146 THOMPSON YATES AND JOHNSTON LABORATORIES REPORT 
The next most constant symptom is haemorrhage. Although it is usual to 
get a history of amenorrhoea in the early months, sooner or later haemorrhage 
almost invariably occurs. In five out of every seven cases haemorrhage was a serious 
symptom. The blood loss may be slight and occur only from time to time, or it 
may be so severe as to endanger the patient's life, in which case rapid dilatation and 
evacuation of the mole are indicated. 
A thin watery discharge, tinged with blood, is present in a small percentage 
of cases, but, when it is present, is a most valuable and characteristic symptom. 
When accompanied by the discharge of molar vesicles, the diagnosis is complete, 
but as this happens very rarely, too much stress should not be laid on its 
occu rrence. 
In two of my cases, however, a watery discharge was noted, and in one of 
these, vesicles were passed. 
The history is as follows : — 
Mrs. W., aet. 26, married four years, two children. 
After the second child was born the patient suffered from subinvolution and 
endometritis. The last period ceased on December 7, 1900, and on April 17, 
1 90 1, a vaginal discharge was noted, at first watery, but later tinged with blood. 
It was, however, on account of headache, insomnia, palpitation (neurotic symptoms), 
and vomiting that advice was sought. 
On examination, the fundus uteri was found two inches below the umbilicus, 
uterine souffle was made out, but no foetal heart sounds were heard. Per vaginam, 
there was glandular erosion of the cervix, the os was patulous and admitted the 
finger, on withdrawing the latter, a vesicle was found on it, and, almost immediately, 
two or three more vesicles were passed. The following day, after profuse 
haemorrhage, the complete molar mass was found lying in the vagina (see Fig. 7, 
Plate X). This was easily removed, and the patient made a good recovery. This 
is the only case 1 have to record in which the uterus was bigger than the period of 
pregnancy to which it corresponded. 
Pathology 
As shewn by the accompanying photographs, the vesicular mole is composed 
of a mass of grape-like vesicles springing from the chorion. These cysts are 
formed by the degeneration of successive parts of a villus, the unaffected portion 
forming the stalk of the next vesicle. They vary greatly in size even in the same 
specimen, small vesicles are seen springing from the larger ones, they possess no 
regularity or arrangement, and are attached by delicate filamentous stalks to each 
other and finally to the chorionic membrane. The whole mass may be enclosed 
in a thin covering of decidua, or the vesicles may be found to be lying almost 
free, the only traces of decidua being found at the upper end, which is usually 
