HYDATIFORM DEGENERATION IN TUBAL AND UTERINE PREGNANCY. 359 



Perhaps I may here add a word of caution, however, in regard to a possible 

 change in attitude toward the question of malignancy with a consequent relaxation 

 of vigilance. It is true that out of the 21 cases of Briggs only 2 developed chorio- 

 epithelioma, but it must not be forgotten that Briggs in part was, and I to a far 

 larger extent, am dealing with a different class of hydatiform moles than those 

 upon a study of which the prevailing conception of malignancy is based. Hydati- 

 form moles which continue to grow and which survive for months after the death 

 of the embryo evidently are more vigorous, and hence no doubt also more dangerous 

 than those which are aborted early and spontaneously. Since the latter formed the 

 great majority of all moles here considered, opinions regarding malignancy formed on 

 this basis probably would lead to disaster if applied in practice. Such conceptions 

 would be based upon a totally different incidence than the current one of 1 hydat- 

 iform mole in every 2,000 cases. Instead of relaxing our vigilance it would seem 

 wise to increase it, particularly in the cases of so-called spontaneous abortions 

 the cases in which no ascertainable cause for the termination of pregnancy can 

 be found, especially if the chorionic vesicle is empty or if the embryo belongs in 

 one of the early groups of Mall's classification. 



The average age of 36 women aborting hydatiform moles was 31 years. 

 Although I do not regard the alleged ages as necessarily the actual ones, this average 

 age agrees very well with that of 6 cases reported by Poten, 10 by Donskoj, 23 by 

 Briggs, 6 by Gromadski, and 8 by Robertson. The average age of Poten's cases 

 was 32 years, of Donskoj 's 25 years, of Briggs's 28 years, of Gromadski's 29.6 years, 

 and of Robertson's 28.4 years. Pazzi (1908 3 ) , on the other hand, stated that Briquel 

 placed the greatest frequency of hydatiform degeneration between 20 and 30 years. 

 These averages are so far on the near side of the menopause that one can make 

 liberal allowances for the proverbial disinclination of women to state their exact 

 age, even to physicians, and nevertheless regard the prevailing opinion undoubtedly 

 as ill-founded. If, as Lewis (1906) stated, it is necessary to add only half a year to 

 the average age of a large group of women in order to ascertain the actual average 

 age when considering general social statistics, then everyone will a'dmit that still 

 less allowance than this need be made in the case of women who are speaking to 

 their physicians, knowing that whatever they may say will be regarded as strictly 

 confidential. That it is unncessary to make large allowances for under-statement 

 of their age on the part of these women is indicated also by the average duration of 

 their married life before aborting moles. This in the case of 29 women was 7.1 

 years. Hence, if one bears in mind that the average age of first marriages according 

 to Webb (1911) is 25.1 years, one can easily see that the average age of the women 

 aborting hydatiform moles, which was given as 29.6 years, is probably not too low 

 at all, thus confirming the findings of Williamson, who denied that hydatiform mole 

 was especially common near the menopause. 



The conclusion that the average age of 29.6 years undoubtedly is near the 

 actual is confirmed also by the fact that a hydatiform mole was the first abortion 

 in 19 out of 41 women, or almost half the number; 12, or almost one-third, had 

 aborted twice, and only 10 had aborted more than twice. But what is still more 



