ON THE FATE OF THE HUMAN EMBRYO IN TUHAL PREGNANCY. 



63 



seem occasionally to include specimens in which pathological changes must have 

 begun very early. It may be that the change in the spinal cord in No. 808 might 

 have continued to the end of gestation to produce a spina bifida. Otherwise the 

 tubal monsters at term must have arisen from specimens which were normal up to 

 the twelfth week. No doubt the normal specimens of the sixth, seventh, and eighth 

 week, as given in table 4, are of the kind that produce the monsters at the end of 

 pregnancy, as described by Von Winckel. In fact, there is every indication that 

 No. 657 might have turned into a monster, as its head appears to be somewhat 

 atrophic. 



I have been unable to collect any good data regarding the frequency of mon- 

 sters in tubal pregnancy, but, according to Joachimsthal, they are very rare, and 

 according to Leopold they are relatively rare, while Martin and Orthmann, Huge, 

 Olschausen, and Veit state that they are more common than in uterine pregnancies. 

 It may be that the latter gynecologists confused early pathological embryos with 

 older monsters, while the former did not. The line of demarcation between them 

 is difficult to draw, hence the distinction is not frequently recognized. 



Von Winckel has done us a service in collecting those fetuses from tubal preg- 

 nancies which continued to live and were removed alive from the abdominal cavity. 

 His fetuses must have arisen from the 16 per cent of normal embryos found by me 

 in unselected unruptured tubes. 84 per cent of the specimens were so markedly path- 

 ological and so far destroyed that they could not possibly have lived until the end of 

 pregnancy. Von Winckel's cases are especially valuable for determining the fate of 

 the embryos that must have been normal before the tube ruptured, that is, during 

 the first months of pregnancy. He first gives the cases that have been published by 

 others, as follows: 



TABLE 12. 



It will be seen that the percentage of monsters increases from year to year. 

 However, Von Winckel thinks that it is safe to say that one-half of the fetuses in 

 ectopic pregnancy are deformed, the most common deformity being defects of the 

 hands and feet. He further collected 87 cases (14 of his own) and found that in 

 57 of them the fetuses were much deformed and in 12 were markedly monstrous. 

 Among these there were 6 cases of hydrocephalus and 1 each of hydromeningocele, 

 encephocele, anencephalus, omphalocele, spina bifida, and hyospadia. In addition, 

 the head was found deformed in 57 specimens, the legs in 44, (he arms in 35; in 12 

 there were club-feet, and in 4 cases amniotic bands. The placenta was usually 

 deformed, sometimes multiple, broad and thin, or short and thick, and often very 

 hemorrhagic. 



