This pathognomonic sign is unfortunately rare, and when it does occur, it is usually shortly before the expulsion of the entire mass.
diagnosis is based upon these symptoins, and is diffi cult to make. The first symptom occurs in false pregnancies, and with ovarian cysts. The second would le,ad one to think of cancer of the cer vix, and of a vicious insertion. The third is rare, and appears too late.
To make the diagnosis, therefore, both the first signs must be present during the first months of pregnancy, when uterine development is more easily appreciated, and a faulty placental insertion is not likely to be ac companied by frequent hemorrhages.
The older authors did not consider the mole as always due to preg nancy, and claimed that the MaMMLe did not develop. That is not the case, for Cartereau has demonstrated the abundant presence of milk. They said the mother did not feel life; but there are moles where the child is born living, and at term. Finally, the uterus shows the ordinary ine qualities, and all the signs of pregnancy, nausea, vomiting, etc., may be present.
.Fbr the grave. In many cases the mother succumbs, not from the development of the mole, but from hemorrhage. The only instance where death could be attributed directly t,o the mole is that of rupture of the uterus mentioned by Madame Boivin. The hemorrhages are usually moderate at first, and usually only become seri ous towards the end of pregnancy, and at the moment of expulsion.
There are several instances on ree,ord of women who have had several vesicular moles (Depaul cites one in which it occurred three times); but as a rule, it happens only once, and does not predispose to a recurrence.
2d. lbr the is always serious. In the two first varieties, the child is liquified or dead; in the third it is almost always injured and ail ing, and ill-prepared for life.
Treatment. —We can only treat the hemorrhage as an accident of the pregnancy. General measures and expectant treatment, if it is slight; tamponing, if it is severe. The expulsion of a few vesicles during the pregnancy does not affect the treatment. If labor has commenced, and the hemorrhage is serious, tampon again if it is thought that the hydatid product cannot be extracted. If, however, that can be done either manu ally or with forceps, it should be at once resorted to.
Finally, Breslau, Eberth, and Spiegelberg, have described another form which they call diffuse myxoma of the membranes. It consists of a mucoid infiltration of the chorion by a homogeneous mucoid substance with thick fibres, with round or star-shaped cells, partly physaliphores. The amnion is thickened, and the intermediate layer but little developed, being com pletely absent in places. The superior chorional surface shows numer ous flattened, slightly fluctuating processes, from pea to cherry sized. A partial myxoma of this kind has been demonstrated by Rokitansky and Winogradow. The latter found a goose-egg sized mucoid mass, soft, trembling like jelly, and absolutely analogous to Wharton's gelatine, some three inches distant from the placenta.