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



seemed quite normal, a number of tufts being vacuolated. No embryo was found 

 in this specimen. 



It having been shown that the ovum must gradually disintegrate and be 

 absorbed, we have looked with special care to find remnants of specimens after the 

 small ovum has fallen to pieces. A good specimen of this kind is No. 472. There 

 is little to be said about it, as only a few villi were found scattered within the tube 

 lumen. A larger group of villi, shown in plate 2, figure 2, was found in the lumen 

 near the fimbriated end, lying within a cleft which no doubt had held them there for 

 some time. The degree of fibrous degeneration and reaction of the villus with its 

 trophoblast upon the tissue of the tube wall have already been described. In other 

 parts of the section are other smaller groups of villi which have undergone a greater 

 degree of degeneration. Some of the trophoblast is found well embedded within 

 the smaller clefts of the tube wall, and, wherever it is present, we find signs of a 

 reaction upon the tissue of the tube wall. In the immediate vicinity of the villi 

 there is fibrinoid degeneration, surrounded by extensive leucocytic infiltration. 



The specimen which fits in with No. 472 is No. 787. It is much like it except 

 that the few scattered villi are encircled with a great deal of fresh blood. The 

 specimen consists of four blood-clots, which with the distended right tube, measure 

 11 mm. in diameter, the distention being near the fimbriated end. The blood clots 

 were produced by blood which had leaked into the peritoneal cavity. The tube 

 was examined with great care and it was found that its uterine end and folds were 

 matted together, almost obliterating its lumen. There are also numerous out- 

 pocketings of the epithelial lining. In the middle of the tube the adherent folds 

 form a plexiform mass, encircling the organized clot. There are also numerous 

 fresh hemorrhages. At one point a small group of fibrous vilh' was found lodged 

 between the clot and the mucosa, which in this region was infiltrated with fresh 

 blood. This shows clearly that the hemorrhage in these cases arises from the tube 

 opposite a small mass of fibrous villi. No doubt in the course of time this bleeding 

 would flush away the loose villi and thus bring these cases of tubal pregnancy to a 

 happy conclusion. 



Another specimen in which there is a large blood clot and few villi is shown in 

 the sections from No. 514. The blood clot here appears to be quite fresh and 

 scattered through it are a few fibrous villi. At points surrounding the villi are 

 small tufts of vacuolated syncytium, showing that there is some activity left when 

 the trophoblast comes in contact with fresh blood. It appears as if the few villi 

 have been engulfed by a fresh mass of blood, which will ultimately be discharged 

 into the peritoneal cavity, carrying these villi with it. A different fate is shown in 

 specimen No. 539. This shows a highly organized clot full of fibrin, which is 

 especially marked [at its periphery. The clot is also markedly infiltrated with 

 leucocytes at its periphery. It peels out easily, measuring 1 cm. in length and 5 mm. 

 in diameter. After it had been cut into serial sections, a few degenerate villi were 

 found scattered through the middle of the clot. Some of these had undergone 

 mucoid changes and others were fibrous. Many of the villi were filled with poly- 

 morphonuclear leucocytes, which were very numerous throughout the clot. In the 



