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



covered with an extensive trophoblast. None of the sections, however, showed the 

 trophoblast in its relation to the tube wall. The only definite point gotten from 

 this specimen is that we have a normal embryo in an apparently normal chorion 

 which has been peeled out of a hemorrhagic bed. 



There are three good specimens with embryos, ranging around 25 mm., in 

 which the implantation of the ovum can be studied to advantage. The first (No. 

 790) contains what may be regarded as a normal embryo about 20 mm. long. This 

 specimen was no doubt alive at the time of the operation, and its surface had been 

 attached to the side of the embryonic cavity by means of a stitch. The attachment 

 of the umbilical cord had not been destroyed, so that it was relatively easy to get 

 suitable serial sections. The wall of the cavity is somewhat hemorrhagic; it con- 

 tains numerous hyaline necrotic patches and has attached to it the tips of the villi. 

 There is a marked inflammatory reaction. The villi of the chorion are fibrous and 

 tipped off with trophoblast, which often form masses with necrotic cores. The 

 trophoblast enters the tube wall and there is diffused among the muscle bundles. 

 It often encircles and permeates the venous sinuses. The accompanying strands 

 of cells show a considerable amount of hyaline degeneration, which gives to the 

 sections a cartilaginous appearance. Here we have a peculiar attachment of the 

 trophoblast without any marked intervillous hemorrhage. 



No. 657 contains an embryo which appears to be normal. It measures 25 mm. 

 in length, is unusually white, and has a very delicate umbilical cord, which may have 

 been injured at the time of the operation. The entire mass has been preserved in 

 formalin, which did not penetrate to the embryo very quickly, a fact that may 

 account for its appearance. Otherwise, the specimen seems to be normal. The 

 amniotic cavity is especially well defined and sections of the chorionic membrane 

 show a normal structure. The spaces between the chorionic membrane and the 

 tube wall are filled with a spotted mass composed of old fibrous strands and fresh 

 hemorrhages. The villi traversing this zone are largely necrotic, but some of 

 them appear to be perfectly normal. The trophoblast covering some of these villi 

 is active, but as the muscle wall of the tube has for the most part been destroyed, it 

 has had no place to implant itself. It seems to have found nourishment in fresh 

 hemorrhages right under the tube wall. At any rate, at this point the trophoblast 

 is active and appears to be normal. Most of the hemorrhagic mass is filled with 

 necrotic villi, showing that an intervillous circulation, when present, strangulates 

 the villi. Only a few of those which perforate this mass freely and have an oppor- 

 tunity to grow again on the tips seem to survive. These no doubt are the ones 

 which have served to nourish the embryo (plate 7, figs. 1 and 4). 



The last specimen of this group (No. 183) contains a normal embryo, 28 mm. 

 long. In general the relation here is identical with that found in No. 657. There 

 is a large quantity of fresh blood between the chorionic membrane and the muscle 

 wall of the tube. The space, which is here distended to a maximum, contains dead 

 villi and large necrotic masses of trophoblast. At certain points tufts of the villi 

 pass through this mass and reach the tube wall. Here the trophoblast is very active 

 and vacuolated and ramifies among fresh blood. The tissue of the folds of the tube 



