RELATION OF VESICULAR MOLE TO CHORION CARCINOMA 157 
mitral. This seems to be infective, and has just developed within the last two 
weeks.' 
From this date up to the beginning of June, the patient remained much in 
the same condition ; there were frequent rises of temperature, on two occasions as 
high as 106 0 , preceded in each instance by a severe rigor. On June 8 severe pain 
was complained or in the lower abdomen, and, on the following day, death ensued. 
During the last few days of the patient's life, the uterus was noticed to 
increase in size, somewhat rapidly. 
The cervix appeared normal, but nodular swellings were felt bimanually at 
the fundus. The extremely low condition or the patient prevented any operative 
interference. 
The post-mortem examination revealed an enlarged uterus ; the body had 
assumed an almost spherical shape and shining through the thin, almost trans- 
parent uterine wall ; dark red haemorrhagic-looking tumours were seen. 
The appendages, although slightly congested, appeared otherwise normal. 
On laying open the uterus, the body is seen to consist merely of a thin 
membrane of pale muscular tissue, measuring 1 mm. in thickness, enclosing a bleed- 
ing fungating mass, which corresponds in general outline to the original wall of the 
uterus. This gives the impression that the malignant growth had begun at the 
mucous membrane, and by some inherent phagocytic action had completely replaced 
the original tissue. On the inner surface of the growth, forming an almost complete 
lining to the cavity, is a greenish-yellow slough. Filling up the cavity, but 
adherent only at one point, is a large projecting tumour mass, resembling in appear- 
ance and consistence a placental polyp. This also is covered in places by a 
purulent exudation. 
The recent appearances are reproduced in the accompanying drawing (see 
Fig. 14, Plate XI). 
In the lungs numerous secondary deposits were seen. These varied greatly 
in size, a few being as large as a walnut, but by far the greatest number only about 
the size of a green pea. They felt hard to the touch, and on section were seen to 
correspond exactly with the primary tumour. A fibrous looking capsule enclosed 
each nodule, so that they appeared sharply cut off from the surrounding lung tissue. 
The smaller deposits were distinctly paler than the larger ones, which were more 
haemorrhagic, and, therefore, appeared darker in colour. 
An ill-defined area of pneumonia surrounded the tumours, and it is remarkable 
that these did not give rise to any symptoms during lite. The bronchi appeared normal. 
On examination of the heart, a few brittle vegetations were found on the 
curtains of the mitral valve. 
The rest of the organs, beyond absence of tat and an undue pallor resulting 
from the profound anaemia, shewed nothing of interest. 
