50 MALL. [Vor. XIX. 
According to Williams* “the death of the foetus is fre- 
quently due to abnormalities in the development of the em- 
bryo which are inconsistent with feetal life. More often, how- 
ever, it results from changes in the foetal appendages, which 
interfere with its nutrition, such as excessive torsion of the 
cord, producing hydramnios, hydatidiform mole or syphilis. 
Abnormalities of the generative tract likewise play 
an important part in the etiology of abortion. ‘Thus develop- 
mental anomalies of the uterus, or imperfect development of 
the normally formed organ, may be responsible for conditions 
which are unfavorable for the implantation of the ovum and 
later for the development of the placental circulation. Chronic 
metritis is supposed to act in the same way. . . . The 
most important factor in the production of abortion is af- 
forded by diseases and abnormalities of the decidua. In 
hypertrophic forms of decidual endometritis—decidua poly- 
posa—the bulk of maternal blood brought to the placental site - 
goes to nourish the hyperplastic decidua, while in the atrophic 
forms the conditions are unfavorable for the normal implan- 
tation of the ovum and the development of the placenta. More 
important still is the part played by chronic glandular endo- 
metritis and acute inflammation of the decidua. The former 
is usually acompanied by hemorrhagic changes, and is the 
most frequent cause of abortion in the early months.* 
I gather from conferences with competent scientists of large 
*Williams, Obstetrics, New York, 1903, p. 522. 
*Marchand, writing on moles, says in Eulenberg’s Encyclopedia, 
Vol. 15: “Abortives Ei ohne Spur eines Embryo oder mit mehr oder 
weniger unbekanntlichen Resten derselben. Ein sehr haufiges Vorkomm- 
niss bei Aborten, welche wohl in den meisten Fallen durch frithzeitige 
Unterbrechung der Ernahrung infolge beginnender Losung des Eies von 
der Uteruswand, Blutungen in der Decidua basalis und capsularis oder 
durch vorausgehende Erkrankungen der Uterusschleimhaut bedingt ist. 
Zuweilen findet sich ein kn6tchenfOrmiger Rest des Embryo an der 
Innenflache oder ein Rest des Nabelstranges oder eine mit Fltssigkeit 
gefiillte Blase. Ist der Embryo nicht vollstandig zu Grunde gegangen 
und erfolgt die Ausstossung des Ejies nicht, so kénnen anderweitige 
Missbildungen die Folge sein. Bei der Ausstossung findet man die Decidua 
basalis und capsularis mit Blutextravasaten durchsetzt (Blutmole).” 
