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



attached to the tube wall. In the first specimen of this group (No. 825) the chorion 

 appears to be normal and the coelom well defined. This specimen is described in 

 the protocols and is accompanied with two good illustrations. Plate 9, figure 5, 

 shows a section through the middle of the most distended portion of the tube. One 

 can see, at once, that the ovum contains two cavities, and further examination 

 shows definitely that we have a double ovum; but in neither was there an amnion, 

 and only one showed any trace of an embryo. This consisted of a very small, 

 delicate nodule representing probably the last remnant of the attachment of the 

 embryo to the chorion. This specimen might be classed with those containing 

 pathological embryos, but since the embryo has been practically destroyed, it is of 

 special value when placed at the head of the present group. The villi of the chorion 

 are very active and their trophoblast is firmly attached to the tube wall. The 

 implantation seems to be normal; but for some unknown reason the embryo has 

 been destroyed. 



Another specimen which naturally follows this is No. 874. Here we have also 

 a double ovum, one part of which lies within the uterine end of the tube and the 

 other is somewhat distant and in process of abortion. Between the two divisions 

 of the ovum the tube is constricted and contains no chorion within its lumen. Near 

 the uterine end the chorion is well implanted within the tube wall. The lumen of 

 the tube is on one side of the specimen, but the chorionic mass has broken into it. 

 Beyond this the tube lumen is filled with a very much disintegrated ovum, the tro- 

 phoblast of which, however, shows marked activity. The villi are matted together 

 with fresh blood and the trophoblast is extremely active. At only one point is 

 there a remnant of the embryo, which is being invaded by leucocytes and is under- 

 going histolysis. In many respects the picture suggests a tissue culture. At any 

 rate, this specimen shows that if the fresh ovum is crushed and intermingled with 

 fresh blood, it may undergo a further growth. The portion of the ovum, which is 

 in process of abortion, has undergone some fibrous degeneration, but the tropho- 

 blast is still very active. This portion of the specimen is markedly infiltrated with 

 leucocytes, which have also invaded some of the fibrous and necrotic villi. This 

 specimen differs greatly from No. 835, which seems to show simply a double ovum. 



In No. 874 the ovum is double, owing to some injury, whereby the normally 

 implanted ovum has been crushed, partly destroyed, and pushed into the lumen of 

 the tube, and a portion of it is being discharged into the abdominal cavity. There 

 is no history to account for this condition, but examination of the section certainly 

 suggests that the distribution of this crushed specimen was due to some mechanical 

 injury. Another point worthy of notice is that the ovum which is being aborted 

 contains a remnant of a chorion in a somewhat advanced stage of degeneration, 

 whereas the portion near the point of implantation seems to be quite normal. In 

 other words, as this ovum left its point of attachment to move out into the tube, it 

 began to undergo necrosis and fibrous degeneration (plate 11, fig. 1). 



There is a small group which follows closely upon the two just described. In 

 these specimens there is a sharply defined cavity which has not collapsed, and 

 some of them contain an amnion. In each the ovuna is fairly well implanted within 



