356 HYDATIFORM DEGENERATION IN TUBAL AND UTERINE PREGNANCY. 



and his own) it usually was less than 1 inch long, even when retained for a period of 

 from 3 to 10 months. 



This apparent contradiction regarding the presence of the fetus in hydatiform 

 moles is explained easily by the fact that the cases in the earlier literature are old, 

 far advanced in degeneration, while the more recent literature contains many more 

 in the earlier stages of degeneration. Yet in spite of this fact the earlier opinion 

 survives to the present day, for Graves (1909-10) spoke of "the very unusual 

 presence of a normal fetus inside a mole," and Vineberg (1911) still more strangely 

 held that the presence of a fetus excludes the specimen from the class of true hydati- 

 form moles! 



Among the specimens concerned in this report many contained a fetus. This 

 was true of 24.5 per cent of 49 tubal and 64.4 per cent of 121 uterine specimens, 

 including some (9) doubtful cases. In some early specimens the fetus is in a state 

 of excellent preservation. This is what one might expect, for the onset of hydati- 

 form degeneration is gradual and often partial. The condition of the fetus in many 

 of them alone also suggests that its death was secondary to the degeneration. 



The fetal length ranges from 1 to 90 mm. in the uterine and from 1 to 80 mm. 

 in the tubal series. Although the average length of the embryo in the tubal series 

 is 12.3 mm., and that of the uterine only 10.1 mm., 58 per cent of the tubal speci- 

 mens nevertheless were below 7 mm. in length as contrasted with 52.5 per cent of 

 the uterine. 



The presence of a fetus with a frequency almost three times as great in the 

 uterine series again indicates that the abnormal conditions within the tubes lead 

 to early death, digestion, and absorption, or at least to dissolution, of the embryo. 

 This fact again points directly to a faulty nidus as causative agent, for if the absence 

 of a fetus is to be laid to primary ovular defects, then one must admit that relatively 

 far more of such diseased ova become implanted within the tube than within the 

 uterus. 



Of the many explanations which have been offered for the advent of hydati- 

 form degeneration, none seems to be better established than that of endometritis. 

 This was first emphasized by Virchow (1863), and Lwow (1892) also reported 4 

 cases in patients under his care in whom lues could be excluded but in whom he 

 held endometritis responsible. Emanuel (1895) was the first, it seems, to demon- 

 strate the presence of cocci in inflammatory foci of round cells in the decidua 

 accompanying a case of hydatiform mole. Veit (1899) also believed that disease 

 of the decidua is the cause of hydatiform degeneration. Veit further stated that 

 Waldeyer, Jarotzky, and Storch also believed that an irritative condition of the 

 decidua is responsible. Stoffel (1905) also found cocci other than gonococci present 

 and says he can not avoid holding endometritis responsible in his case. The asso- 

 ciation of hydatiform degeneration and endometritis was noted also by Marchand 

 (1895), Oster (1904), and Sternberg; also by Essen-Moller, who reported the phe- 

 nomenal case of a woman with endometritis, who had aborted a hydatiform mole 

 18 times in 9 years. Falgowski, on the contrary, concluded that the ova themselves 

 were diseased and argued that hydatiform degeneration should be much more 



