DESCRIPTION OF THE INDIVIDUAL SPECIMENS. 



No. 109. 



(Dr. Harvey Gushing, Baltimore.) 



Embryo OR 10.5, NL 11, AR 9.5 mm. 



(Plate 1, figs. 1, 2, 3, and plate 4, fig. 3.) 



"The patient, a widow, had her last normal period m the 

 latter part of September (1897). She thinks she was 

 impregnated just before her November catamenia, which 

 was very scanty and appeared in the middle of November. 

 The operation, which was for supposed appendicitis, took 

 place December 16, at 10 p. m." 



At the operation the tube was found ruptured and from 

 it an ovum, 30 mm. in diameter, protruded. This speci- 

 men appeared normal and upon being opened a normal 

 embryo was found. In handling, the head became com- 

 pressed a little, thus accounting for the slight injury of the 

 midbrain. The specimen was first placed in dilute and 

 then in 95 per cent alcohol. The embryo was stained in 

 alum carmine, and cut into sections 20^ thick. Sections 

 were also made of the chorion through its attachment to the 

 tube wall. These were stained in various ways. 



The villi of the chorion are beautifully developed, with 

 a delicate mesenchyme, to all appearances normal. Their 

 epithelial covering is very extensive and the trophoblast 

 grades over into a layer which covers the tube wall. At 

 certain points the chorion and tube wall are separated, the 

 opening being filled with blood. On the one hand is the 

 tube wall witli its epithelial lining, and on the other hand 

 the villi butting up against the blood clot. When the 

 trophoblast comes in contact with the blood clot, the cells 

 invade it first as a layer and then as individual cells. 

 These findings correspond with those of Bryce and Teacher 

 in their young specimens. Between the outer border of 

 the trophoblast and the mesenchyme of the villi are numer- 

 ous characteristic groups of syncytial cells. The outer 

 layer of the trophoblast not only permeates the adjacent 

 blood clots, but also the wall of the tube, where it often 

 forms layers encircling the blood lacunae. Apparently the 

 trophoblast cells have invaded the blood sinuses of the 

 tube wall; in places both trophoblast cells and character- 

 istic endothelial cells he side by side. Of course it might 

 be possible to describe this outer layer as belonging to the 

 decidua, but as the cells are identical in appearance with 

 the other trophoblastic cells and very unlike the endothehal 

 cells of the blood sinuses, this interpretation is excluded. 

 Where the villi do not come in contact with the tube wall, 

 its epithelial lining is intact; at the point of juncture 

 between the tube, epithelial colls, and trophoblast, the 

 former degenerate, while the latter are very active in 

 appearance. Occasionally groups of leucocytes are seen, 

 showing that these are also implicated in the process which 

 is destroying the tube wall. Apparently no decidua is 

 present. The villi appear normal; they have a clear cellu- 

 lar mesenchyme, in which are embedded numerous embry- 

 onic blood vessels. The embryo is also normal. 



No. 154. 



(Dr. Boldt, New York.) 



Ovum 10X7X7 mm., found within a mass of blood with 

 the uterine tube. 



When it was cut into serial sections no trace of an 

 embryo could be found, but the sections show that the 

 chorion had been torn, though the edges of the tear were 



68 



rounded and infiltrated with mesodermal cells. The main 

 wall of the mesoderm and the villi in the neighborhood of 

 the tear were fibrous and atrophic. The rest of the villi 

 were normal in appearance. The villi at the attachment 

 of the mesochorion showed curious processes which in 

 section make them look like "jacks." No amnion was 

 found. 



No. 175. 



(Dr. Boldt, New York.) 



Embryo CR 13, NL 13 mm. 



This specimen came from an emergency case of tubal 

 abortion, the patient having peritonitis at the time. 



"The patient was supposed to suffer with acute dyspepsia; 

 subsequently the condition was diagnosed as appendicitis. 

 It was stated also that she had skipped her period 4 days, 

 when a sound was put into the uterus and turned around 

 several times, after which slight bloody discharge was 

 present. Examination showed uterus slightly softened, 

 perhaps enlarged, but owing to already existing peritonitis 

 the conditions (?) could not be definitely mapped out in 

 cul-de-sac. Moderate pouching, as though from intra- 

 peritoneal period, was discerned. Face anemic; features 

 pinched, as found in cases of beginning peritonitis. On 

 right side, diagnosis, ectopic pregnancy with rupture of 

 tube; operation li hours later, proved to be tubal abortion. 

 Abdomen full of blood ; tube still bleeding freely, hence it 

 was taken off with the ovary. The ovum is intact and the 

 distal part of the tube shows beautifully where the ovum 

 has been contained. The latter floated out with the 

 blood when the abdomen was opened. Usually they are 

 lost." 



On June 10 Dr. Boldt sent the ovum. It was put in 

 95 per cent alcohol within 5 minutes after removal from 

 abdominal cavity. The normal ovum measured 30 by 

 25 by 25 mm. and was well covered with villi. Normal 

 embryo'. Sections of the chorion are not satisfactory. 

 The villi, which are embedded in a mucoid mass, are en- 

 circled by a thick membrane containing maternal blood 

 vessels infiltrated with lymphocytes. Apparently the 

 portion of the chorion sectioned is covered with a thin 

 layer of inflamed tube wall, either giving rise to the peri- 

 tonitis or due to it. 



No. 179. 



(Dr. Ellen A. Stone, Baltimore.) 

 Embryo CR 70 mm. 



This specimen was found free in the abdominal cavity 

 mixed with blood at an operation by Dr. Gushing. Normal. 



No. 183. 



(Dr. Boldt, New York.) 



Embryo CR 28, NL 23 mm. 



" I send you a specimen of tubal pregnancy in the course 

 of abortion; at least I think that I was able to feel the 

 embryo still in the tube about 1.5 cm. from the abdominal 

 extremity. The clinical part is very peculiar, in fact 

 probably unique. The patient had been having hemor- 

 rhages off and on for 3 weeks, accompanied by intense 

 pain, so that her physician thought she would abort daily; 

 she not aborting, counsel was requested with a view of 

 removing the uterine contents. When I examined the 



