RELATION OF VESICULAR MOLE TO CHORION CARCINOMA 145 
The patient, aet. 32, had had one child previously, but no abortions. The 
present pregnancy dated from September 26, 1892, the hill term being due 011 
July 3, 1893. On May 6 haemorrhage occurred, and the uterus was noted to be 
only at the level of the umbilicus. Alter a few weeks' rest in bed the bleeding 
ceased, but from July 12 to 18, a fortnight beyond the lull term, bleeding was 
resumed, the uterus still remaining the same size. Labour was induced by Dr. 
Briggs, who placed in utero, four gum elastic bougies, and at the end of 
seven-and-a-halt hours a large hydatidiform mole was expelled entire, the bougies 
not having penetrated any portion of it. 
In one case only did the uterine enlargement correspond at all closely with 
the period of pregnancy, and there the history was ot four-and-a-half months, and 
the uterus judged at the time of abdominal section to be four months. 
Therefore, in describing the physical characters of the uterus in this condition, 
it is necessary to divide the cases into three classes. 
1. Those in which the uterus is larger than the period of pregnancy would 
lead one to expect. 
2. Those in which the uterus corresponds to the period of pregnancy, and 
3. Those in which the uterus is smaller than the period of gestation. 
The enlarged uterus is, as a rule, soft, fluctuating, and elastic, ballottement 
cannot be obtained, and in many cases marked tenderness is complained of. In some 
instances, however, the uterus is irregular on the surface and peculiarly hard and dense. 
This was specially noted in the following case, where the density of the uterus 
gave rise to considerable trouble during the abdominal section, performed for the 
removal of ovarian cysts. 
E.G., aet. 29, two children, no abortions. 
Admitted complaining of severe vomiting and bleeding from the vagina. The 
last menstruation occurred about the middle of January, and towards the middle of 
April haemorrhage set in accompanied by severe vomiting. This persisted on and off 
up to the time of admission to hospital on May 28. 
On examination, per vaginam, cystic disease of both ovaries was made out, the 
uterus being about the size of a four months' pregnancy. 
On May 30, abdominal section was performed, multilocular cysts of both 
ovaries removed. The uterus, although corresponding in size to a four months' 
pregnancy, reached to the level of the umbilicus, being pushed up from behind by the 
cystic ovaries. Hardness of the uterus was noted at the time, as it caused much 
difficulty during the ligaturing of the pedicles. 
On May 31 clots were passed per vaginam, and, labour pains setting in a few 
hours later, a large vesicular mole was passed early on June 1, accompanied by much 
haemorrhage and blood clot. 
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