156 THOMPSON YATES AND JOHNSTON LABORATORIES REPORT 
evidence it is highly probable that metastatic deposits had occurred, although their 
existence could not be verified. 
Gebhardt has recorded a case in which an hydatid villus was enclosed in 
the tumour, while Apfelstadt and Aschoff record a remarkable instance of 
' malignant disease of the uterus following the spontaneous evacuation of a 
vesicular mole; both the primary tumour and a metastasis in the labium majus 
were found to consist of a cluster of vesicles, having the structure typical of the 
vesicular or hydatidiform mole.' 
Although many observers have suggested that chorion carcinoma is developed 
in the above manner, observation of the process under the microscope has only been 
possible in very rare cases, and it is admitted by all, that it is only by the 
careful study of the conditions existing in the vesicular mole, when it is known 
to precede this disease, that a true solution of the pathology of chorion carcinoma 
can be hoped for. 
The second case I have to describe was under the care of Dr. Nathan 
Raw, of Liverpool, to whom I am indebted for the clinical notes and permission 
to investigate the case. 
The patient was a married woman, aet. 39, who was admitted on January 18, 
1902, to Mill Road Infirmary, Liverpool, complaining of profuse haemorrhage 
and offensive discharge from vagina, which had occurred on and off ever since a 
miscarriage three months previously. 
No information could be obtained about the pregnancy, but the foetus was 
thought to be of about the seventh month. 
On admission, the patient's temperature was 99°, but from that time it 
gradually rose, and on January 25, preceded by a rigor, it reached 105 0 . The 
injection of 20 c.c. of antistreptococcic serum reduced the temperature to normal, 
and the patient remained fairly well till February 13, when a severe flooding 
occurred. On the 15th there was another rigor and rise of temperature to 104 0 . 
February 17. The haemorrhage and offensive discharge still continuing, 
chloroform was given and the uterus curetted. During the operation the 
haemorrhage was most profuse, blood gushing out in a most alarming manner. 
This was arrested by packing ; the patient, who was now extremely anaemic, 
remaining free from bleeding until March 2, when there was another rigor, 
followed by a sharp rise to 105*2°. 
March 11. Rigor and rise of temperature to 106*2°, accompanied by the 
passage of a large clot. 
March 12. Another rigor and rise of temperature to 105°. 
March 20. ' Since the last injection of antistreptococcic serum, the tempera- 
ture has dropped nearly to normal. She is still very pale, and perspires every night. 
There is now a soft blowing systolic murmur heard at the apex, and evidently 
