ON THE FATE OF THE HUMAN EMBRYO IN TUBAL PREGNANCY. 37 



The specimens containing embryos from 8 to 14 mm. are easily brought together 

 into a single group, with the exception of No. 729 (plate 10). The tube wall and the 

 chorion of this specimen have every appearance of being normal. The embryo was 

 not found, but judging by the degree of development of the cord, it is estimated that 

 the escaped embryo must have been about 8 mm. long. The remaining specimens of 

 this group usually show markedly hemorrhagic chorionic walls. The first specimen 

 of this group (No. 524) contains an embryo 14 mm. long. The ovum contains a 

 cavity about 25 mm. in diameter, which is encircled by a wall 15 mm. thick. The 

 wall is composed of an organized clot ramified by numerous necrotic villi. There 

 is some irregular or active trophoblast upon the villi, but in general it does reach 

 to the tube wall. There are also signs of extensive inflammation. The chorionic 

 wall is fibrous, the amnion is well developed, and the umbilical cord appears as 

 though the specimen might contain a normal embryo. In many respects the 

 chorionic wall appears much like that of No. 535, which contains a normal embryo. 



In the next case (No. 685) the amniotic cavity is practically obliterated, but it 

 contains within a dissociated and macerated embryo. In general the chorion is 

 entirely separated from the tube wall. It contains no active villi. A similar 

 process is seen in No. 766, but the wall of the chorion seems more fibrous, and in 

 general the chorion is detached from the tube wall. An earlier stage of reaction, 

 like the one just given, is found in No. 846. The dissociation of the embryo is not 

 quite so marked and the hemorrhage around it seems fresher. Practically all of 

 the villi are necrotic and the wall of the ovum is fibrous and has a single active 

 mass of trophoblast upon it. Complete destruction of the embryo is well illustrated 

 in No. 804. The chorion here is destroyed entirely, only a faint outline of the villi 

 remaining. The cavity of the ovum is entirely filled with a homogeneous mass of 

 cells representing the embryo. In other words, the dissociation is complete. 



We have in this group all stages of the destruction of the embryo, beginning 

 with what appears to be the normal embryos (Nos. 729 and 724) and ending with 

 complete destruction, as in No. 804. It is quite clear that this destruction is due 

 to extensive hemorrhage between the villi, which ultimately detaches the ovum and 

 causes its strangulation. 



There are four specimens in the collection containing pathological embryos 

 over 20 mm. long. In two (Nos. 307 and 314) marked changes have taken place 

 in the embryo. The first is thoroughly dissociated and the second, in addition to 

 this dissociation, is small and atrophic. It resembles the embryo in No. 478, 

 although it is not quite normal in form. It is one of those border-line cases in 

 which it is difficult to determine whether the embryo is normal or pathological. 

 The examination of the chorion in this case was not extensive, but it was sufficient 

 to show that most of the villi were necrotic. There are 3 normal embryos between 

 20 and 28 mm., and an equal number of pathological ones in our collection, showing 

 that about half of the embryos succumb after they reach this size. Beyond this 

 are 8 normal embryos ranging from 35 to 96 mm. and 1 specimen (No. 479) which 

 contains a pathological embryo 80 mm. long. This remarkable specimen consists 

 of a ruptured tubal pregnancy with a protruding fetus, whose tissues are edema- 



