ON THE FATE OF THE HUMAN EMBRYO IN TUBAL PREGNANCY. 7 



have excluded the reports of 82 of these specimens in which the lubes had ruptured 

 before the operation. Of the 46 that remain the histories state that they were 

 unruptured and varied from 1 to 6 cm. in diameter; 2 of the 46 contained normal 

 embryos of the second month and in 5 of them pathological embryos were present . 

 The rest, 39 in number, contained entire ova without embryos or simply villi of the 

 chorion in various stages of degeneration. Usually the dilated tube was found 

 filled with blood, through which were found scattered villi, the chorion rarely being 

 intact, that is, it was not encircling a ccelom. The chorion had collapsed, leaving 

 scattered villi, which were variously described in different cases as "degenerated," 

 "poorly formed," or "necrotic." Usually it is stated in the records, "Scattered 

 villi were present in the clot; no embryo was found." 



The normal embryos need not be discussed more than to mention that the 

 amnion was very small, as is usually the case in these specimens. The pathological 

 specimens, however, show a similar nature and degree of degeneration as in speci- 

 mens obtained from the uterus. A number of small specimens which were cut into 

 serial sections contained no embryos at all; they are included among the 39 men- 

 tioned above. From my experience in searching for embryos in pathological ova 

 I am of the opinion that a few more pathological embryos would have been found 

 had the specimens been examined with greater care. It is unlikely, however, that 

 more normal embryos would have been discovered, inasmuch as they always lie 

 in a crelom or in an amnion filled with clear fluid. I have never found a normal 

 embryo in an ovum which did not contain a cavity showing a definite sharp wall 

 and filled with transparent fluid. Hence, I believe that those who made the sec- 

 tions for microscopical examination could hardly have overlooked any normal 

 embryos. 



These data, which were obtained 7 years ago, form the basis of the present 

 study. By reference to table 2 a comparison can readily be made between the 

 number of specimens which came to me after preliminary examination, between 

 those which were not examined and the 46 unruptured cases from Dr. Kelly's 

 laboratory. The difference between the first and second lines of the table is easy 

 to explain. In the specimens represented in the first line a selection was made by 

 the surgeon, whereas those of the second line were unselected. The difference 

 between the second and third lines is more difficult to explain. In all probability 

 Dr. Kelly's statistics include more small specimens than mine, for frequently the 

 surgeon sends apologies with a small specimen containing no embryo. I am 

 inclined to believe that many small specimens were discarded by the surgeons as 

 worthless for our purposes. Again, the question of early diagnosis must not be 

 overlooked. It is probable that in well-regulated clinics tubal pregnancy is recog- 

 nized more readily than in outside practice. In fact, most of the very small speci- 

 mens in our collection came from the Johns Hopkins Hospital. That the number 

 of pathological embryos found in our statistics is larger than in Dr. Kelly's is easy 

 to explain. My examinations were probably more thorough. At the preliminary 

 examination we also found only 10 per cent of pathological embryos, whereas more 

 careful search brought this percentage up to 25. Had serial sections been made 

 of all of these specimens it would no doubt have been higher. 



