58 



ON THE FATE OP THE HUMAN EMBRYO IN TUBAL PREGNANCY. 



the tube. The larger specimens (e. g., Nos. 576, 431, 657, and 484) reached this 

 stage of development because they did not rupture. In these the tube is evenly 

 distended. In other words only 4 pregnancies among 117, or less than 4 per cent, 

 have survived. Only these are suitable for development to full term. We must 

 look to this group for the specimens which become markedly deformed towards 

 the end of pregnancy. According to Von Winckel, four-fifths of the fetuses are 

 markedly deformed. Therefore the probabilities are that of 117 specimens under 

 discussion only one might reach maturity as a normal fetus. 



TABLE G. List i>f 13 normal embryos lliat came to the laboratory without examination 

 or selection before the specimens were sent. 



TUBAL PREGNANCY CONTAINING PATHOLOGICAL EMBRYOS. 



Whenever the degree of alteration in the tube wall is pronounced and accom- 

 panied with marked infection, the ovum does not implant itself well and consequently 

 the embryo does not develop normally, but becomes atrophic and degenerates. The 

 more severe this process the more pronounced is the reaction upon the ovum; or, in 

 case it begins to develop normally, excessive hemorrhage around the ovum detaches 

 the chorion from the tube and strangulates the embryo within. It dies suddenly 

 and shows no tendency to grow in an irregular fashion. Later it disintegrates. 



The pathological changes found in the tube are well described by Werth 1 and 

 appear in most specimens I have studied. First, there are marked outpocketings 

 of the epithelial lining of the tube, with a thickening of the muscular layer. This con- 

 dition was first described by Werth, and according to the study of my specimens it 

 appears to be chronic, as it is not accompanied with any leucocytic infiltration. 

 Secondly, an acute condition, which is more frequently found, consists of a hyper- 

 trophy of the folds of the tube, which subsequently become adherent, thus forming 

 numerous small pockets in the tube. This condition was first well described by 

 Opitz and is known as follicular salpingitis. The mucous membrane is swollen and 

 infiltrated with leucocytes and there is often an extensive exudate. According to 



'Werth, Die Extrauterineschwangesehaft. Vou Winckel's Handbuch Geburtshulfe. B.I. 1>, Ti-il 2, Wiesbaden, 1904. 



