360 HYDATIFORM DEGENERATION IN TUBAL AND UTERINE PREGNANCY. 



confirmatory is the existence of a surprising parallelism between the data on abor- 

 tion and those on births; 9 of 33 women had given birth to but 1 child, and an equal 

 number had given birth to but 2. Hence over 50 per cent of the 33 women had 

 borne children twice, or less than twice, and only 15, or less than half, had borne 

 oftener than this. 



This undoubted evidence of the youth of these women is confirmed still further 

 by the statement of Lewis who, from an analysis of 10,325 first births, found that 

 nearly one-half of them occur between the ages of 20 and 24, almost three-fourths 

 between 20 and 29 years, and that first births are more frequent between 30 and 40 

 than between 15 and 19 years. I realize, to be sure, that social statistics can not 

 be translated from one country to another without modification, but in such a 

 mixed population as ours this modification probably need be less (rather than 

 greater) than in case of some countries. 



The conclusion that the occurrence of but a single birth before the advent of 

 hydatiform degeneration probably implies that such women are relatively young 

 is emphasized still further by the statement of Lewis that in one-third of the mar- 

 riages in Scotland "the bride had a child when unmarried or was pregnant at the 

 time of marriage," and that 50 per cent of the first births in Scotland occur within 

 9 to 24 months after marriage. Lewis also gives the average interval between 

 marriage and the first birth in 16,176 first births as 13.54 months, but little more 

 than one year. Since Lewis stated that the interval between the birth of the first 

 and that of the second child is but little longer than that between marriage and the 

 birth of the first child, being only 3.07 years, it is evident that not even those women 

 who had borne two children before the advent of hydatiform degeneration could 

 have been near the menopause. This conclusion is emphasized still further by the 

 fact that in 96.12 per cent of 16,176 fruitful marriages fertility was demonstrated 

 within three years after marriage. 



Nevertheless, in spite of the clear implication of all these facts, I wish to empha- 

 size again that since what have been heretofore regarded as hydatiform degenera- 

 tions were large specimens mainly, it well may be, and according to certain authors 

 it is true, that such cases occur later in the reproductive life of women. Yet it 

 certainly is significant that Findley in tabulating 500 of such cases from the litera- 

 ture found that 275, or 55 per cent, occurred before the thirty-fifth year, and of 36 

 specimens from the Mall Collection 23, or 63.6 per cent, came from women below 

 this age. It may also be recalled that 78 per cent of Kehrer's 50 cases and 90 per 

 cent of Bloch's occurred before the fourth decade. 



Fourteen out of 23 cases, or 61.3 per cent of the uterine series, in which the age 

 was given, occurred at or before the thirtieth year, and 18 out of 23, or approxi- 

 mately 80 per cent, at or before the thirty-fifth year. These things abundantly 

 emphasize the conclusion reached by some investigators that hydatiform mole is 

 not absolutely more common at or near the menopause. But it nevertheless may be 

 relatively more common. That is, the number of hydatiform moles aborted after 

 40 compared with the total number of pregnancies or births after 40, actually may 

 be greater than this ratio before 40 years. 



