LYSIS AND RESORPTION OF CONCEPTUSES. 277 



rences of such instances of spontaneous cure of tubal pregnancy undoubtedly are 

 exceedingly rare, evidence at hand seems to show that they can not be wholly 

 excluded. This, I am told, agrees also with contemporary clinical opinion. 



The possibility of tubal abortion with subsequent intraperitoneal disintegra- 

 tion, lysis, and absorption must also be borne in mind. The occurrence of nothing 

 but fragments of villi in a tubal clot, as shown in the case of No. 977, represented 

 in figure 174 (plate 16, Chapter XI), however, can not be accepted as positive 

 proof that all the rest of the conceptus was absorbed intratubally. A portion may 

 have been aborted, yet specimens such as Nos. 2035 and 1938 speak eloquently for 

 the possibility of absorption. The embryo and yolk-sac in the latter specimen are 

 disintegrated almost completely and the scarcely recognizable remnants lie isolated 

 in the chorionic cavity, which is moderately filled with an amorphous coagulum. 

 The stroma of the chorionic membrane is edematous and degenerate, but never- 

 theless contains some well-preserved vessels, a few of which contain some blood- 

 cells. The same thing is true of the stroma and of the vessels of the villi, which 

 also are in process of dissolution. A moderate amount of trophoblast is present, 

 but there is very little syncytium. The epithelium of some of the villi has under- 

 gone hyaline degeneration. The blood-cells in the large clot in which this chorionic 

 vesicle, which measured 8 by 5 mm. in section, was embedded, are preserved fairly 

 well, especially near the vesicle. Nevertheless, the old conceptus very apparently 

 is in a state of disintegration and lysis, the tube-wall is very thin, and the mucosa 

 congested, hemorrhagic, and atrophic. 



No. 2035, also a tubal specimen, likewise is an empty chorionic vesicle in 

 process of disintegration, and many other specimens might be listed, but these 

 examples suffice to indicate that intratubal as well as intrauterine lysis and, in 

 part at least, of resorption of conceptuses undoubtedly occurs in the human being. 

 It is of course exceedingly unlikely that in case of the uterus this can occur before 

 the impregnated ovum is embedded, for, failing to embed, it undoubtedly would 

 escape relatively promptly, although the observations of Kirkham (1916) show 

 that the fertilized ova in mice suckling their young may lie unimplanted within 

 the uterus for over a week. 



A free fertilized or unfertilized ovum which disintegrated within the tube 

 might be absorbed completely. The same thing holds for early conceptuses 

 within the implantation cavity, for a relatively small amount of hemorrhage could 

 detach them completely without rupturing the capsularis. Death, disintegration, 

 and absorption, as illustrated in the cases above, might then occur. In case of 

 older specimens, the hemorrhage responsible for the loosening of the conceptus 

 would have to be proportionately much greater, for the attachment of the placenta 

 is firmer, though rupture of the capsularis is probably easier. That this assumption 

 is correct is shown also by the almost universal history of bleeding in these cases, 

 and it is only in the early stages of development that the conceptus can be expelled 

 intact while still contained in the implantation cavity and aborted, completely 

 wrapped in the decidua, as in case of No. 698. 



