ON THE FATE OF THE HUMAN EMBRYO IN TUBAL PREGNANCY. 15 



itself. The variations of these two varieties of outgrowths are seen in succeeding 

 specimens (Nos. 488 and 513). In Nos. 515 and 517 we have indications of infec- 

 tion. In the first case an infected corpus luteum was found, and in the second there 

 had been pelvic pain for a year. In a third case belonging to this group (No. 519) 

 a large open cavity was found within the ovary. 



A very remarkable specimen is No. 734, which is from a tubal pregnancy with 

 a menstrual history of two weeks (plate 9, fig. 2). The uterine end of the tube is 

 markedly hypertrophied and shows large strands of muscular tissue, between which 

 radiate numerous outgrowths of diverticula from the tube lumen; in fact, we may say 

 that instead of one there are twenty lumina. A typical case of follicular salpingitis 

 is shown in No. 726 (plate 8, fig. 5) . The tube lumen on the uterine side of the 

 pregnancy is very large, about 5 mm. in diameter, and completely cut up by numerous 

 anastomosing folds of its mucous lining. At some points the outgrowths are so 

 numerous as to remind one very much of a section through the villi of the intestine. 

 There is also evidence of infection. In the case of No. 488, which will be taken up in 

 greater detail subsequently and for which we have a very complete history, the 

 trouble must have originated from induced abortions, which caused pelvic trouble 

 ending in two tubal pregnancies. Here also there is a follicular salpingitis. 



Nos. 741 and 773 are especially interesting, since they indicate that the tubal 

 pregnancy originated from a pocket in which the ovum had lodged. The first is 

 from a long-standing pregnancy, the operation having taken place about 20 weeks 

 after the last menstrual period. There was a large pus tube on the opposite side, 

 while on the pregnant side was a well-organized clot containing the form of a degener- 

 ate ovum (plate 8) . On cross-sections the clot appears mottled, being oat up by 

 numerous fibrous bands between which are fresh hemorrhages. The tube wall is also 

 markedly inflamed. On one side the clot is penetrated by degenerated folds associ- 

 ated with a large mass of leucocytes. Apparently we are dealing here with secondary 

 changes in the folds of a localized follicular salpingitis. This condition is also well 

 represented in No. 773. Here the main part of the ovum is encircled by a crescent- 

 shaped shell composed of degenerated folds of the tube wall. The ovum had 

 apparently eaten through the walls of one of these pockets, thus entering the main 

 lumen of the tube, which became filled with blood, causing its distension. Lying 

 within the lumen of the tube is a compartment from which the ovum has escaped. 

 There has evidently been a destruction of the mucous folds which formerly produced 

 this compartment. 



Of the 9 specimens bearing numbers between 800 and 900, 8 show pathological 

 changes in the tube wall. There are either outpocketings or a follicular salpingitis 

 or both, often associated with a history of severe inflammation or sometimes of 

 gonorrhea. 



From the review of this group it is evident that a sufficient number of the speci- 

 mens show alterations in the tube wall marked enough to allow the generalization 

 that tubal pregnancy is usually caused by obstructions within the tube due to an 

 inflammatory process. These changes are of two varieties; in the first, a morpho- 

 logical condition produces a hypertrophy of the folds within the tube, whereas in 



