RELATION OF VESICULAR MOLE TO CHORION CARCINOMA 153 
The symptoms usually set in shortly after parturition, though in a few cases, 
a brief respite occurs. On examination, the uterus is found to be enlarged, tender, 
and of a doughy softened consistence. Per vaginum, the os is patulous, but other- 
wise the cervix is apparently healthy. Small nodules may be present in the wall of 
the vagina, if metastasis has occurred. On passing the finger into the uterus, the 
whole or part of the interior is found converted into a raised boggy mass, resembling 
placenta to the touch. In places, deep excavations may be felt, and at these points 
the extreme thinness of the muscular wall is noted. Rupture ot the uterus may occur, 
death ot the patient following rapidly on the accident. In one ot the cases about to be 
described, the muscular wall of the uterus measured only 1 mm. in thickness, the tumour 
being easily visible from the outside, shining through the attenuated muscular tissue. 
Although curettage of the uterus should never be performed in this condition, 
in those cases where it has been done, it has always been accompanied by excessive 
haemorrhage, the blood gushing out in a most alarming manner. This is regarded 
by some as a point of diagnostic value, but it would be well if, in doubtful cases of 
this kind, the examining finger were used for the removal of pieces of tissue required 
for microscopical investigation, as haemorrhage once started, is extremely difficult to 
arrest, owing to the large blocd spaces present in the tumour, and the inability of the 
thinned-out muscular wall to contract. 
For permission to investigate the following case, I am indebted to the kindness 
of Professor Briggs. 
The history of the case is as follows : — 
Mrs. B., aet. 43, ten children, youngest aet. 14. No abortions. Menstrua- 
tion normal. The last two periods ceased on May 9 and June 20, 1900. For some 
time previously, the patient, who was of a neurotic temperament, had been subject to 
much mental strain, caused by domestic troubles, and her general health had become 
much impaired. Towards the end of August, when she considered herself about 
three months' pregnant, she began taking pills to procure abortion, and these she 
continued to take in September and October. 
On September 7, uterine haemorrhage set in, and the patient became anaemic, 
her general condition being by this time very low. 
On October 12, she was seen by Dr. Briggs, who described the uterus as 
feeling harder than the normally pregnant uterus, and diagnosed a vesicular mole. 
The uterus was larger in size than would be expected from a pregnane}' dating from 
June 20, but smaller than one dating from May 9. Owing to the weak state ot the 
patient, no attempt was made to rapidly empty the uterus. Three gum elastic 
bougies were placed in utero at nine ; .m., and the mole was naturally expelled on 
the evening of the next day. 
After the expulsion of the mole, the patient continued to bleed, the amount 
lost being small. Symptoms of septicaemia now appeared, and the temperature rose 
and fell irregularly, sometimes rising as high as 105 0 , with occasional rigors, 
v 
