RELATION OF VESICULAR MOLE TO CHORION CARCINOMA 143 
'Virchow and Frankel say that if we have to do with syphilis of the father, 
which has left its mark on the ovum, we must expect to find it has exercised most 
of its influence on the chorionic villi.' 
Endomentritis has been largely upheld as a predisposing cause, and in support 
of this is pointed out that multiple molar pregnancies have been known to occur in 
the same patient. Etheridge mentions one case who developed the condition 
eleven times. Other pathological conditions of the uterus have also been suggested, 
such as fibroids, polypi, etc., but, so far, there has not been sufficient proof for these 
suppositions. 
Veit believes that structural changes in the maternal mucous membrane 
interfere with the proper circulation of the blood in the ovum, and thus the chorionic 
villi become oedematous, and vesicular mole is produced. 
Kieffer has advanced a similar theory, tracing the condition to proliferating 
arteritis, and this he attributes to the abuse of emmenagogues in early pregnancy. 
He was not able, however, to demonstrate his theory by any histological evidence, 
but the idea is of interest in view of one of the cases about to be recorded, where 
the patient had repeatedly taken pills to procure abortion. 
Berry Hart, assuming the death of the foetus to be primary and not 
secondary, pointed out as a possibility (rather a remote one, perhaps) that, by the 
death of the foetus, the action of the thyroid is withdrawn, and so a myxomatous 
condition of the chorion results. 
Eudwig Frankel has shewn that there is a marked tendency to the develop- 
ment of vesicular mole in cases where ovarian cystoma already exists. This has been 
confirmed by other writers, among whom may be mentioned, Matvieff and Sykoff, 
who recently exhibited at the Moscow Gynecological Society a gravid tube containing 
a typical vesicular mole. The adjacent ovary contained two corpora lutea in a state 
of cystic degeneration, and it is maintained by these observers that the cystic condition 
of the ovary was the ' undoubted cause ' of the mole. 
Although not prepared to accept such an unqualified statement, I fully believe 
that there is a close connexion between the two conditions. Out of the seven cases 
of which I have full notes, in two, the patients were operated on for cystic disease of 
the ovaries before the molar condition was recognized, and it is highly probable that 
ovarian cystic disease is present in a still greater proportion of cases where the symp- 
toms have not called for operative interference, and so have remained unnoticed. It 
is interesting to note that in the history of the following case, the ovarian, and not the 
uterine condition was the one for which advice was sought. 
The patient, aet. 29, was admitted complaining of a painful swelling in the side 
of eight months' duration. She had had six children, the last two years ago, no 
abortions. Menstruation was regular up to the onset of the present illness, when it 
ceased. During the following eight months of amenorrhoea, the pain in the side 
