Cystic diseases of the chorion / by J. Foster Palmer.

  • Palmer, James Foster.
Date:
[1909]
Catalogue details

Licence: In copyright

Credit: Cystic diseases of the chorion / by J. Foster Palmer. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    CYSTIC DISEASES OF THE CHORION. By .T. FOSTER PALMER, M.R.C.S., L.R.C.P. We are sometimes told, even by members of the profession, that medical treatment is chiefly based on empiricism ; that its advances are usually due, not to pathological research, but to the adoption of some popular superstition or old woman’s remedy. This may have been so in the treatment of rheumatism by the salicylates. It was certainly not so in the treatment of “ Cystic Diseases of the Chorion.” The old pathology was hopelessly wrong. Cases were looked upon as enormous developments of hydatid cysts, and, it would appear, as incurable. In the Museum of St. George’s Hospital are four cases thus described, two of which, at least, one under Sir Benjamin Brodie, and the other under Mr. Caesar Hawkins, died of haemorrhage without being diagnosed. In the present day no fifth year’s student would let such a case slip through his fingers. Since the researches of Paget, Cruveilhier,Gierse, and Mettenheimer on the subject,such a result would be almost impossible if the case came under observation at all. Indeed, it is said that the natural tendency is for the diseased structures to be expelled by uterine action. The cases referred to, however, show that this is not always the case. The pathology of this condition is now known. In a normal pregnancy the chorion is practically surrounded by villi, which pass to the uterine wall. By the end of the fourth month, however, these villi have entirely disappeared, except in one spot, where they have taken on special growth, and have developed into an integral portion of the placenta. In “ cystic diseases of the chorion,” however, they do not disappear, nor do they take on special growth at one point. Instead of this, some morbid process sets in, the whole of the villi become dropsical, and swell out into innumerable small vesicles, and the further development of the ovum becomes impossible. The vesicles, it is true, bear a certain resemblance to hydatid cysts, so that the mistake of the older surgeons is not surprising. This is what occurs in the earlier months of pregnancy. Later on the process is naturally confined to the placenta, and the symptoms are somewhat different,