ON THE FATE OF THE HUMAN EMBRYO IN TITBAL PREOXANOY. 11 



severe reaction, and this may account for the severe inflammatory process seen in 

 the neighborhood of the implanted ovum in the tube. Wall.ui-cn recognizes all this 

 and also admits that in the attachment of the ovum to the tube wall then; must 

 be a large number of variations. He finds himself unable to describe a single normal 

 type of implantation, for in some instances it may be due to a kink in the tube wall, 

 in others to a congenital diverticulum, while in still others the cause may be a con- 

 striction due to an inflammatory process. For this reason he does not exclude 

 chronic inflammation of the tube, which in some way may cause a constriction of its 

 lumen. In fact, he is not inclined to admit that tubal pregnancy is usually due to 

 salpingitis. The chief reason for this statement seems to be that he could not deter- 

 mine whether or not the marked inflammatory process observed was primary or 

 secondary. In a study of the normal tube beyond the region of the pregnancy he 

 was unable to confirm the work of Opitz, for in most instances he found that there 

 is but slight change in the tube wall between the ovum and the uterus. Further- 

 more, in specimens containing the older embryos he did not find that the change 

 was more pronounced than in those containing the smaller ones. To me this does 

 not seem to be an argument against the view of Opitz. 



In the earlier part of this paper it was stated that the specimens with numbers 

 below 500 usually came to the laboratory without the tube wall, or in the examina- 

 tion the tube wall was omitted; later on, in specimens somewhat above 500, the 

 tube wall was at first occasionally examined, and finally the complete examination 

 was added to the routine. Hence it follows that in general the condition of the tube 

 wall can be considered systematically only in the second half of the tubal preg- 

 nancies. As far as this examination has now been carried on, we can in general 

 confirm the work of Opitz, namely, that the folds of the tube wall are hypertrophic, 

 inflamed, and united at their tips, giving on transverse sections a reticulated 

 appearance; in other words, they show a " follicular salpingitis." This is frequently 

 the condition found in the uterine end of the tube, which often appears to be 

 abnormal. When normal it is lined with delicate folds which are in no way attached 

 to one another, nor do they obstruct the tube lumen. However, if such specimens 

 be examined with great care, we frequently find, at the periphery of the greatest 

 dilatation, a mass of hypertrophic and adherent folds, forming a localized follicular 

 salpingitis, and for our purpose this is sufficiently marked to account for the lodg- 

 ment of the ovum within the tube. We can readily imagine that the protrusion 

 formed by the enlarged folds, as well as the pockets between them and the tube 

 wall, might arrest the ovum in its descent. It may be that on account of this enlarge- 

 ment the cilia could not propel the ovum, nor could this be brought about by a 

 vermicular action of the muscular wall of the tube, provided it still acts normally. 

 Even if we admit that the ovum does have the power to wander, it would be difficult 

 to understand how it could escape from one of these pockets in case it got caught in 

 it. In other words, it seems quite clear that frequently localized changes in the 

 mucous membrane of the tube are sufficiently marked in many of the cases to 

 account for the arrest of the ovum in the tube. On the other hand, there is another 

 possibility, namely, that the localized follicular salpingitis is due to the presence of 

 the ovum, which in its attachment to the tube produces a marked inflammatory 



