ON THE FATE OF THE HUMAN EMBRYO IN TUBAL PREGNANCY. 



09 



woman, two clots of blood, as big as my fist, escaped per 

 vaginam and I was told that such profuse bleeding had been 

 in progress for a week, moderate bleeding 2 weeks sooner. 

 The patient was exsanguinated from loss of blood. The 

 abdomen, too, showed that the bleeding, intra-abdominal, 

 had been going on quite a while. It was full of blood; the 

 bleeding from the tube could be seen very nicely. Some 

 blood quite recent; blood very old, large clots of blood, 

 probably 2 or 3 days old, were numerous. The oldest 

 blood, which was in firm yellowish red clots, was on the 

 floor of the pelvis. If you find anything to account for 

 this typical picture, I would be pleased to get full par- 

 ticulars. It was suggested that it might be due to a pla- 

 centa praev. in the tube." 



Dr. Boklt sent a specimen of tubal pregnancy, in which 

 the fetus of 2 months was found still within the tube. 

 The great interest in this case lies in the fact that the opera- 

 tion was performed as the process of tubal abortion was 

 taking place. The abdominal extremity of the tube is 

 dilated to a diameter of 1 cm. The uterine end is com- 

 pletely occluded. The tube is 2.5 cm. in diameter at the 

 thickest point. The patient had had bleeding for 3 months 

 at irregular intervals, accompanied by cramp-like pains. 

 During the week before the operation the bleeding was 

 very profuse, so that the physician (who thought that the 

 patient had an intrauterine pregnancy) said that she would 

 abort. Large clots were expelled per vaginam. The patient 

 was very anemic and suffered great pain. In the abdomen 

 there was a large quantity of blood which had escaped 

 at different times, as shown by the varying degrees of 

 consistency; some clots were recent, bleeding having con- 

 tinued from the tube, while some were very firm and yel- 

 lowish-red, the latter being on the floor of the pelvis. 

 The bleeding for such length of time without completion 

 of the abortion is the main interesting feature. 



The entire tube is 85 mm. long and 38 mm. in diameter. 

 The chorion fills most of the tube and the amniotic cavity 

 is small, and encircles closely the normal embryo. The 

 tube is open at its fimbriated extremity. In the folds of 

 the fimbria; is a large quantity of blood. All stages of 

 degeneration are found in the villi of the chorion. 



No. 196. 



(Professor Brodel, Baltimore, Maryland.) 



The specimen, hardened in formalin, contained two 

 suspicious bodies which were cut into serial sections. One 

 proved to be the embryo, greatly deformed, representing 

 a stage about 3 weeks old. The tissues of the embryo were 

 quite homogeneous, only the central nervous system being 

 recognizable. One eye and a large blood-vessel could 



Flo. 1. Outline of tube of No. 196, showing method by which 

 it was opened. X 3. From a sketch by Mr. Brodel. 



still be faintly outlined. At points the amnion and 

 umbilical vesicle were blended completely with the chorion. 

 The outside of the chorion had attached to it a few long 



and thick villi which did not branch. The chorion and 

 these villi were covered with a layer of syncytium of 

 unequal thickness, which in many places had invaded the 

 mesoderm. The whole chorion was embedded in a large 

 mass of mother's blood. The most remarkable part of 

 this specimen is found within the blood-vessels of I hi' 

 chorion. They are gorged with nucleated blood corpuwlcs 

 filled with a pigment of the same color as that surrounding 

 the mother's blood. It appears as if the syncytium, in de- 

 stroying the mesoderm of the chorion and the mother's 

 blood, at the same time made it possible for the blood of 

 the embryo to take up the blood pigment thus liberated. 

 At any rate, the blood of a human embryo 3 weeks old 

 contains no pigment, and the sections of this specimen 

 permit of this interpretation. There is also a considerable 

 quantity of mother's blood within the ovum around the 

 embryo, but as the specimen was opened before it was 

 hardened and the corpuscles are all perfect, they need not 

 be taken into consideration in the interpretation just 

 given. The villi are covered with trophoblast, etc. On 

 the outside of the clot is an extensive round-cell infiltra- 

 tion. 



No. 197. 

 (Dr. Little.) 

 Normal embryo (CR 11?), 6 weeks old. 



No. 256. 



(Dr. Mabel Austin, Boston, Mass.) 



Embryo CR, 16 mm., AR 11 mm. 



(Plate 6, fig. 1.) 



On October 27, 1905, Dr. Austin wrote to Dr. Knower: 



"I gave you two cat embryos and one human embryo. 

 The former were in quite perfect condition, but the little 

 human had lost one eye, due to the fact of its sticking to 

 the dry sponge on which it was laid at the operation. We 

 remarked at the time that its aspect was very animal-like 

 and compared it later with the cat embryos which it seemed 

 so much to resemble. My notes say that the human 

 embryo measured about 2 cm. in length, while the cat 

 embryos were larger. The following is a page from my 

 notes: 



"'Mrs. W., aged 30. Para I, no miscarriages, child 8 

 years. Last menstrual period, January 10, 1904. Had 

 regular flowing from that time until March 9, when she was 

 taking with nausea, vomiting, and great weakness. She 

 was operated upon March 10 at about 1 a. m. The fetus 

 popped into view as soon as the abdomen was opened, 

 floating on a mass of half-clotted blood. One uterine 

 tube was found ruptured, with villi protruding through the 

 aperture, which was 1 cm. in diameter. Microscopic 

 examination of the tube wall showed it to be edematous, 

 with foci of lymphoid cells. Some decidual cells and nu- 

 merous well-preserved villi were found in the section. In 

 the ovary, removed with the tube, was a large corpus 

 luteum of pregnancy.' " 



When the embryo was received it was found that the 

 head had been injured and the midbrain and forebrain had 

 escaped. A large hole over the eye shows where the brain 

 had escaped from the head. The collapsed head makes 

 the specimen look much like a cat, but the other features 

 are human. There is no tail and there are twelve ribs. 

 Normal. 



No. 294. 



(Professor Brodel.) 



Normal embryo, CR 35 mm. 



