74 



ON THE FATE OP THE HUMAN EMBRYO IN TUBAL PREGNANCY. 



No. 478. 



(Dr. A. Miller, Portersville, California.) 



Embryo, CR 22.5 mm. 



"Aged 26. Four months ago the patient felt as if 

 something were pressing against the rectum and as if the 

 bowels must move. One month later she had another 

 attack. During the following week there were three such 

 attacks. Then the discomfort changed to pains like labor 

 pains. Such pains have occurred at intervals to date. 

 Patient has had three children, the youngest 2 years old. 

 The baby was nursed 14 months. Menstruation occurred 

 every month during lactation and continued regularly 

 for 5 months after, that is, menstruation was regular up to 

 and including June 1909. July was missed. In August, 

 3 months ago, after going 2 weeks over time, she passed a 

 clot and flowed freely. She menstruated again in Septem- 

 ber. Three weeks ago she had morning sickness for a 

 week. November 27, 1909. Laparotomy. Removal of 

 left extra-uterine pregnancy." 



Tumor mass 85X60X45 mm. Within, a displaced 

 pregnancy with a well-marked amniotic cavity just large 

 enough to hold the embryo. Sections of the wall of the 

 cavity showed villi curiously and evenly embedded in blood 

 with an inactive trophoblast and round-cell infiltration 

 of the mesoderm. It appears as if the embryo had been 

 dead for some time, and although normal in form, does not 

 look natural. The tube wall is markedly infiltrated with 

 leucocytes, that also invade many villi. Irregular masses 

 of trophoblast scattered all through the specimen. Lumen 

 of outer end of the tube is filled with a fibrinous clot which 



is organizing. 



No. 479. 



(Dr. T. Cullen, Baltimore.) 



Pathological fetus, SO mm. long. 



Dr. Cullen writes: "A patient of Dr. Jump; came to see 

 me on January 9, 1911. She has had two children, one 

 miscarriage. Her menstrual history began at the usual 

 time and was regular; the flow was free and without pain. 

 She did not miss any period, but since October the flow has 

 been almost continuous. It would cease for a day or two 

 and then reappear. There has been almost continual 

 pain in the abdomen. It hurts her to sit down or to lie 

 down. There has been no fever. Four years ago she first 

 had an attack of appendicitis. Since then there have been 

 several attacks, the last one just before Christmas of this 

 year. On pelvic examination I could feel the uterus in 

 normal position. To the right was some thickening, to the 

 left and continuous with the uterus a mass about 3 times 

 the natural size of the uterus. To the medical men as- 

 sembled I said that the history was that of extra-uterine 

 pregnancy. Bimanual examination suggested myoma. 

 On opening the abdomen we found to the left of the uterus 

 a dark reddish-blue mass about 7 cm. in diameter. Over 

 its surface were congeries of congested vessels. It proved 

 to be the left tube. On the surface were a few brown clots, 

 much browner that I have heretofore seen. They were 

 leathery in appearance. We removed the left tube and 

 ovary. The right tube was adherent to the appendix. 

 The ovary was normal. We removed the appendix and 

 drained through the vagina. The patient stood the opera- 

 tion well. I regret exceedingly that I can not give you a 

 definite menstrual history, but there was none. Some of 

 our patients miss one period and then commence bleeding ; 

 others have a period that is rather tardy, but that continues 

 intermittently without any definite missing of the period." 



The ruptured tube mass measures 90X70X70 mm. 

 The fetus protrudes. It is flattened and edematous, one 



foot being more swollen than the rest of the. body. Evi- 

 dently it has been dead for some time. Its condition 

 must be accounted for by changes in the circulatory system. 

 The fetus is adherent to the chorion by a band of tissue 

 which reaches from the wall to the neck. The chorion 

 is necrotic, its mesoderm being edematous and the tropho- 

 blast is irregular and scanty. At some points it is invading 

 the mesoderm of the syncytiuui. Sections of the leg of the 

 fetus show marked changes in the bone; the epidermis has 

 fallen off and the skin is infiltrated. All these changes can 

 be accounted for by the death of the fetus, which must 

 have occurred at the time of the rupture of the tube. 



No. 481. 



(Dr. T. Cullen, Baltimore.) 



Normal fetus, 57 mm. long. Obtained two hours after 

 the operation. The blood vessels were injected with 

 India ink. 



No. 484. 



(Dr. T. Cullen, Baltimore.) 



Normal fetus 96 mm. long. Injected with India ink 

 two hours after operation. It came in a distended uterus- 

 shaped tube, 110X100X80 mm. Apparently normal. 

 Beautiful large villi with scanty trophoblast. Its blood- 

 vessels are distended with blood and the mesoderm is 

 quite rich in nuclei. At its juncture with the tube wall 

 the trophoblast is active and is invading the wall of the 

 tube. 



No. 487. 



(Dr. R. B. Slocum, Wilmington, North Carolina.) 



Normal embryo, about 11 mm. long. 



"I am sending part of an embryo from a case of extra- 

 uterine pregnancy which had ruptured into the abdominal 

 cavity. The woman menstruated regularly December 20, 

 1910, and the rupture occurred January 22, 1911. It was 

 broken and put at once into 95 per cent alcohol before I 

 knew it." 



No. 488. 



(Dr. Hunner, Baltimore.) 



(Plate 5, fig. 4.) 



Ovum about 5 mm. (?) in diameter. 



On January 25, 1911, Dr. Hunner sent i,b*i following: 

 "Since the operation in July 1910 the periods have 

 always been over one week late. In December she was 

 visiting in New Orleans and her period came two weeks 

 late. It began December 11 and she menstruated nor- 

 mally for 3 days. The first intercourse after this period 

 was December 10, on her return from New Orleans. 



FIG. 7. Outline of the tube which has been cut off 

 sufficiently to free the ovum (No. 488). XJ. 



Intercourse took place one or twice a week until the 

 January period, which began January 16, 8 days late. 

 The first day of the period she walked a great deal and got 

 chilled and that evening the period had almost stopped. 



