92 CARNEGIE INSTITUTION OF WASHINGTON. 



observed incidentally in some cases, and making allowance for this, 

 Dr. Meyer calculates that the actual incidence in 2,089 specimens, 

 both normal and pathological, would be 10.9 per cent in the uterine 

 and 20.8 per cent in the ectopic cases. The increase of 100 per cent 

 in the incidence of the condition in the tubes may be due to the less 

 favorable nidus found there. If so, it throws a significant light 

 upon the probable cause of hydatiform degeneration, which would 

 seem to lie in the conditions surrounding implantation rather than 

 in the ova or spermatozoa themselves. 



The prevailing belief that the disease is more commonly met with 

 at or near the menopause is not confirmed by the records of the 

 Carnegie Collection. In the uterine cases the average age of 36 women 

 was 31 years, which was about equaled in the ectopic cases, where in 

 20 women it was 33.9 years. In the uterine group 19 out of 41 women 

 had aborted for the first time, 12 had aborted twice, and 10 more than 

 twice; 9 out of 33 women had borne once, 18 twice. Of the ectopic 

 group 8 out of 23 women had borne but once, 4 twice, and 3 more 

 than twice, and 14 had aborted once. That a number of these women 

 had borne 1 or 2 normal children would signify that the endometrium 

 was normal at the time of marriage. As to the time of expulsion of 

 hydatiform moles, it is found that the average menstrual age in 51 

 uterine cases in which it was given was 66.6 days. In 25 ectopic cases 

 it was 43.4 days, most of these specimens being young, empty chorionic 

 vesicles, or remnants of such. 



Certain criteria regarding the diagnosis of early hydatiform degen- 

 eration are emphasized by Dr. Meyer. He urges the most careful 

 examination of the chorion with the binocular microscope, by the aid 

 of which typical changes in the villi can often be detected. He also 

 points out that the process begins in the stroma and is associated with 

 the centripetal degeneration and disappearance of the blood-vessels. 

 The epithelium, in contrast to the stroma, is usually in a splendid 

 state of preservation. It may or may not show active proliferation. 

 Dr. Meyer is to continue these studies, and the attention of physicians 

 is called to the important bearing which this disease may have in 

 cases of repeated abortion of unknown cause. When the diagnosis is 

 uncertain, specimens should be submitted for examination. 



An entirely different type of pathological process has been studied 

 by Dr. Theodora Wheeler, and attention may be called to her paper 

 on a human spina bifida monster. Until quite recently investigations 

 of this condition have been based upon external form alone. Dr. 

 WTieeler selects a typical example of the group known as iniencephaly 

 and applies to it the more exact anatomical methods, with the result 

 that an unexpected series of anomalies is encountered. It is from 

 such data alone that we can hope to bring these fetal abnormalities 

 into harmony with known embryological facts and thus arrive at 

 their etiological classification. 



