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



divcrticula, some of which were quite pronounced. In fact, he is of the opinion that 

 a third of all tubes will probably show such anomalies, and in view of their great 

 frequency he believes that they are of little importance as the cause of tubal preg- 

 nancy. Under normal conditions the ciliated cells of the tube will carry the ovum 

 over such a pocket or out of it in case it becomes lodged in one of them, provided 

 only that there has been no previous inflammatory process to interfere with the 

 action of the cilia. If the latter, however, do not act, normally, the ovum may be 

 retarded in its progress and may have grown too large to pass through the uterine 

 end of the tube when it reaches it, as most of the diverticula are in the ampulla. 

 This explanation would account for the large percentage of pregnancies found in 

 the outer portion of the tube. 



Simple transverse folds of mucous membrane are to be viewed as normal 

 structures and not as evidences of disease. They are to be found as the remnants 

 of pseudo-follicular salpingitis. This condition can be recognized with the naked 

 eye, for the individual folds are much less marked, having become matted together 

 as a result of the inflammatory processes, the folds having become confluent. Nor 

 does Kroemer believe that this condition is due to gonorrhea, because as a conse- 

 quence of this disease there is a distention of the tube, with obliteration of the tube 

 folds, and the entire wall of the tube becomes smooth, there being no formation of 

 pockets. He states that chronic forms of gonorrheal inflammation show no anoma- 

 lies of the folds of the tube wall, but that the ovum is retarded on account of the 

 destruction of the ciliated covering. His ideas are based upon the theory that 

 there is a normal stream of fluid passing through the tube to the uterus, that this 

 stream is caused by the action of the cilia, and that, inflammatory conditions check- 

 ing the stream, the ovum is not carried through the tube. Tubal pregnancies 

 following gonorrheal salpingitis indicate that the process is healing. The ovum is 

 carried partly through the tube because the healing process is not complete. In 

 fact, there is a tendency to view follicular salpingitis as healing process. 



Kroemer's description of a single case is very suggestive, but his conclusion 

 rests upon evidence which this case can not give, for we have yet to know the extent 

 and activity of the ciliated lining of the tube in question. He finds these pockets 

 in a tube from a woman 48 years old, and because they appear to be normal he 

 rules them out as a cause of tubal pregnancy. His paper, however, is valuable, as 

 it gives us a better idea of the form of the entire tube than we possessed before. It 

 remains to extend this work, as he himself suggests, to include the study of a great 

 number of other tubes which are believed to be normal. Such a study should also 

 consider the extent of the ciliated lining within the tube. 



In my own collection no effort was made at first in the earlier cases to secure 

 histories, but those with clinical histories which bear upon the subject are numerous 

 and may be collected into three groups: those containing normal embryos, those 

 containing pathological embryos, and those containing pathological ova. 



