusion regarding the greater incidence of hydatiform degeneration in 

 the early months of pregnancy is conclusively confirmed by the occurrence of 32 

 of the 48 tubal specimens within the first two classes of the pathologic division of 

 Mall, and 104 of the 112 uterine specimens in the first six classes of this division. 

 Most of the specimens in these classes are composed of villi, of empty chorionic 

 vesicles, or of vesicles with embryos most of which have a length of less than 20 

 to 30 mm. That hydatiform degeneration is more common in the early months of 

 pregnancy is indicated also by the well-known reports of Kehrer (1894) on 50 cases, 

 and of Borland and Gerson (1896), who found that 63 per cent of 100 cases had 

 aborted in the fourth and fifth months of pregnancy. According to Seitz, Hirtz- 

 man (1874) also found that 62.8 per cent of 35 cases had aborted between the third 

 and sixth month. Only 4 per cent of Kehrer's 50 cases and only 3 per cent of 

 the cases of Borland and Gerson aborted at the tenth month. Bonskoj stated that 

 7 of the 10 cases reported by him aborted in the fourth month and none after the 

 sixth month. He stated further that 56 per cent of Bloch's 50 cases aborted before 

 the sixth month, 44 per cent later than this, one being retained until the fourteenth 

 month. The latter case is especially interesting because retention not only beyond 

 term but after the death of the mole seems to be regarded as relatively rare. This, 

 however, does not imply that retention beyond the period of growth of the hydatid 

 mole does not occur, although Sternberg (1910), who also emphasized the great 



