«. The placenta offers considerable variations as to size, without being morbidly affected. We have here only to mention that extreme development of the intervascular substance of the decidua which compresses the vessels; as well as the occurrence of atrophy with relaxation, a contraction accompanied by coriaceous toughness, the causes and original seat of which doubtless vary, but with the exception of inflammation are unknown.

3. The Placenta

The Placenta presents no remarkable pathological changes in point of form, with the exception of its division into a few large or numerous smaller lobules. The various shapes presented by the placenta offer no interest in reference to pathology.

y. The placenta presents numerous deviations in regard to position; its position at the inferior segment of the uterus deserves particular mention, as its eccentric or concentric development at the os uteri induces considerable perils towards the end of pregnancy, by giving rise to frequent and lasting hemorrhage.

d. Allied to this hemorrhage are the floodings which, though the placenta occupies its normal position, are brought on by concussion or contusion of the pregnant womb, inducing a forcible separation of the placenta from the uterus, or a laceration of the former, or which are the result of rupture of the uterine vessels of the placenta caused by extreme congestion. Whether or not accompanied by external bleeding, they represent apoplexy of the placenta, one of the most frequent causes of abortion; the blood may be diffused through the parenchyma to a greater or less extent, or be extravasated and accumulated at one spot, which may either adjoin the uterine parietes or be situated deeply within the placental tissue. The placenta is undoubtedly sometimes affected with plethora, congestion, and diminution in the rapidity of the circulation, a condition which is important on account of the impeded vivification of the foetal blood. It is then of a darker color, externally and internally of a dark violet or livid hue, the vessels are overcharged, the entire organ appears enlarged and heavier, and feels harder and denser.

e. Among the textural diseases inflammation is the most frequent; it generally occurs in the lobular form, as it attacks small sections or lobules, and rarely larger portions of the placenta. Still a considerable portion may be simultaneously or successively attacked even in the first instance, inasmuch as the products of the process are found scattered over numerous spots. It recurs at different or new points to the end of pregnancy; an opportunity is thus presented of observing it, if not in its first stage, at least shortly after the formation of the product, and of tracing the metamorphoses of the latter.

Inflammation of the placenta generally gives rise to a plastic fibrinous deposit, which is reddened by the coloring matter of the blood which it contains, and by which the diseased portion is rendered denser and more lacerable. This may be termed hepatization of the placenta; it may be recognized by the increased resistance and nodulated tumefaction presented to the touch. In the course of time the deposit assumes a pale red, grayish or yellowish-red, or even yellowish-white tinge; at the same time it becomes firmer, and together with the included obliterated tissue, contracts and shrivels. The inflammation has thus terminated as it usually does, in induration and obliteration of the placental tissue, which is converted into an ashy, tough, leathery callus, resembling elastic tissue.

It appears an established fact that an adhesion may form between the placenta and the uterus in consequence of a process of this kind; the extent as well as the intimacy of the union naturally varies.

In rare cases the inflammation may give rise to a purulent product, causing suppuration of the placenta in the shape of circumscribed globular abscesses, or of diffused infiltration and fusion of the placental tissue - phthisis placentae.

The question as to the seat of the inflammatory process, or rather as to which of the vascular systems is affected, has not as yet been answered; doubtless either of the two may be involved, and it is to be presumed that in both cases the results will be the same, on account of the intimate connection existing between them.

Inflammation and consequent obliteration of the placenta are the more likely to induce imperfect nutrition, and consequent tabes of the foetus, the more they are diffused and the greater the number of placental sections attacked at the same time.

The foetal portion of the placenta, as we have already mentioned when speaking of the villi of the chorion, is not unfrequently attacked by a degeneration in the shape of round or oval, fusiform, pedunculated, serous vesicles or hydatids, which diminish, and even entirely obliterate the cavity of the amnion. This is a vesicular or hydatid mole, Laennec's acephalocystis racemosa.

Foreign observers have given instances of osseous deposits in, or ossification of the placenta; they are gibbous, nodulated, or cordate formations, which are probably developed in the placental tissue after it has been obliterated by inflammation, or in the fibrinous coagula caused by hemorrhages.

Tubercle does not occur in the placenta; one must be careful not to confound the product of inflammation, which sometimes has a cheesy, friable, and chalky appearance, or a fibrinous coagulum caused by hemorrhage, which is undergoing a similar metamorphosis, with placental tubercle.

The observations recorded of scirrhus, or scirrhous degeneration of the placenta, may justly be considered as erroneous; the cases described as such, are obliterations of the placental tissue after inflammation, indurated inflammatory products, or old, shrivelled, decolorized extravasations of blood, etc. Adhesions similar to those which we mentioned when speaking of the membranes, are found to occur between the placenta and the foetus.