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



tous, one foot being swollen more than the rest of the body. Evidently the fetus 

 had been dead for some time. The secondary changes observed in this specimen 

 are best accounted for by an impairment of circulation. The fetus is adherent to 

 the chorion by a band of tissue, which reaches from the chorion to the neck. It 

 is one of those secondary bands occasionally observed in pathological embryos. 

 The tissues of the chorion are also edematous, the mesoderm of the villi being more 

 or less destroyed. Remnants of blood-vessels are left, but contain no blood. There 

 is some hemorrhage between the villi, but in its neighborhood the trophoblast is not 

 active. 



PATHOLOGICAL OVA IN TUBAL PREGNANCY. 



Under the two previous headings, ova with normal and pathological embryos 

 were considered; the first in order to make comparison with normal uterine implan- 

 tation; the second, in order to describe the preliminary destructive changes after 

 the ovum has been normally implanted in the tube. In this way only has it been 

 possible for me to consider, in any sort of a connected fashion, tubal pregnancy 

 containing pathological ova. Were it possible to describe the very earliest stages 

 in the tube, it would not be necessary to resort to the cumbersome and inverse 

 method employed in the present description. With the pictures of normal and 

 pathological ova in the tube and uterus clearly before us, we can make something 

 of the earlier specimens, in which implantation was not properly effected or, when it 

 had occurred, detachment from the tube wall speedily followed. Usually in such 

 cases the ovum is thrown into the lumen of the tube, where it undergoes degenera- 

 tion before it is aborted into the abdominal cavity. At the same time, there is 

 every indication that a specimen may be completely destroyed and absorbed in case 

 it fails to be aborted. The other possibility regarding the fate of the ovum is that 

 it may eat through the tube wall quickly and by this direct path enter the abdominal 

 cavity. This is usually the case when the ovum becomes lodged at the uterine end 

 of the tube. When implantation is opposite the attachment of the broad ligament, 

 the ovum may perforate the tube on the broad ligament side and then burrow for 

 itself a large cavity. This is usually the fate of an ovum in which the embryo 

 undergoes normal development. 



In most of the specimens in which the ovum becomes detached and enters the 

 tube lumen, or possibly may never have been well implanted, we hardly expect a 

 normal development of the embryo. It is this group which I wish to consider first. 

 We have one very good specimen (No. 754) belonging to this group. It came with 

 a history that rupture had occurred, but careful examination did not show the 

 point of the rupture. The patient had given birth to a normal child 5 years before, 

 and was operated upon for tubal pregnancy a week after the beginning of the last 

 menstrual period. Clinically, there was no indication of disease at the time of 

 the operation. 



Microscopic sections show that the tube wall is infiltrated with round cells, 

 but is otherwise normal. The ovum, which measures 1 by 2 mm., was lying free 

 upon the folds of the fimbriie without entering the adjacent blood clot. For the 



