Joulin, 1867, thinks the foci have two distinct seats: 1, the utero-pla cental mucous membrane, and 2, the placenta.
He ascribes the effusion to fusion of the vessels and to partial destruc tion of their original walls. If the solution of continuity be considerable, the pressure of the liquid may cause separation and the blood may then enter the spaces between the cotelydons or escape externally. The pla cental hemorrhages are seated further in the capillaries, but their mechan ism is different He ascribes them to traction on and laceration of the capillaries from their displacement and their change of direction during the enlargement of the organ. Perhaps there is a disease of the capil• laries which e,auses the hemorrhpge. However it be, the hemorrhages are rarely exactly the same and the quantity of blood is very variable. The effusion may cover the whole surface of the ovum, as an irregular layer, sending prolongations into the depressions hollowed out by the sep amtion. It may, in other cases, be in smaller, more numerous, isolated and circumscribed foci. It always stops at the inner surface of the organ, without rupturing the epithelial covering of the uterus.
The appearance of the clots is variable, according to the date of extra vasation. They are black, like thin jelly, or whitish, or in yellowish-white resisting plaques, which have been inappropriately compared to scirrhous tissue.
111. Otangee in the Vint.
Ch. Robin considers these changes as the consequence of the natural development of the of the chorion accidentally affecting the villi of the placenta.
A. According to him, we sometimes find parts of different cotyledons depressed, hard, friable and with a shreddy irregular surface. This tis sue is formed of villi in an advanced state of fibrous degeneration. The substance of the chorion proper is very granular and often thin. The nuclei are less numerous than in the normal state. The granulations are small and not all of them are fatty. The villi are adherent, and between them is a little amorphous tissue and a few granules.
B. In some placents3 the cotyledons are separated by deep furrows.
The tissue is harder than normal, yet friable, is gmy, yellowish-gray or yellowish•white, and less moist than normal. At a deeper level the tissue is more normal but denser, less red and less moist. These parts of the tissue are composed of villi obliterated by cellular tissue, but many of the villi have their own normal substance or contain only a few fatty granu lations. • The nuclei are generally partly or entirely absent where these fatty gmnulations are in contact, but this is not constant.
The diseased cotyledons are more involved on the uterine surface than on that of the chorion, where they have their normal softness, humidity and reddish tint.
The fatty deposit is, thus, only a complication of the obliteration of the villi, which is accidental. The term fatty degeneration is, therefore, not exactly correct.
Barnes thus describes the lesion, in the cases observed by him: The maternal placental surface is deeply divided by furrows, resembling cere bral tissue in color and lobulation. All the lobes are yellow and shiny, like fat. At the bottom of the furrows the color is red, elsewhere the placenta is pale. The fatty aspect is more marked near the uterine pla cental surface, and the microscope shows the villi there to be more ex tensively changed. The villi are, however, nowhere perfectly healthy, but in the firmest lobules are fragile and poorly outlined, and their ves sels are ruptured. The chorion is largely destroyed, and the nuclei in the walls of the vessels are enlarged and filled with granules. In the less diseased parts the vessels preserve their normal volume.
D'Outrepont, Wilde and Kilian regard this lesion as a fatty degener ation of the placenta.
So soon as the investigations of Robin were published, observations were multiplied, but it was soon noticed that the facts were not so simple as they appeared from these clear and precise descriptions; and mixed cases, i.e., cases characterized by both placental apoplexy and fatty degeneration of the villi, were cited.