ON THE FATE OF THE HUMAN EMBRYO IN TUBAL PREGNANCY. ."> 1 



the tube wall and to all appearances the cavity should contain a normal or certainly 

 a pathological embryo. In general they represent a stage of degeneration in advance 

 of that seen in No. 825. The first specimen belonging to this group is No. 430. The 

 chorionic wall is well infiltrated with blood, the villi are mostly necrotic, and there 

 is a great deal of nuclear dust, which also indicates that a large mass of trophoblast 

 has undergone rapid destruction. Even the chorionic membrane itself is fibrous. 

 No. 495 shows appearances very similar to those just described, except that the degen- 

 eration is not so far advanced. There is still some active trophoblast left, but large 

 masses of it are necrotic. At certain points the chorionic wall and villi are being 

 invaded by the syncytium. No. 507 also belongs to this class. In the following 

 two specimens the degeneration seems to be less advanced than in those just 

 described. No. 515 had been examined before it was fixed, and was found to con- 

 tain a smooth internal surface without amnion. The villi appeared to be fibrous, 

 and some of the trophoblast had undergone hyaline degeneration. No. 517 con- 

 tained an amnion and possibly the remnants of an embryo. It appeared as though 

 the embryo had been removed through mechanical means. The chorionic wall and 

 the amnion were normal in appearance, but the trophoblast was beginning to undergo 

 complete hyaline degeneration. The specimen suggests that the whole ovum had 

 become detached sometime before the operation, since most of the trophoblast and 

 villi are necrotic and large clumps of nuclear dust are present. The specimens 

 that have just been considered show degrees of degeneration in a reverse order. 

 In none was there any marked effort towards further growth, but it appears as if 

 the ovum had become strangulated and had undergone necrosis promptly. There 

 are, however, other specimens (e. g., Nos. 561, 602, and 694) which show an attempt 

 at further growth after the embryo had been destroyed. In all three there is still 

 great activity of the trophoblast, although much of it is necrotic. We have in these 

 specimens, side by side, some villi that are very active and well implanted and others 

 that are necrotic. A pregnancy of this sort may continue for a considerable time 

 and form a large tubal mole. It all depends on how long the mass receives nourish- 

 ment from the tube wall. If the trophoblast continues to erode the tube wall, new 

 blood sinuses are punctured, and if this blood in turn comes in contact with the 

 ovum, the specimen may continue to grow. In fact, we see every indication of 

 such a growth when the tubal mass is large. The specimen becomes mottled, that 

 is, between the long fibrous strands larger areas of fresh fluid blood appear, which 

 can be seen through the tube wall and become very apparent when sections are 

 made. Hence the further growth of this type of tubal pregnancy can continue 

 along two paths; first, we may have the generally slow growth throughout the chorion, 

 and secondly, when the strangulation is nearly complete, development may con- 

 tinue, owing to the advent of large quantities of new blood. Illustrative of the 

 former type we have several good specimens. In the first (No. 418) the ovum was 

 still attached to the tube wall, although the chorion had undergone almost complete 

 fibrous degeneration. In many respects the arrangement of the chorion to surround 

 the clot is similar to that shown in plate 10, figure 1. A less advanced stage of 

 degeneration is shown in No. 513. The ovum has collapsed and the villi are long 



