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



reaction and changes which are expressed by the hypertrophy and adhesion of the 

 folds. If this objection could be removed definitely, it would be found that local- 

 ized salpingitis is common in inflamed and adherent tubes without pregnancy. 

 Proof of this can not be produced at present, but we already have other evidence 

 which points in the same direction. When the ovum develops normally in the tube 

 and becomes well adherent to the wall, the inflammatory reaction is usually slight 

 and does not appear to be due to infection, whereas, in those cases in which the 

 tubal folds are adherent, there is often a very marked inflammatory reaction, indi- 

 cating that a bacterial infection exists; in fact, the accumulation of leucocytes is 

 often so great as to form abscesses. This would seem to indicate that the inflam- 

 mation, which expresses itself in the changes of the tube wall, in turn causes the 

 arrest of the ovum. 



TUBAL PREGNANCY WITH NORMAL EMBRYOS. 



The minimal changes are found in the tube wall in cases in which the embryo 

 is normal. They are more pronounced in the specimens containing pathological 

 embryos and are most marked in those in which the embryo has been entirely 

 destroyed and the ovum has undergone extensive degeneration. 



In only 25 per cent of our specimens containing normal embryos have we data 

 which bear upon their ages, and in only a few of these cases are there any observa- 

 tions on the condition of the tube wall. In 5 cases (Nos. 175, 179, 183, 387, 898) it 

 is stated that tubal abortion had taken place. This would indicate that with the 

 embryo normal, 10 per cent end in tubal abortion. 



The first specimen (No. 109) contains a beautiful normal embryo and an 

 extensive normal implantation of the chorion in the tube wall. This point is illus- 

 trated (plate 1) and will also be discussed more extensively later on in this article. 

 The tube wall has not been examined with care, except where it is in apposition with 

 the chorion. Here there is no indication of infection. The only point bearing upon 

 this question is that the specimen came from an immoral woman. 



A few additional data may be given of the specimens belonging to this group. 

 In No. 183 there is a group of pockets in the tube wall to one side of the chorion. 

 The same is true for specimen No. 503. In this the folds are very pronounced and 

 each is filled with very large venous sinuses. In No. 790 there is a well-marked 

 salpingitis. The tube folds are matted together. The chorionic membrane appears 

 to be normal, but some of the villi are fibrous and degenerated. This specimen con- 

 tains an embryo 20 mm. long, and is from a woman 28 years of age, who had been 

 married 7 years, this being her first pregnancy. The history states that the 

 year after her marriage she began to suffer with uterine trouble, and was operated 

 upon by a surgeon who removed uterine polypi. Several years later she was 

 operated upon twice for a similar condition. At the time of the operation it was 

 found that the uterus was markedly enlarged. No doubt we are here dealing with 

 an inflamed condition which may have been due to infection, the uterus being 

 enlarged and the inflammatory condition expressing itself in the uterine end of the 

 tube, which shows hypertrophy, the folds being matted together. In Nos. 867 and 

 898 the wall of the tube is markedly inflamed. 



