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



is also destroyed, leaving only the wall of the chorion, which becomes strangulated 

 and necrotic and is finally lost in the blood clot. If the ovum implants itself well, 

 so that the embryo can get a start, we have a different story, as is shown by speci- 

 mens Nos. 324 and 697. In the first the embryo is round and stunted, and in the 

 second a later stage is represented; the embryo has almost entirely disappeared, 

 repeating again conditions found in pathological ova in the uterus. 



The first specimen of the next group is No. 567, which contains a dissociated 

 embryo 5 mm. long. At first we believed this embryo to be normal, but serial 

 sections soon showed that it had undergone decided changes, most of its tissues being 

 dissociated. However, it was still possible to locate the organs in it. The chorionic 

 wall is thin and contains numerous slender villi which radiate through the well- 

 organized clot, some of them reaching to the tube wall. Upon these are found 

 occasional masses of active trophoblast containing vacuolated syncytium. These 

 clusters are feeding upon fresh blood. They do not seem to be sufficiently numerous 

 for the proper nourishment of the embryo. At any rate there are so many necrotic 

 villi among the normal ones that one is led to believe that the nutrition of the ovum 

 is impaired. There is also a marked infection in this case. A tuft of vacuolated 

 syncytium, invaded by leucocytes, is shown in plate 2, figure 5. Either the faulty 

 implantation or the infection would be sufficient to account for the death of the 

 embryo. 



In the three following specimens, Nos. 477, 784, and 838, the embryos are 

 markedly deformed, so that the process must be regarded as being further advanced 

 than in the one just described. No. 784 contains an embryo that is markedly 

 deformed, but can hardly be considered normal. The chorion is completely sepa- 

 rated from the tube wall, but within this mass of blood is considerable active tropho- 

 blast, together with a large number of necrotic villi. The tube has been practically 

 eaten through and there is a very active inflammation in its wall and lumen. In 

 No. 838 it appears as though the chorion has become entirely detached by a sudden 

 hemorrhage; the blood clot around it is more uniform than usual, as a tuft of villi 

 was protruding from the clot when it arrived at the laboratory. Much of the 

 trophoblast is active, but a great many of the villi are degenerated. It appears as 

 if the villi are being compressed into a single mass. The embryo within (plate 11, 

 fig. 2) is very much deformed. The tissues are markedly dissociated, so much so 

 that the central nervous system and many of the organs can hardly be recognized. 



In the last specimen of this group, No. 342, the chorion is fibrous and contains 

 a thickened amnion. The umbilical cord is of the normal size for an embryo about 

 10 mm. long, and upon its tip rests a small nodule containing a cavity. No doubt 

 this is all that is left of the embryo (plate 5, fig. 2). 



After the embryo attains a length of about 5 mm., affections of the ovum in the 

 tube seem to influence it much as in the case of pathological ova from the uterus. 

 The embryo does not disintegrate so rapidly as is the case in younger specimens, but 

 its tissues become dissociated, finally run together, and in this way produce atrophy 

 of the embryo. The beginning of this change is beautifully illustrated in No. 567 

 and the end of it in No. 342. 



