Millet is opposed to these views and thus expresses himself in his thesis: "a. The extravasations in the centre of the cotyledons come from rup tured umbilical vessels, and not from maternal vessels.
"b. The supposed false membranes, referred to by certain writers, on the uterine surface of the placenta, and regarded as an inflammatory exu dation, are only heaps of epithelial Cells, which have undergone a real hypergenesis, or hypertrophy, at certain points." Certain microscopists have found aneurisms of the umbilical vessels, at the entrance of the latter on the fcetal side of the placenta, which would explain the apoplectiform extravasation& 2. There is no proper focus. The blood is infiltrated in one or more lobe& It may, however, be more abundant at some places.
3. The blood is in regular, circumscribed foci, the number of which may vary from two or three to twenty. The placental tissue around them is healthy. Being first decolorized at their circumference, they seem en veloped by a new cyst. There are, sometimes, very numerous small and regular foci, containing coagula, which closely resemble seeds of black grapes, and which, being in different stages of transformation, indicate recent and old coagulations.
These extravasations may coexist with the lesions of ordinary uterine hemorrhages, internal or external, but they often occur alone or only lead to the lesions in question at a late date. Dubois and Desormeaux make two different degrees of the disease, congestion and apoplexy of the pla . cents. The congestion may lead to extravasations in the placenta, on either placental surface or between the decidual membranes and the chorion. The congestion may result from disturbances of either the ma ternal or of the fcetal circulation. Simpson holds this view and Jacque mier rejects it, believing that hemorrhage is always the result of rupture of utero-placental veins.
The surface of the placenta is violet or livid, its tissue of a deep pur ple color, its vessels full of venous blood. The organ is larger and heav ier. A liftle effort on the patient's part, and extravasation occurs from the torn vessels.
In the first three months it occurs between the chorion and the de cidua, later in the placenta, and nearer the fatal surface as pregnancy is less advanced. This is the placental apoplexy of Cruveilhier, the utero
placental of Jacquemier.
In true placental apoplexy, is it the rupture of the umbilical vessels, the placental parenchyma or the utero-placental vessels, which causes extravasation? We never find, except in the case of Cazeaux and Grisolle, even when the foci are near the fcetal surface, any torn umbilical vessels.
Is there rupture of the parenchyma or laceration of the utero-plae,ental vessels? This is the sole cause, according to Jacquemier and Simpson.
Their seat is determined by the very structure of the placenta, which is less close on the side of the chorion.
These extravasations, almost always multiple, present themselves as foci, generally rounded and circumscribed. Sometimes their form and outline are irregular. When they are near the fcetal surface of the pla centa, and the blood is extravasated between the decidua and the chorion, the latter and the amnion are elevated and form on the side of the cavity of the ovum an hemispherical or conical prominence. The adhesion of the clot to the chorion is then, sometimes, very intimate.
Near recent extravasations, the placental tissue is redder, darker, and this state, dependent, perhaps, upon the infiltration of a certain quantity of the extravasated blood, may result, also, from the presence of a num ber of diminutive foci around the chief focus or of little clots formed in the vessels. The color of the blood is ordinarily of so deep a brown as to simulate melanotic degenerations.
In other cases the blood is decolorized, becomes successively chocolate colored, yellow, reddish or brownish, deep yellow, and dirty white when the coagulum contains only fibrin.
The shrinking of the clot, and the expression of the serum into the cavity left by the contraction, might simulate a serous cyst.
Finally, the tissue near the extravasations becomes changed. It is ex sanguihe, atrophied, and the atrophy may become general if the foci are multiple.