ON THE FATE OF THE HUMAN EMBRYO IN TUBAL PREGNANCY. 



71 



No. 338c. 



(Prof. C. S. Minot, Boston, Mass.) 



(Plate 6, fig. 4.) 



Distorted embryo of fifth week. Normal. 



No. 342. 



(Professor Minot, Boston, Mass.) 



(Plate 5, fig. 2.) 



Pathological ovum, 30X20X20 mm.; pedicle within, 

 5X1 mm. The specimen has a very thin fibrous chorion, 

 with traces of blood-vessels, practically without villi. 

 Within is a thickened fibrous amnion, to which the process, 

 the umbilical cord, is attached. The cord is also fibrous, 

 contains remnants of its blood-vessels, and has attached 

 at its free end a curious group of round cells, which prob- 

 ably represents what remains of the embryo. 



No. 350. 



(Professor Brodel, Baltimore.) 



Normal embryo, CR 15 mm., NR 12 mm. 



No. 352. 



(Brodel Collection No. 36.) 



Embryo, CR 9, NL 9 mm. Specimen normal in shape, 

 but macerated. Outline of organs sharp, which would go 

 to prove that the specimen is normal. 



No. 361. 



(Dr. Egbert, Washington.) 



Ovum, 10 mm. in diameter. 



" I am sending you what I think must be a 10-day ovum. 

 I am indebted to Drs. D. Olin Leech and J. Thomas Kelley 

 for the specimen, the case having occurred in Dr. Leech's 

 private practice. The patient began her last menstrual 

 period on April 15. Did not menstruate as expected on 

 May 13. Attacked with severe pain, tenderness, and 

 muscular rigidity in right iliac fossa on May 23. Opera- 

 tion refused. Patient grew rapidly worse until the after- 

 noon and evening of May 26, when she was taken to the 

 Sibley Hospital and consented to an operation, which was 

 performed at 10 p. m. by Drs. Kelley and Leech. A mass 

 of clot was found embedded in the pelvis and embedded in 

 one of these I found the ovum. The tube was not ruptured, 

 so that a tubal abortion must have occurred at the time 

 of the sudden attack of severe pain on the 23d. Hemor- 

 rhage was still active, coming from the right tube near its 

 distal end. Probably development ceased at the time of 

 the abortion, as the ovum was entirely free from the tube. 

 Considering the size of the ovum, impregnation must have 

 taken place about May 13, 10 days prior to the abortion. 



"The ovum was found in a mass of blood within the ab- 

 dominal cavity, due to a tubal abortion. The operation 

 was performed just 41 days after the beginning of the 

 last menstrual period." 



The specimen came after it had been in water for 24 

 hours. It was well covered with villi and filled with a 

 mass of dense reticular and granular magma. No embryo 

 could be found by direct observation. The specimen was 

 macerated too much to allow careful microscopic examina- 

 tion. 



No. 367. 



(Dr. Hunner, Baltimore.) 



Ovum, 10X7X5 mm. 



(Plate 4, figs. 1 and 2.) 



"This is the specimen of April 24, 1906. Patient's 

 age 33, married 14 years; two children, 12 and 11. Men- 

 struation usually regular every 28 days; flow 3 to 4 days, 

 scanty, no clots. At times intervals of six weeks between 

 periods. Last period April 8, 1906. Since then constant 

 daily spotting. Previous period March 12. Previous 

 period, February 16. These two periods perfectly normal." 



The ovum from a tubal pregnancy came to me unopened, 

 and with some adhering cells and blood clot it was cut into 

 serial sections. The chorion was torn on one side, but 

 its interior was packed with a dense reticular magma. 

 No trace of an embryo was found. The mesoderm of the 

 main wall of the chorion was of normal thickness, but on 

 the side towards the coelom it was not sharply defined. 

 Frequently strands of cells were found partly separated and 

 running out into the magma. The tissue of the mesoderm 



FIGS. 4 and 5. Sketch of ovum and tube, with an additional 

 figure of the clot which was peeled out of the lumen of 

 No. 367. Above this there is a figure of the remnant 

 of the ovum which was attached to the lower part of 

 the clot near the abdominal end of the tube. X 3. Fnun 

 sketches by Prof. Brodel. 



of the villi was not clearly defined as in normal specimens, 

 some having undergone marked degeneration. The villi 

 were developed better on one side of the chorioii than on 

 the other, and here they contained structures which were 

 undoubtedly blood-vessels. The trophoblast was not well 

 developed. However, at points where it had come in 

 contact with blood clots the individual cells were wandering 

 away from it. The surrounding tissue was full of fibrin and 

 contained numerous fragmented nuclei and some blood. 



It is natural to read into this specimen the following 

 history: The embryonic mass grew long enough to send its 

 blood-vessels into the chorion and then the nutrition was 

 cut off because the villi did not attach themselves properly. 

 That this was the case is shown by the capsule of necrotic 

 tissue which encircles the villi. As a result of impaired 

 nutrition the embryo was destroyed, leaving only the iso- 

 lated chorion filled with reticular magma. 



