NODULAR CYEMATA. 



127 



siderable pain and hemorrhage due to the introduction of 

 a bougie to produce abortion. The monthly period had 

 been five days overdue when the abortion occurred. The 

 bougie had been introduced several days earlier. 



(5) In stirring up the ovum the woman punctured it, 

 and it then became filled with maternal blood, which 

 formed a clot around the embryo. The leucocytes 

 invaded the walls of the ovum, the stem of the yolk-sac, 

 and even the blood-vessels of the embryo, and show all 

 stages of fragmentation within the embryonic tissue. The 

 yolk-sac itself is most interesting, as it shows the effect 

 of an infraction upon a very young normal embryo. The 

 stem of the vesicle is quite extensive, and in it are embry- 

 onic blood-vessels filled with blood. Many of them extend 

 into the chorion and some into the yilli. The walls of the 

 yolk-sac are composed of three distinct layers. The inner 

 is composed throughout of a single layer of sharply defined 

 cubical epithelium the entoderm. Immediately next to 

 this is an extensive mesoderm which continues into the 

 mesodermal layer of the stem to the chorion. Near the 

 attachment of the vesicle to the chorion there is a sharp 

 evagination of the vesicle, which is lined with a thick layer 

 of epithelial cells the ectoderm. This layer lines only 

 the evagination and does not extend over the rest of the 

 vesicle. Beyond and on the distal side of the evagination 

 the mesoderm is arranged in five groups of cells which in 

 every way suggest myotomes. In this region there are 

 embryonic blood-vessels filled with blood. The syncytium 

 is very extensive. 



The blood-clot from the mother's blood, within the 

 coelom, is recent, as is shown by the fact that many red 

 blood-corpuscles are present. In the periphery of the 

 clot, next to the chorion, the red corpuscles are partly 

 broken down and appear as an imperfect granular detritus 

 containing a network of fibrin. There are as yet no pig- 

 mentary changes in the tissues adjacent to the clot. The 

 latter extends through a tear in the chorion into the ccelom, 

 and as this portion is approached it is noticed that its 

 characters change. The red blood-corpuscles diminish in 

 number, and the main coagulum consists of leucocytes 

 which extend through the surrounding tissues. This mass 

 of leucocytes also extends along the border of the red clot 

 into the cavity and walls of the vesicle. The blastoderm 

 cells are intact on one side of the vesicle, whereas on the 

 other they have suffered desquamation and have retracted 

 from its walls. A part of the leucocytes composing this 

 part of the clot are in a very imperfect state of preserva- 

 tion. They show great irregularities in the forms of their 

 nuclei and are in a state of fragmentation. Fragmented 

 leucocytes extend throughout the clot, a great portion of 

 the chorion, and through the walls of the embryonic vesicle. 

 The tissue elements of the embryo are for the most part 

 well preserved. There is no evidence of extensive necrosis. 

 Occasionally where the clot of red and white corpuscles 

 and fibrin becomes clearly intermingled with the villi of the 

 chorion the syncytial cells stain imperfectly. The blood- 

 vessels of the chorion contain numerous leucocytes, con- 

 stituting in some instances what appear to be leucocytic 

 thrombi. One section was stained for bacteria, but none 

 were found. The process as a whole is to be interpreted 

 as an acute hemorrhagic inflammation of the embryonic 

 structures. The large number of leucocytes undergoing 

 fragmentation indicates that the inflammatory irritant 

 was of a severe nature and had acted with a considerable 

 degree of intensity, as is shown not only by the rich immi- 

 gration of leucocytes, but by the severe retrogressive 

 changes which they have undergone. 



No. 161. 



(1) H. F. Cassidy, Baltimore, Maryland. 



(2) A 50X25X25 mm.; B 10mm. 



(3) "Last period at the end of August. Abortion 

 November 17. After missing the next period patient 

 took medicine and had a rubber tube introduced into the 

 uterus. Purulent leucorrhea during the past six months. 



(4) The entire ovum was covered with hard clots of 

 blood, but on one side the villi appear to be normal. Upon 

 opening the ovum a mass measuring 10X5X5 mm. was 

 found attached to its walls; 



(5) Upon sectioning, this proved to be a strangulated 

 embryo of the fifth week, filled and covered with round 

 cells. These cells have obliterated the structure of the 

 head entirely, but as the tail end of the body is approached 

 the outline of the organs still can be followed. The villi 

 of the chorion are enveloped in a great mass of blood and 

 pus, and the syncytium is excessive. Within the stroma 

 of the villi at many points are numerous round cells which 

 appear to be migrating cells from the embryo. The vessels 

 of some of the villi and of the chorionic membrane appear 

 to be normal. 



(6) Decidua necrotic and infiltrated. 



No. 162. 



(1) A. Wanstall, Baltimore, Maryland. 



(2) A 70X30X30 mm.: B 1 mm.' 



(3) "Last period from September 2 to 7, five days being 

 the usual length of periods. The woman began bleeding 

 November 9 and passed the specimen on November 22. 

 She is the mother of five children and states that this is the 

 only time she has aborted. There is not the slightest 

 indication of uterine disease." 



(4) Within the specimen is a cavity measuring 35 X 12 X 12 

 mm., lined with a smooth wall and filled with a jelly-like 

 substance, within which is a very small embryo. 



(5) The sections show a remarkable atrophy of the 

 embryo and umbilical vesicle. The chorion is very thin 

 and composed of mesoderm only. The villi and epithelial 

 cells are lacking, but in their place is a thick layer of mater- 

 nal blood. The entire chorion is lined with an amnion, and 

 into its cavity the nodule-like embryo projects. Its tissues 

 are not uniform, being thickened at some points, necrotic 

 at others, and mucoid at others. Throughout the center 

 of the nodule are some capillaries filled with blood. At the 

 point of juncture between the amnion and chorion there 

 are three projections from the embryo into the ccelom: 

 (1) the umbilical vesicle; (2) the allantois; (3) the heart. 

 That the second is the allantois is indicated by its cavity 

 which is multiple at points. The heart is within a pocket 

 of the ccelom and has an irregular lumen which is well 

 filled with blood. At the base of the nodule there is a 

 short tube which communicates with the allantois the 

 intestine. 



No. 166. 



(1) H. F. Cassidy, Baltimore, Maryland. 



(2) A 40X40X40 mm.; B 2.5 mm. 



(3) Last period October 18; on December 29 there was 

 a discharge of blood which continued until the 31st, when 

 the mole was expelled. 



(4) The mole is composed of very thick, fleshy walls, 

 within which there is a cavity with a smooth wall, measur- 

 ing 30X20X20 mm. On one side there is a small 

 atrophic embryo 2.5 mm. long. 



(5) The sections of the chorion show that its villi are 

 well formed and are embedded in a mass of blood. Pos- 

 sibly the syncytial layer of epithelium is increased. The 

 ccelom side of the chorion is mooth and in contact with 

 the amnion. Attached to the latter is the embryonic 

 mass or remnant which does not reach to the chorion. No 

 umbilical vesicle is to be found. The amnion and embryo 

 are completely separated from the chorion, which is non- 

 vascular. The embryo is nodular in form, being at- 

 tached throughout half its length to the amnion, and 

 passes through the latter. In the center of the embryo 

 there is a solid column of cells quite sharply defined the 

 remnants of the central nervous system. At the tail end 

 of the embryo there is a blind tube the allantois. The 

 coelom of the embryo, which lies as a pocket on its ventral 

 side, contains an irregular sac which may be either the 

 heart or the umbilical vesicle, probably the former. 



