All of the internal organs were markedly shrunken, but still plainly showed their normal form, excepting the brain, which was compressed between the depressed cranial bones, and was changed into a thick, red dish mass.
The cartilage and bone were normal. All of the other structures were hardened and darkened, as were Wharton's jelly and the placenta. There was a white detritus in the arteries, veins, heart and internal cavities of the body. There was a thin layer of material similar to vernix caseosa, covering the foetus, excepting where it was adherent to the decidua.
On microscopical examination, all of the internal organs were found shrunken, but their different anatomical structures could plainly be seen. Fine needle-shaped crystals, of unknown composition, were found scat tered through the body.
The original location of the ovum is unknown.
In the second case Professor Chiari found a lithoptedion in a woman sixty years of age, who died from heart disease. It came from a gravid ity in the partially developed left horn of the uterus; the foetus was in the fourth month, shrunken, adherent in Douglas's cul-de-sar, and was carried by the woman without trouble for from fifteen to twenty years.
Pfeffinger and Fritze described a similar termination of pregnancy in a rudimentary horn of the uterus. The foetus remained in the rudimen tary uterine horn for thirty years. Rokitansky found a similar prepara tion that showed this termination, 1873, and presented it to the museum (No. 3253) with the following description: " In fupdo excavationis recto vaginalis femime 58 annorum, legaliter sectte, locatum lithoptedinm, vol u mine ovum gallinaceum accedens, pseudo-membranis involutum. Uterus unicornis dexter, ex cujus margine sinistro intra ejus apicem exit pro pago 2-211! longs fine libero tumidula, solids, tubam cum ovario (3 m. gerens). In ipso hoc extremo tumidulo supra tube insertionem depre henditur conspicua cicatrix." Very often the tissue alterations are more serious than they were in the above cases. Then we find a shapeless mass composed of fat, lime salts, cholesterin, and pigment; the whole forming a more or less moist mass in the midst of which the foetal skeleton will be found in a varying state of preservation (Blob). Kirrhonosis of the foetus, a yellow pig
mentation first noticed by Lobstein in the serous membranes and the spinal cord, and more recently recognized by Virchow as a general change, is of interest in this connection. Kieser found a citron or golden-yellow pigment iu all the tissues of Leinzell's lithopa3dion.
In still another way the process may end in recovery. At any time during the pregnancy, most commonly near its middle, inflammation of the fmtal envelopes may occur, and adhesions to neighboring organs, to the rectum, vagina, bladder and uterus, ending in abscess formation, and piecemeal elimination of the foreign body.
In this category belong in all probability the cases which Ebersbach, in 1774, and Morlani and Josephi, in 1803, have described as gravidi tas vesicalis. In the latter case the product of conception is said to have remained fifteen years in the bladder. Thompson, in 1863, removed from the bladder, arms, legs, pelvic and cephalic bones by cystotomy; and the woman got well. Two remarkable eases of graviditas stomachica have been recorded by Salmuth, in 1605, and Maroldus, in 1670.
But even with so comparatively favorable a termination, a lithoptedion may eventually cause the death of its bearer. To Professor Heschl I am indebted for the following history, belonging to preparation No. 1974 in the Pathological Museum at Gratz. A woman became pregnant in 1864, and Dr. Possi of Gratz diagnosticated extra-uterine pregnancy. It ended in the formation of a lithoptedion. The woman subsequently became pregnant three times, and since the stony mass greatly diminished the pelvic cavity, Dr. Possi three times induced premature labor. In 1872 the woman died, after a peritonitis, and the opening of an abscess into the rectum. At the autopsy Heschl found an adherent tumor the size of a man's head between bladder and rectum, inside of which he discov ered a well-developed foetus.
Interstitial pregnancies may terminate in very surprising ways. Thus if the placenta is developed towards the uterus, the foetus being well in the tubal cavity, the former may be born and the latter fall into the peri toneal sac, there, if it does not cause the mother's death, to undergo the usual changes.